Heart problems? Please AME or whoever help!!

[isWorried]

I don't know where to begin, not even sure if I am writing this or just dreaming this up...

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First some details about the subject:
I'm 44, male, ATP flying line & charters in Europe. Non-smoker, "normal" drinker, good BMI, always regularly practiced sports, never had any major health problem.
Passed my last class 1 medical 5 weeks ago, no remarks.

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About 6 months ago, woke up in the middle of the night. My heart was hurting like hell, and I thought, here we go, a stroke... Well, I calmed down and fell asleep again. In the morning just thought I had had a nightmare.
Then, about 2 months ago, I started having some mild and diffuse pain in the chest, around the heart. It kind of came and go for about 4 days, then left.
Up to 3 weeks ago. The pain came back, as before. Now I start to get slightly worried.
Present status is that I now feel this pain which at some times is acute. It seems to come in with a wavy pattern, the peak being in the evening around 7 P.M.

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Now, some questions:
- Even when I go and run some miles or any other sort of exercise, my body and my heart react normally. How come, if there is something wrong with my heart?
- What are your suggestions, i.e. what shall I do. Wait it out, is there any chance it might pass on its own?
- Say I resign and surrender to the AME, what will happen. Tests and then grounded?
- Any precedent, people with "minor" heart disease and returned to flight status?

As you may understand, I'm very anxious about this. Flying was and is my life, thanks for any inputs.

[Sagey]

Mmmmm,

And you sure it isn't chronic heartburn?? On any medication?

If I was you get yourself to a Dr and ask for his advice. If you are really worried you could always call the Brompton hospital and explain to them what occurs. I think it is the Brompton that is the heart specialist hospital, could be wrong!

Sagey

[Gerund]

isWorried

The advice to see a doctor has to be the only advice! But we all know where that can lead!! I imagine the reason you haven't been to see your doctor is that he knows you are a pilot etc etc etc.

But you don't have to see your own NHS doctor who has that wad of notes from the past, which may come back to haunt your future. In the UK we assume the only doctor is our good old family doctor with whom we are registered!

You have two basic options (unless anyone can give me some more!)

1. Pick a doctor from a medical practice by recommendation, or at random, and book a private appointment. This is the normal way it works in lot of countries anyway! You can use any name you like - he's not going to know and won't care anyway. You can tell him you are a pilot and worried stiff about your symptoms, without any possible repercussions. He may ask who your GP is, but there is nothing sinister in this. You can just say you don't have one. This option costs, but not a lot considering. However, many doctors in the UK do not do private work, so you may have to phone around a bit.

2. Bowl up at a medical practice and say you need to see a doctor, but are a "temporary resident" in the area. You can give any name and local address, and say that as you are usually abroad you are not registered with any UK doctor. There will be a minimum of form filling and, voila, you have your appointment.

I am sorry if the above sounds a bit cloak and dagger, but I feel sure you haven't been to see a doctor because of the possible implications. Use one of the above methods and put your mind at rest.

Good luck.



[This message has been edited by Gerund (edited 03 May 2001).]

[Nightstop]

isWorried

Get yourself to a Doc asap. Forget your career for a moment and consider the consequences of not getting treatment for whatever it may be. A good friend of mine woke up at 4am when he was 42 with chest pains and self diagnosed indegestion....turned out to be a heart attack! Into hospital within an hour and a guest of the Cardiac Care Unit for a week. The CAA temporarily suspended his Class 1 medical for 18 month's during which time he underwent heart bypass surgery. He's back flying again and happy as larry.
GO and see the Doc, please!

[caqtas air]

For Gods sake mate get to a Doc asap. It could be nothing more than a strained chest muscle, (quite common) but important that you find out if for nothing more than peace of mind. Don't tell him anything you don't have to until you find out the answer, then and only then make that decision.. GO NOW. You will probably be fine, especially since you can exercise and everything else without pain....Probably nothing to worry about...

[isWorried]

Thank you all for your inputs and some good advice.

Go and talk to the doc, of course it was my first thought. Unfortunately my experience with them has not been that good. Most are a mixture between a car mechanic (your car is in better shape before than after) and some policemen (first shoot then talk) http://www.pprune.org/ubb/NonCGI/frown.gif
The thing is, I feel so good and "just" have this little pain now and then, so I am reluctant to go and see a doc. But if things don't improve, I will rush to see one

Yesterday morning I went skating (roller blades) around the airport, distance about 12 miles, full blast for almost an hour. Heart beat peaked at 140/minute. Now just back from the fitness, peaks at 175, back to 120 after 1 minute rest. During these exercises no pain at all.

One more symptom is that, when feeling the pain, swallowing a hot beverage such as tee or coffee makes the pain stronger at the moment the liquid passes in what I guess is the heart region, strange.

The good news is I haven't felt anything for the last 2 days.

Any medical student, doctor or AME on line that is able to tell me what could be going on?
Would the upcoming ECG of the next medical show the problem?
Shall I take my blood pressure?
Any analysis or trouble shooting I can do myself?

[Flap40]

Might be "Osophogeal reflux"(sp). Basically it is when acid from the stomach gets into the osophogus. It is easily treated with tablets (Losec) and is not a bar to flying.

NOW GO AND SEE A DOC!

