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Judiann, July 13,  2020  9:46pm EST

When do you go to the ER?

First, I should say I had a STEMI with 3 stents placed, and I came in 3 days later so consequently have anteroseptal hypokinesis.  I'm continuing to have problems, mostly with shortness of breath.  When you have symptoms like chest pain even  after taking a couple of nitros or have shortness of breath, what does your doctor tell you to do?  I only go in if I am having rather extreme or unusual symptoms.   Lately, however, I've been to the ER every couple of months. My cardiologist says I should go to the ER, not to Immediate Care and not to call him because he would just send me to the ER.  At the hospital, the doctor said I should even be coming into the ER if I have an episode of feeling really hot and have profuse sweating.  Obviously, I can't be going in every week. What do you do?  What alternatives have you tried?  What about using Kardia or other home EKG monitors?  What advice does your cardiologist give you?

3 Replies
  • Djwel
    Djwel, July 13,  2020  11:11pm EST

    Sorry to hear you are having so many events, and getting no where.  I have what I thought was hot flashes (but sounds like what you are experiencing). I have visited with my cardiology group & they usually answer with more questions.  We seem to go around like that for a while - then I just give up.  I wish we could all find answers, because this is new for us > and we need guidance.  I will post if I get something for you.  Please do the same.

    God Bless


  • AHAASAKatie
    AHAASAKatie, July 14,  2020  9:06am EST

    Good morning, I am so sorry that this is what you are having to manage. It has got to be very difficult. The decision regarding when to go to the ER or not is a hard one to make. I can understand not wanted to go every few months, which could get expensive and frustrating. However, the alternative of missing an important event that needs immediate attention could be life-threatening. 

    My thought is two-fold, ask your doctor to help you make a list of symptoms that ranks an ER trip- it which does sound like you have done, honestly. Then, if you feel that your overall treatment is not moving in the right direction, a second opinion could also be of benefit to you.  

    Thank you for letting us know what is happening in your world. Best Katie

  • KarlR
    KarlR, July 14,  2020  10:28am EST

    Regarding your question about EKGs, I found a vetted article that compared portable EKGs (click here).  It appears that there are several potential difficulties if you get one.

    1. According to the article, "published biomedical literature regarding their diagnostic accuracy, reproducibility, or utility is scant."

    2. It looks like portable EKGs generally have been tested for their accuracy in detecting a fib, not STEMIs.

    3. Some models don't display real-time data.  They're meant to download the information later, so a doctor can review it.

    4. Reading an EKG takes some training and skill.  For example, the EMTs who responded to my 911 call could tell that I was having some kind of cardiac event, but they weren't seeing the telltale signs of an infarction.  When they showed their results to the ER doctor, he said, "Let me show you something.  Take these three leads off and put them on his back here, her and here."  Moments later, when the results came out, "There's your infarction."  Their standard EKG didn't pick up my posterior STEMI when used in the usual manner.

    5. In your case, it will probably be more complicated.  I suspect that your anteroseptal hypokinesis shows up in EKG readings.  If you use an EKG that's designed to raise a red flag when it sees anomolies, you'll probably be raising those red flags every single time.

    A portable EKG may turn out to be the best option for you.  I don't believe that it will be a simple solution, however.

    Good luck.  I hope you find a solution that works for you.

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