Another 30 something heart failure

[guest username]

What? The primary reason that people go to the ER is chest pain. SOB with exertion is the primary cause in women, the primary cause in men is angina. The greek work for strangulation. Women feel heart attacks differently than men. But c'mon, the instance of IHSS is so very rare in comparison to coronary artery disease, why bring it up?

IHSS and vtac is a screening test in athletes that one can hardly justify the cost! Now, sudden cardiac arrest, we would be looking more towards long-QT syndrome more than a bulging ventricular septum. The idea of chest pain being from angina due to high blood pressure due left ventricular hypertrophy which is caused by lack of blood flow through a thickened myocardium (i.e the inner wall of the heart gets starved of oxygen due to the distance blood has to travel as the myocardium-muscle squeezes, causing chest pain) again rare.

The reason why people go to the ER, is first gerd, second, chest wall pain. 3rd, heart disease.

IHSS is down the list to probably to nil, never, ever

Out of several thousand patients I can tell you how many have had IHSS, beyond a sigmoidal septal defect that affects many elderly. It is so rare, that I can count on my left hand.

Ridiculous

Nowhere in my post did I mention the primary reasons why people present to the ER. What I mentioned was the primary symptoms associated with IHSS and cardiomyopathy.

Nonetheless, I really appreciate you educating me -- an emergency physician -- on the reasons people present to the ER. I find it informative and thought provoking.

 

[guest username]

what do u think of IM/EM combined residency? Just a quick yay or nay?

Wouldn't do it. You should pick one specialty and stick with it. It would be difficult to practice both. Although the educational value of additional training would be good, you will likely never put it to use by practicing both specialties.

 

[-SD-]

statdoc is really smarty and shit stuff

 

[maldorf]

Its quite simple actually,

Why does androgen use shorten lifespan. It is the same process that high blood pressure increases stroke and heart attack.

It is the thickening of the muscle of the arteries! Most practicioners know that what causes these maladies is a direct result of thickening of the muscle that involves the arteries of the cardiovascular system.
High blood pressure is a sheer mechanical force against the inner linings of the arterial system. Steroids in and of themselves increase the blood pressure through the angiotensin renal system.

What the double effect of these though, is not only does it increase the pressure in the system which increases risk of stroke and heart attack by a minimum of 3-fold. Is that it also aggravates the muscle building effects of the tension in the system.

The arteries are muscular, increase that muscle. Then you increase the risk of bursting and/or rupture of small plaques that build in there. The plaque in arteries has the consistency of toothpaaste. Those can rupture especially with undue stress. The thickening of the artery muscle as well makes it more brittle and prone to these issues.

If one were to be genetically incline to a heart attack, even if they controlled for blood pressure. The risks of 'building areterial muscle" would make it a reason not to engage in an experiment.

The disease process is fairly clear as far as the thickening of arterial muscle and heart attacks as in hypertensive heart disease. The idea one could escape it by simply controlling blood pressure is not well stateed, In fact, the evidence points to the fact that the thickening of arterial walls is more suggestive of stroke and heart attack than blood preessure alone.
That most steroid users fail to control their blood pressure causes the disease process of atherosclerosis to accelerate, but regardless if they do. The evidence is that it would be fruitless. As they tend to develop coronary arterial disease at an accelerated rate regardless if they 'control' for the side effects usually regarded as risk factors.

All evidence points to, if statistically taken into analysis, that steroid use is a strong indicator of eartly cardiac mortality, morbidity and disease regardless if risk factors are controlled. Genetic links if someone has had a heart attack prior to age 55 in the family will exponentiate that risk.

It really depends on if the person has a reason to use steroids, be it that they have low self-esteem or if they have a family whom they love. People will make that decision. But it is pretty clear that anabolic steroid will affect the anatomy of the arteriovascular system. More muscle in the artery system is directly correlated, directly correlate AGAIN with more stroke and heart attack..

Taking a muscle building agent, will decrease your life as an epidemiological study can prove

One thing I cant figure is why I got that blood clot in my right coronary artery. When they did the angiogram they found that my arteries were wide open, no narrowing with plaque etc. In fact, once they had sucked that clot out of my artery he wanted to put a stent in but they didnt have one big enough to fit! He said my arteries were huge and they did not have a stent that big. So it doesnt sound like i had a plaque that ruptered. Most of the cardiologists I saw told me thats what happened. WOUldnt the artery be narrowed down?

 

[maldorf]

Most of these people do not have chest pain. The only symptom they usually get is shortness of breath, primarily with exertion. They sometimes have palpitations. With cardiomegaly or IHSS (idiopathic hypertrophic subaortic stenosis), usually the first sign of illness is a sudden cardiac arrest where the person goes into ventricular tachycardia.

