Flight medical with Stable Angina?

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DMD3.

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DMD3.
During the past few days, I've been having symptoms of stable angina. Whenever I'm active, there is pressure in my chest and my heart rate increases more than it should (even walking causes me to get a bit short of breath). The more strenuous the activity, the greater my heartrate and chest pressure. Whenever I rest, my heartrate returns to normal and the pressure in my chest goes away (it takes a few moments to ease off at first). After looking up the symptoms, I'm almost certain I have stable angina.

I'm a 31 yr. old male and am not overweight, I do plenty of walking at my current job, and I don't have high blood pressure, though it has been borderline the past several times I've had it checked; within the 130/85 area (the highest it's ever been was 139/88). The primary reason I have this is due to anger/stress and rage. During the past few months, I've experienced a slight tightness in my chest whenever I'd be angry about something, but it would always go away when I would calm down. Now it's not going away even though I'm not angry or emotional.

I'm planning on going to the doctor Tuesday (I'm posting this on a Saturday on Memorial Day weekend), but I wanted to embace myself for the bad news. Even if I haven't suffered a heart attack, angina is said to be a symptom of coronary heart disease. If I am diagnosed with this, will my fight medical be suspended? I realize it's possible to regain a flight medical after being diagnosed with a heart attack or heard disease, but not after a long arduous fight with the FAA.
 
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You should go to the ER when that happens, no hesitation. The docs will chime in hopefully, and I'm not a doc, but at 31 I doubt it's angina but you need to get checked in case it is, more likely you will walk away with blood pressure pills, take them if you get them, they take a few weeks to get used to, then they are nothing.

I'm willing to bet you have blood pressure that goes up when you get anxious/upset, I get the same although never any pain, it just shows up at the doctor's office, but it's not good for you, I take BP meds. Stop worrying about the FAA, get what ever is going on under control. It's probably nothing, relax.

Here is the new standard for high blood pressure...… http://www.philly.com/philly/health...in_3_Adults_May_Need_Blood_Pressure_Meds.html
 
My wife gets the same symptoms when she gets stressed out. (It's why she doesn't drive on the highway.) She has had this since we have been married, when she was in her mid twenties. (She calls it husband pain.) She has had countless cardiac work-ups over the last twenty years, and no one has ever found anything wrong with her. Still, when she gets stressed out, she has squeezing in the chest and shortness of breath. (All of which goes away if she removes herself from the stressor and calms down.)

While I agree that you should get a full work-up, as long as the symptoms reside I personally wouldn't run to the ER. ($$$ and likely a poor diagnosis. It's an ER.) Do get a work up though. Your cardiologist will probably put you on a treadmill, which will probably invoke your symptoms, so he'll get a good look at what's going on. Chest pain doesn't always equal a myocardial infarction. (Heart attack) But you want to make sure that it doesn't. (I was a paramedic for 12 years, and we were taught that commonly men are in denial about heart attacks, so don't be that guy.)

As for your BP: Get yourself a home BP monitor. There are plenty of great ones out there. I took BP meds for years. When I got in better shape, I discovered that my BP came down to well within normal range, but at the GP's office, it was always higher. I don't take BP meds any longer, but I still check my pressure at least twice a day. Although I'm sure plenty of doctors will come along to tell me I'm full of s#$%t, I believe that a BP taken at the GP's office isn't a really good measure. Half the time, the med-techs don't know how to put on a BP cuff correctly. (Usually way too loose.) Also, if they are using a stethescope, there is some variation in when they think the sound of your heart beat indicates a reading point. (Some take your Systolic the moment they can hear a pulse beat, others take it when the pulse beat changes from faint to max volume. (That right there can be a 20 point difference.) You don't get that kind of variation in readings with an automated unit. And nowadays, most of those home units are just as accurate than your GP, if not more so. It is also very common for your BP to be elevated at the doctor's office. Keep in mind as well that your BP fluctuates up and down as much as 20 points depending on stress levels, activity, body position, etc... So, one BP taken quickly after you've been waiting for an hour to be seen is not likely to be an accurate indicator. Another advantage of the home monitor is that you can see what effect different activities have on your BP. You can get a really good idea of what activities, and on what schedule these activities will help you maintain a healthy BP. Your doctor's office can't do that. No way.

