Dr. Ilir Sharka
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am attaching a word document detailing cardiac issue symptoms. I have been experiencing this for the past seven months of this year since I ended up in A and E. It outlines the issues and tests so far. At present, I have chest pain that comes and goes on the left-hand side under the breast, and it is not a tightness it feels more like an ache. Left-arm pain that comes and goes, lightheadedness and woozy sadness, especially when walking or standing. I want to get the thoughts, and some advice on what could be the possible issue, and any further tests recommended.
Hello,
Welcome to icliniq.com.
I passed carefully through your concern and would like to explain that your recent clinical symptomatology seems to be related to THC (Tetrahydrocannabinol), alcohol, and cocaine use. They are potent stimulants, and apart from leading to blood electrolytes imbalances, heart rhythm disturbances, and central nervous system symptoms may also lead to coronary blood flow disturbance and cardiac ischemia. Not rarely, when taken in excessive amounts, they may lead to life-threatening cardiac arrhythmias and myocardial infarction. That is why I strongly recommend you to be careful and to avoid those substances in the future, possibly. To clarify any potential myocardial damage, I recommend you to discuss with your doctor on the opportunity of performing a cardiac ultrasound test and if possible, a cardiac magnetic resonance imaging test. I hope to have been helpful to you. Let me know in case of any further questions.
Thank you.
Patient's Query
Thank you, doctor,
Yes, it all seems to be related to the drugs mentioned since the symptoms did subside in the past only to be brought back after more alcohol or cocaine use. Currently, though it has been over a month since last drug use and I am still experiencing the chest pain or lightheadedness etc., Yes, I had a cardiac ultrasound test (echo) done already, and this did not find anything. However, when this test was undertaken back before two months, my symptoms had subsided (brought back again now, however, after alcohol or cocaine use). Do you think it is worth asking for a cardiac MRI? Or do you recommend any other tests? All my symptoms point to a cardiac problem, but any test I have done does not find anything which is frustrating, this is why I am hesitant to return to my doctor as he has already referred me to a cardiologist and I am not sure what else he can do for me which is frustrating.
Hello,
Welcome back to icliniq.com.
Considering regular previous cardiac tests is a good first step. They are a reference point when currently reviewing your cardiovascular conditions. In the range of a few days from the chest pain, checking cardiac enzymes (CK-MB, Troponin) would be a valuable tool for detecting any myocardial injury or damage. Also, a new cardiac ultrasound coupled with exercise or pharmacological stress could be more specific and sensitive in identifying areas of cardiac ischemia. And regarding cardiac magnetic resonance imaging test, my response is yes. Cardiac MRI (cardiac magnetic resonance imaging) is the most sensitive and specific tool for the evaluation of even small myocardial and other cardiac structural lesions or abnormalities. I would highly recommend it in case the other tests do not confirm anything.
Thank you.
Patient's Query
Thank you doctor,
Am I correct in saying based on your response you suspect my issue is cardiac ischemia? If that is correct, is there any possibility it would subside on its own? Considering these symptoms subsided on their own in the past. If cardiac ischemia is detected in tests, does it require a surgical procedure? Heart surgery at 26 seems daunting. Also, I have prescribed Metoprolol (but only take it on an as-is basis - before important meetings, presentations). Will Metoprolol help?
Hello,
Welcome back to icliniq.com.
I do not think you are suffering from any clinically important cardiac ischemia syndrome. Anyway, as you are using dangerous substances, that may lead to severe cardiac disorders, including ischemia, we need to be sure that no such findings be present. That is why I suggested the tests mentioned above. The best strategy to avoid these cardiac issues would be to stop using those stimulants in the future.
Thank you.
Patient's Query
Hello doctor,
I went back to my doctor and he is referring me back to a cardiologist. I just have a question. When I ended up in the hospital originally after taking the THC capsules, which started all these symptoms the emergency medicine doctor said she was not convinced. I was having a heart attack, so it must have been quite close. I do not have the actual report to attach. I can try to request it from the hospital. All I know is it was the scariest experience of my life I think my heart rate was like 190 bpm with unbearable chest pain. In the hospital I was hooked up to a machine monitoring me, they took a blood sample and I had a chest x-ray. All these were normal. They gave me Diazepam twice and discharged me 5 hours later at a bpm of 100 bpm. Since then I have had multiple ECGs, 24-hour ECG holter monitoring, and an echocardiogram. With all the above normal, would it be right to say that when I ended up in the hospital that it did not cause any heart damage? Like a heart attack causes heart muscle damage, if I had similar damage it should show on an Echo, ECG, or in blood, etc.
Hello,
Welcome back to icliniq.com.
Let me explain that you are right. Important cardiac issues like myocardial infarction (heart attack or myocardial injury) would be easily detected with your already performed cardiac tests. So, you have to relax as they have concluded all normal. Anyway, the above tests could not detect a transient coronary vessel spasm due to cocaine, as it could subside by the time of ER arrival. The fact you had excessive tachycardia raises suspicions about a possible implication of THC. I personally would recommend you avoid future use of those stimulants as they could be really harmful leading to permanent cardiac damage.
Thank you.
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Cardiology
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