Thats how it happend with me. I felt fine, and then the next minute after I finished my set of squats I felt really sick to my stomach and dizzy. I sat down and broke out in a cold sweat. Never once though did I get a chest pain. After I got home from the gym I did get the feeling of having heartburn. Just like it was acid reflux or something. I took 2 aspirin and some antacid. After a bit I knew it was time to hit the ER. I should have gone right from the gym, but instead i drove the car home while I was having a heart attack. So for me at least I did not have any chest pain at all. It was a referred pain that felt like it was coming from my esophagus. Perhaps it has something to do with the cranial neves that run down there? Vagus nerve or something??

 

[wynem]

I'm personally through with steroids........especially the one's that may elevate cholesterol. The only thing I might "consider" doing in the future is plain Test........that's it...........nothing else ever ever ever again.

Now i wonder what brings you to the conclusion that steroids are the problem here?

Without scientific proof we have no way of knowing it was the steriods.

Once again steriods are blamed without proof.

 

[maldorf]

BTW, I did not post this in this forum. I posted it in anabolic steroids but it was moved. Wondering how many actually look in this forum.

 

[maldorf]

Now i wonder what brings you to the conclusion that steroids are the problem here?

Without scientific proof we have no way of knowing it was the steriods.

Once again steriods are blamed without proof.

Cant ever say that if you use steriods that this will happen to you, but it puts you at risk. there is enough evidence out there to say so and sound science behind it. You can choose to ignore it, thats your choice. Its your life. YOu have to determine what your priorities are, and decide if this risk is worth it. The cardiologist I see now is renown allover this country and has seen many young AAS using professional athletes with heart problems. I was surprised too. It is starting to show up now more than ever. Ask Mike Matarazzo if he thinks steriods contributed to his heart attack. Did you listen to his interview I posted on this thread?

 

[guest username]

Thats how it happend with me. I felt fine, and then the next minute after I finished my set of squats I felt really sick to my stomach and dizzy. I sat down and broke out in a cold sweat. Never once though did I get a chest pain. After I got home from the gym I did get the feeling of having heartburn. Just like it was acid reflux or something. I took 2 aspirin and some antacid. After a bit I knew it was time to hit the ER. I should have gone right from the gym, but instead i drove the car home while I was having a heart attack. So for me at least I did not have any chest pain at all. It was a referred pain that felt like it was coming from my esophagus. Perhaps it has something to do with the cranial neves that run down there? Vagus nerve or something??

Most people who die of cardiovascular events at young ages (<35) don't have traditional MI's (heart attacks) where an artery becomes blocked, but instead have arrhythmias from hypertrophic disease (IHSS, cardiomyopathy, etc.) or right ventricular dysplasia. Some also have primary abnormalities in their conduction system, such as prolonged QT syndrome. These people usually don't experience chest pain and don't have typical heart attacks. Often their condition causes sudden death without warning.

The youngest person I've seen was a 14 year old who had an acute MI. The pediatric ER doc said he was glad that they hadn't opened yet because he wouldn't have even done an EKG on him.

All patients who present with chest pain, shortness of breath, syncope (passing out), palpitations, or weakness get an EKG. Depending on risk factors, I will also order a troponin. The younger you are, the more convincing of a story is required to get enzymes. MI's do happen at a young age, but you can't chase every chest pain patient as an MI just to catch the 1:5,000 <35 year old who is having an NSTEMI (a heart attack without classical EKG findings). This is adjusted by other EKG findings like T-wave inversions, ST depression, etc.

 

[maldorf]

Most people who die of cardiovascular events at young ages (<35) don't have MI's (heart attacks), but instead have arrhythmias from hypertrophic disease (IHSS, cardiomyopathy, etc.). These people usually don't experience chest pain and don't have typical heart attacks where an artery becomes blocked.

The youngest person I've seen was a 14 year old who had an acute MI. The pediatric ER doc said he was glad that they hadn't opened yet because he wouldn't have even done an EKG on him.

All patients who present with chest pain, shortness of breath, syncope (passing out), palpitations, or weakness get an EKG. Depending on risk factors, I will also order a troponin. The younger you are, the more convincing of a story is required to get enzymes. MI's do happen at a young age, but you can't chase every chest pain patient as an MI just to catch the 1:5,000 <35 year old who is having an NSTEMI (a heart attack without classical EKG findings). This is adjusted by other EKG findings like T-wave inversions, ST depression, etc.

Yeah, the ekg usually shows. Mine did. I had the classic st depression I know, and maybe the t wave inversion too. Remember watching it on the screen. I took an ekg class in grad school a long time ago so know a bit about that.
What do you think caused my clot? Considering my atereries were all wide open, including the one that was blocked with the clot. They were able to suck it out in the cath lab and now its totally clear. I had them show me the clot. No stent big enough that would fit the artery.