As for them changing the level at which BP is considered "high", well, surprise surprise, they want more people to take drugs.

Still, get a work up, and get a home BP monitor. Figure this out with the help of a cardiologist. You can't bet your life on info from the internet.
 
My advice is to get ye hither to a cardiologist ASAP. While you're waiting, if you belong to AOPA, get on their forum and search for my experience with your similar symptoms under the thread title: "Well that was interesting". And read this book: http://www.dresselstyn.com/site/books/prevent-reverse/about-the-book/ or at least watch the free videos on Dr. Esselstyn's website.

I've followed the diet plan for seven years now. Had I read the book first I might (I say "might") have been able to avoid PTCA altogether.
 
Rykymus said:
As for them changing the level at which BP is considered "high", well, surprise surprise, they want more people to take drugs.
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I agree with just about everything you wrote, but I was under the impression that there is research now to support a lower BP threshold for medication. Dr. Bruce has written a number of times that endorgan damage is a function of the area under the curve - the curve being BP vs. time. So going longer with sustained elevated, but by previous standards not dangerously elevated, BP can be just as damaging as shorter duration but much higher BP.

As I told the OP privately, though I'm not a doctor I've been evaluated more than once for chest pain, so I have a pretty good idea of what to look out for. Despite his age, the fact that his symptoms happen with exertion and stress is definitely concerning. Shortness of breath while walking is another sign that points in the direction of it being cardiac. He needs a thorough evaluation by a cardiologist ASAP but I wouldn't run to the ER unless things seem to be getting worse or it happens at rest. And it could always be something totally different, like GERD or esophageal spasms. But CAD needs to be ruled out.
 
azure said:
I agree with just about everything you wrote, but I was under the impression that there is research now to support a lower BP threshold for medication. Dr. Bruce has written a number of times that endorgan damage is a function of the area under the curve - the curve being BP vs. time. So going longer with sustained elevated, but by previous standards not dangerously elevated, BP can be just as damaging as shorter duration but much higher BP.

As I told the OP privately, though I'm not a doctor I've been evaluated more than once for chest pain, so I have a pretty good idea of what to look out for. Despite his age, the fact that his symptoms happen with exertion and stress is definitely concerning. Shortness of breath while walking is another sign that points in the direction of it being cardiac. He needs a thorough evaluation by a cardiologist ASAP but I wouldn't run to the ER unless things seem to be getting worse or it happens at rest. And it could always be something totally different, like GERD or esophageal spasms. But CAD needs to be ruled out.
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I agree he needs to rule out CAD, without a doubt. But the only way I'd ever go to an ER is if I'm so bad off I have no choice. (Basically, unconscious.)

I have had a lot of bad experiences with doctors, which have cost me years of pain and suffering, and thousands of dollars. Health care (and I use the term loosely) these days has become so insurance-driven and industrialized that it is almost impossible to get good care. Everything is designed for the health of the herd as a whole, instead of for the health of the individual. And the poor doctors, most of whom I am certain started out as caring professionals, ended up stuck in the system with no way out. (For financial reasons.) I'm lucky that we found a concierge medical practice where we pay $100/mo each, and the doctor treats us as individuals, and spends as much time as needed to meet our needs. We dumped our BC/BS coverage and started putting those whopping premiums into a separate checking account, the balance of which is now growing at a rate of $20k/yr.
 
Rykymus said:
I agree he needs to rule out CAD, without a doubt. But the only way I'd ever go to an ER is if I'm so bad off I have no choice. (Basically, unconscious.)