[Blue Yonder.com]

Hi Is worried,
I am a final year student studying medical science. I gather you are worried that this pain maybe angina which is caused by heart disease. From the symptons you gave, it does not seem typical of angina. Angina is brought on by exercise and promptly relieved by rest. Anginal pain is described as a squeezing, crushing, but seldom stabbing. The pain may radiate to the neck and jaw and especially down the left arm. As u experience no pain on ecessive exercise it would be unlikely that this pain is angina.
One of the major causes of chest pain is due to oesaphagul reflux, oesophagitis or peptic ulcers. All of which are easly treated. Oesaphagus reflux symptons include, heartburn when lying down at night, preventing sleep or awkening the patient several hours after the onset of sleep. On occasions swallowing may be painful (odynophagia) It may cause chest pain indestinguishable to cardiac pain. One clue to this condition is the pain is worse aftera meal, especially acid food or alcohol. also caused after bending over.
I hope this info helps but at the end of the day it is vital you see a doc for a complete diagnosis. Untreated oesophagul reflux can cause more damage but it is so easily treated with antacids. losec is best treatment.

But see a doc!!!

[SEA&ski]

isWorried,
I am a physician and concur with the comments of your colleagues. You need to get your symptoms evaluated. Since I'm in the US, I am not familiar with the strategies of getting around the NHS and word possibly reaching your employer. But it sounds like you have some leads from the posts above.

Your comments suggest that you have thought about your symptoms and their cause. Your reasoning is sound as far as exertional angina goes. However, in a bit of an oversimplification, angina can be caused by two distinct pathologies. In the first, there is a fixed narrowing of a coronary artery. As your exercise, your heart muscle needs more oxygen to satisfy the increased demand placed on it to pump more blood around your body. In the case of a fixed narrowing, at some point flow will not keep up with the demand, and your heart muscle with become ischemic and (possibly) chest pain will develop. This is the classical exertional angina, where a patient knows that they can go up three flights of stairs and then will develop chest pain.

Another, more insidious form of coronary artery disease results when you have an intermittant narrowing of a coronary artery. This could be caused by spasm of the muscular wall of the artery, or more commonly by intermittant formation of a clot partially obstructing a coronary artery, perhaps starting at a rough patch on the inside of the vessel wall. In this case, clot will grow in size until the muscle supplied by this vessel becomes ischemic, then pain can result. With this mechanism, increased oxygen need by the heart muscle isn't the inciting cause, rather increasing size of the clot. Since many things can cause clot size to increase and the clot will grow at an unpredictable rate this type of angina can occur at any time, wake one from sleep, etc.

Sorry that this is so long-winded. The main point is that you need to get yourself evaluated by a doctor. Good luck!

[mach78]

Hi IsWorried
Do remember and let us know how you are!

[caqtas air]

Hi is worried, I keep checking to see if your ok. How about letting us know ol mate...

[Mr Man]

I had exactly the same problem,but the fact that exercise did not make the problem worse meant that the chances of heart disease were slim.Went to the doctor several times and to a specialist,eventually(after 2 years)reflux asophogus was diagnosed,after 3 months of tablets and slight change of lifestyle,now completely recovered.
You say you drink average.I've cut down dramatically on alchahol(suprisingly not that difficult if you set your mind to it).If you drink mainly because your thirsty,drink water before you go out(advise of an AME).
There are free books on Reflux Osophegus,and it affects 1 in 10.Just wondering why the doctors didn't think of it earlier in my case.If you want the booklet(UK)I'll dig it out for you.

[cirrus driver]

I am a retired cardiologist.
This pain does not sound cardiac.
It is highly suggestive of oesophageal pain and may be caused by reflux induced ulceration.
A consultation with a physician and endoscopy would solve it and a trial of a good antacid at the time of the pain will be a guide to the diagnosis.
Avoid large fatty evening meals and spices or chilli.
But HAVE IT INVESTIGATED PROPERLY!
Cirrus

[gingernut]

I would bet Cirus Driver's pension that the cause is NOT cardiac. You need medical evaluation for your peace of mind. The calibre of replies are as expert as you can get. Good luck!

[Happy Harry]

Being a physician also I agree Cirrus Driver; not much more to say. Get a good Doctor who analyzes your symptoms again and makes a physical examination. You need basic bloodtests, chest x-ray and routine electrocardiogram done and then esophageal endoscopy. If nothing is found, then ambulatory 24 hours electrocardiogram and stress testing could be valuable.
HHarry

[cirrus driver]

Well "is worried" have you acted?
There is no future in worrying . Do it and let us all know that you are OK.
Cirrus

[isWorried]

Hi guys!
Yes I'm still alive and doing well!

First a REALLY BIG THANK YOU to all you folks, that have genuinely taken interest in my happenings. From the first message received that almost dismissed any severe heart problems to your enquiries, THANKS, it's all been very recomforting :)

Now I have to excuse myself for not giving any sign of life before. Believe it or not, I was on holidays, northern America, splendid. There I had plenty of exercise, mainly 3-4 hours hikes that took us up and down through the splendid surroundings.

Medical news: following the advice of most of you, I did two, well three things:
1/ I didn't go to the doc (yet)
2/ I completely cut off any alcohol consumption
3/ I started taking Zantac 75 stomach acid reducing tablets, one a day

When I started (about 3 weeks ago), I was still experiencing the above described symptoms, 2 to 3 times a day. Now three days into this diet, all symptoms are gone, no more pain, nothing.
So I have to conclude that your analysis was correct.

Course of action:
I will finish my pack of Zantac and definitely keep my booze consumption down. I will wait it out and if any symptom shows its ugly head again, I will then, promised, go and see the doc!

You've all been great help!

[batemanisbad4u]

Great news Isw, hope that sorts it for you, but if it comes back......well you know! Cheers