I have had a lot of bad experiences with doctors, which have cost me years of pain and suffering, and thousands of dollars. Health care (and I use the term loosely) these days has become so insurance-driven and industrialized that it is almost impossible to get good care. Everything is designed for the health of the herd as a whole, instead of for the health of the individual. And the poor doctors, most of whom I am certain started out as caring professionals, ended up stuck in the system with no way out. (For financial reasons.) I'm lucky that we found a concierge medical practice where we pay $100/mo each, and the doctor treats us as individuals, and spends as much time as needed to meet our needs. We dumped our BC/BS coverage and started putting those whopping premiums into a separate checking account, the balance of which is now growing at a rate of $20k/yr.
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I would probably do the same if I didn't have insurance through my employer. The premiums are trivial, my main complaint is that the coverage (through Cigna) is poor, with 20% co-insurance for just about everything. I would be willing to have significantly more taken out of my paycheck for no or minimal co-insurance.

Sorry to hear about your experiences with doctors. I have had a few as well, but IMO the real problem with health care in this country is the cost, which is much more than the rest of the world pays for comparable service. That 20% co-insurance at today's rates meant $170 out of pocket for a couple of x-rays of my hand after I fell on it while hiking. I hope your concierge practice absorbs the costs of tests done in the office, because even non-catastrophic illness can really cause financial woe these days for those without insurance. Serious illness, such as CAD requiring a PTCA (or worse, CABG), would absolutely break someone today without good coverage.

But of course: "good coverage" just means that someone else pays for it. The system is unsustainable and I dread what health care in this country will be like in 20 years if we don't get things under control.

</threadjack>
 
azure said:
I agree with just about everything you wrote, but I was under the impression that there is research now to support a lower BP threshold for medication. Dr. Bruce has written a number of times that endorgan damage is a function of the area under the curve - the curve being BP vs. time. So going longer with sustained elevated, but by previous standards not dangerously elevated, BP can be just as damaging as shorter duration but much higher BP.

As I told the OP privately, though I'm not a doctor I've been evaluated more than once for chest pain, so I have a pretty good idea of what to look out for. Despite his age, the fact that his symptoms happen with exertion and stress is definitely concerning. Shortness of breath while walking is another sign that points in the direction of it being cardiac. He needs a thorough evaluation by a cardiologist ASAP but I wouldn't run to the ER unless things seem to be getting worse or it happens at rest. And it could always be something totally different, like GERD or esophageal spasms. But CAD needs to be ruled out.
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Plus BP meds are real cheap, the attitude they are doing it to make money can kill you. The thing about BP is that the damage it does mostly will kill you slowly and painfully, not quick and in your sleep. No thanks, I'll take the pills.

As far as doctors are concerned, you need to find a good one and stick with them, which it sounds like the OP has. I have a doctor I have been seeing for years now. I can get in touch with her pretty much any time when I need her, she'll call me back. Looking for a doctor when you need one is a bad way to go in my opinion. Go for yearly checkups and build a relationship.
 
Aside from cost (and more specifically the lack of information about cost and MFN status that insurers demand : a blood test may cost $800 at the "rack" rate plus $25 for the draw, but only $80 at the insurers rate plus a penny for the draw and you won't find that out until you get the EOB from the insurer), we seriously need to revisit the regulatory structure and also encourage doctors to embrace new technologies such as genetic testing as part to the care process. "Trial and error" when there is sufficient evidence from genetics research to point to a solution or drug therapy simply adds to the cost (some docs are pushed by insurers to be Pez dispensers rather than finding a root cause). Not all, some.

Sometimes the drugs to treat a single condition can create a daisy-chain of conditions that then create needs for multiple other drugs. For example, some BP drugs can raise cholesterol and a1c levels and some can cause symptoms that affect cognition. The cholesterol is then treated with drugs that can cause pain and myopathy. A1c is treated with diabetes drugs. Cognition leads you down the mental drugs path. Some - again some, not all- docs won't take the time to find drugs with minimal side effects that don't need all the additional drugs. A lot of it is financial pressure to find something that works, then stop and add other drugs to treat the symptoms of the side effects.

A couple of research studies have indicated that up to 30% of the medical tests and procedures in the US are unnecessary. That adds massive cost to the system. And frankly, with politics and lobbying being what they are, I have no confidence that a government-based system will fix the issues.

As the head of a division of a local hospital noted, the industry needs to be disrupted. After hearing him speak, I fully agree.
 
Totally agree with the above two posters. I'm not crazy about dumping my insurance coverage, but it has gone up 40% every year for the past 3 years. We have had to reduce our coverage level each year just to keep the coverage affordable. I'm self-employed, so it's even more difficult to get coverage. In the DFW area, I can't get PPO, only HMO, which is even worse. Even with coverage, I'm spending hundreds for every test, every doctor visit, etc... And of course, none of them are helping me get healthier. They don't want me healthier, because they don't make any money off healthy people. Quite frankly, the only thing I need a doctor for is to get regular lab work, and get imaging when I need it. We plan to get catastrophic coverage one day, when something that makes financial sense is available. Right now, my auto insurance will pay my medical bills if I get in an accident, as will my aircraft insurance. As long as I don't get cancer or have a heart attack, I'm probably going to be better off putting those outlandish premiums into my own savings account. At the very least, I will no longer be supporting a corrupt, doomed system.

Concierge Doctors are the way to go. Same day appointments. I can text/email/call my doc anytime and she will respond within the hour. Labs in office are $50. With my previous insurance, an MRI for my knee would have been a $500 copay. Cash, that MRI is $350. Same thing with xrays, physical therapy, etc.

I didn't jump into this willy-nilly. I had a full cardiac workup last year and got a clean bill of cardiac health. I still have a few pounds to lose, and my A1c is still a little high (5.3) but I'm working on it. I'd rather put the effort into being healthy than working the extra hours to pay for the insurance in case I need it.

If one of us did get a catastrophic illness, the monthly payments for whatever costs were associated with treatment would likely be no more than what we've been paying in health insurance premiums. Then again, I'm lucky in the aspect that we could live comfortably off my royalties without ever working another day, if I had a stroke or something. And if I die, my life insurance (and the ongoing royalties) will provide my family with financial protection.

Something will change in our health care system. It has to. It's a runaway train headed for a bridge that is out. Unfortunately, when it goes plunging into that gorge, it's going to take a lot of people with it.
 
Update: I'm having signs of unstable angina. The chest pressure is not going away when I lay down (although it does decrease from when I'm standing or walking). I'm about to pay a visit to the ER.

If it's angina but not a heart attack, do I lose my flight medical? Angina is a symptom of coronary artery disease (heart disease).
 
DMD3. said:
Update: I'm having signs of unstable angina. The chest pressure is not going away when I lay down (although it does decrease from when I'm standing or walking). I'm about to pay a visit to the ER.

If it's angina but not a heart attack, do I lose my flight medical? Angina is a symptom of coronary artery disease (heart disease).
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Stop worrying about FAA. Do what you need to survive. And please take an aspirin NOW. I kid you not.
 
Update: I went to the ER and got checked out. Blood pressure and heartrate was a bit high at first, but went down as time went on. They did an EKG and chest x-ray, and there were no signs of heart attack, blood clots, collapsed lung, etc. The doctor said it was probably dehydration and stress, and recommended I drink lots of gatorade. Having downed several bottles, the chest pressure and shortness of breath has diminished. I previously thought I was hydrated enough, but apparently not.

Blood pressure ended up being around 125/93 by the end of the night. Not too bad, but I probably wouldn't pass a flight physical (I've been told if the bottom number is over 90, they won't give you a medical), so I'll need to starve myself a bit when the time comes. :D
 
Glad to hear you're okay! :thumbsup: Your last post the other night was one of the scariest I've ever read on PoA.

I assume they checked cardiac enzymes as well? Normally they will keep you 24 hours or so and check them serially, unless your symptoms have already been going on for days (my case).

Dr. Bruce will be along to let you know if you will need a stress treadmill test to support your case at next medical - personally, in your shoes, I would WANT one before I would be comfortable flying again as PIC, but I think that's your call since you don't have a diagnosis of coronary disease.

The important thing is that you're still with us, and apparently were not having an ACS.
 
Glad you are ok man, quit screwing around, get to a GP doctor, get that BP under control. I suggest vigorous cardio workouts at least 3 or 4 times a week. Run or bike at least an hour. All your problems will fade away. Best of luck.
 
Go low carb (20-30 grams a day) and your BP will be normal in 1-2 weeks. You’ll get rid of all your excess water and feel better too. And all that excercise @PaulS talks about will help too long term. But watching the carbs is the quick way to get it down.
 
glad to here you had that checked out and are not in danger. I have a related question: will afib controlled with medication , pass. The medical
 
I chewed an aspirin or two while enroute to my scheduled stress test the night before it. I was having resting chest pains--and anxiety about them. Thought I was on the cusp of a heart attack and maybe I was in retrospect. As you may know, anxiety increases blood pressure and your heart rate up to, IIRC, about 140 BPM. My blood pressure was 180 systolic. After arriving at my parents' house near the cardiologist's office the blood pressure and heart rate and chest pains went back to more normal--after a good stiff gin and tonic. :) But the next day, after I answered a lot of questions and the Dr. added up my score, he canceled the stress test and told me to report to the cath lab the next morning. I had a 90% probability of a 90% blockage. He turned out to be correct. As for stress tests, he later has told me angina (chest pain) during exertion trumps everything, EKG, CT calcium scans, etc. If you have angina under stress your heart isn't getting enough oxygen no matter what the other studies say and it needs to be investigated.

Now, I'm no doc and could have misunderstood him, but in my opinion you need to talk to a cardiologist. If you have a plaque in a coronary artery ready to burst, the culprit lesion needs to be confirmed and treatment begun before you have a life ending or altering event. Just knowing it exists gives you options denied to those ignorant of their condition. Many of them will die at the onset of their first symptoms. Stents, medicines and lifestyle changes are among them. Forget your medical, think of your life.
 
dturri knows about what he speaks.
Get to a cardiologist.
Get thee a stress treadmill study.
 
Yup. My perspective may be slightly skewed because my chest pains turned out not to be cardiac related at all. But they were also NOT brought on or worsened by exertion, and if they were, I wouldn't have been satisfied without a much fuller workup than the OP reported. I'm actually a little surprised he wasn't admitted for 24 hours and given a stress test or cardiac cath before discharge. My first event that's exactly what happened to me - kept overnight, serial troponins, then the next day a stress echo, then a couple hours wait, then negative result and discharge. If my symptoms had been brought on by exertion I'm sure I would have gone straight to the cath lab.

Maybe the OP hasn't told us the full story? (Hopefully, he told the ER docs the full story!)
 
azure said:
Yup. My perspective may be slightly skewed because my chest pains turned out not to be cardiac related at all. But they were also NOT brought on or worsened by exertion, and if they were, I wouldn't have been satisfied without a much fuller workup than the OP reported. I'm actually a little surprised he wasn't admitted for 24 hours and given a stress test or cardiac cath before discharge. My first event that's exactly what happened to me - kept overnight, serial troponins, then the next day a stress echo, then a couple hours wait, then negative result and discharge. If my symptoms had been brought on by exertion I'm sure I would have gone straight to the cath lab.

Maybe the OP hasn't told us the full story? (Hopefully, he told the ER docs the full story!)
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Hopefully he goes to his regular doctor on Tuesday and gets the same advice Dr Bruce and dtuuri just gave him. The thing about this stuff is you can spend months wondering about it, or worse.... or you go in, fess up to your doctor, get offered a trip to the cardiologist and get a work up. It could save your life, at least if there is nothing, you will know for sure and have peace of mind.
 
PaulS said:
Hopefully he goes to his regular doctor on Tuesday and gets the same advice Dr Bruce and dtuuri just gave him. The thing about this stuff is you can spend months wondering about it, or worse.... or you go in, fess up to your doctor, get offered a trip to the cardiologist and get a work up. It could save your life, at least if there is nothing, you will know for sure and have peace of mind.
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Right, assuming he didn't have the full workup in the hospital and just didn't give us the details. But if he didn't tell the ER docs that he was having exertional symptoms, and they just gave him the tests he mentioned and let him go, then he needs an URGENT referral to a cardiologist (i.e., one who will get him in this week, not 6 weeks from now) or else he is playing with fire.

He seems way too concerned with his medical - a pilot with that mindset might not give his doctors enough info for an accurate picture. I hope I'm wrong about that.
 
Agree with all the others, get a full cardiac workup. Age doesn't matter, one of my best friends had his first heart attack at age 28. The pain increasing with exertion and subsiding with rest is very concerning. I myself have bouts severe chest pain that are completely unrelated to exertion. Nevertheless I got the cardiac workup, all is good. I and my doctors now agree it is esophageal spasm. When it happens I down a full glass of room temp water, that always stops it in its tracks every single time. If it ever doesn't I will go to the ER. One of my doctors told me esophageal spasm pain and angina pain feel exactly the same, he knows because he's had both.
 
Thanks everyone!

Update: I've still been having periods of chest pressure and shortness of breath but not like last week. The pressure is not as intense and does not last all day. The shortness of breath/increased heart rate comes and goes as well. Sometimes I'll have chest pressure with a normal heart/breath rate. Other times I'll be a bit short of breath but not have any chest pressure.

Whenever I experience this I'll go down a bottle of gatorade and it usually helps. As I said, since I've been drinking a lot more (both water and gatorade) the 'angina' has improved, although not subsided completely.

It's sad to read that I may not be out of the proverbial woods just yet, as the EKG, Chest X-ray and blood tests may have missed something. If it doesn't improve I'll go see a cardiologist.
 
DMD3, you seem like a glutton for punishment. Call your doc, tell him you want see a cardiologist as soon as possible, tell the cardiologist exactly what is up, including your thoughts about stable angina. They are nice guys/gals and will want to help you. You are probably having anxiety attacks worrying that you are having a heart attack. Best way to get rid of that anxiety is to go see a cardiologist, who will be able to tell you, either way, if it's just anxiety or if you really have an issue. You'll get this resolved. Call tomorrow.
 
I agree... the sooner you see a cardiologist and get the definitive answer to what is going in, the sooner you can start the treatment that will save/prolong your life.

Continuing to put off the visit to cardiologist just increases chances of irreparable damage.
 
As a survivor of a heart attack, never worry about your medical. As soon as I had the symptoms, pain in the chest, unable to catch my breath, I headed straight for the emergency room. I didn't care if I ever flew again at that point, and I fly for a living.

I did do one stupid thing and I drove myself to the emergency room, but I was only about a half mile from the hospital. While in the emergency room, I started feeling better, so I hoped it was just a warning, but no.

Getting healthy was what is important to me. Seeking help immediately led to what the cardiologist telling me that there is little to no damage to my heart.

Do yourself and your family a favor and get to a cardiologist. Listen to BBChien, aka Dr. Bruce. He is a professional.
 
DMD3. said:
It's sad to read that I may not be out of the proverbial woods just yet, as the EKG, Chest X-ray and blood tests may have missed something. If it doesn't improve I'll go see a cardiologist.
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Unfortunately, if those are the only tests you had, yes they could have missed something.

An acute coronary syndrome (i.e. unstable angina or a MI) does not ALWAYS cause diagnostic changes on a resting EKG. The docs here will correct me if I'm wrong, but I'm pretty certain that's true.

A chest X-ray may likewise not show anything, even if you are having a heart attack.

You don't say what blood tests they did, but even if they did serial cardiac enzymes, all that would show is that there was no damage to the heart muscle... i.e. most likely no heart attack. It would not guarantee that you weren't having angina from a blocked coronary artery, that could, someday soon, develop into a full-blown MI.

Please, for your health, and maybe your survival, get to a cardiologist and have a full and thorough evaluation. ASAP.
 
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