Bangkok Christian Hospital vs Bumrungrad - My nightmare diagnosis

I've been having chest pains for months. They first developed a few years ago and recently aggravated for some reason and have been there constantly since April this year. I've been pretty sure they were just muscular and coincidentally in the same area of my heart... but as they've stubbornly refused to go away, I took the opportunity to visit the Bangkok Christian Hospital last week for some checks and to ask for a possible fix, being as I was passing through town.

I often use that hospital because it's always seemed much cheaper than the well known expat hospitals and I always got the impression of professionalism. However, I've only ever used them for minor ailments, as I've always been healthy (touch wood).

Turning up with no appointment, I was sitting in front of a cardiologist within 20 minutes. A short consultation and after listening to my symptoms, he suggested a cardiac stress test (treadmill + loads of wires connected to chest) and he said that if there is any problem, that would show it. OK, good idea and I was in the room and being wired up by a nurse 10 minutes later. I was in a pretty good mood and I remember joking with myself that I hope that thing was properly earthed.

After what seemed like a long wait, the same cardiologist turned up to perform the test. I won't desribe the test because it's fairly obvious but you walk on a treadmill while they monitor you heart and gradually ramp up the stress on your heart to see how it copes. By the time I was in excess of 180 BPM he slowed me down and then told me to lay down...

My heart just wouldn't slow down. It was pounding and pounding for what seemed like 5 or 10 minutes, before finally beginning to slow down, all the time, the cardiologist looking at the monitor, rubbing his chin and saying 'hmmmm.... hmmmm... hmmmm' to himself... I knew that something unexpected was coming from the way he was pointing and the traces to his assistant and speaking in a concerned tone...

Eventually, he gave me the bombshell. He bluntly announced to me that it appears I have a blocked coronary artery!!! My head started spinning. I can't remember how many times I asked him to repeat himself, just to be sure... 'Blocked coronary artery' and he went on to say that a 64 slide CT scan should be performed to confirm it. I also have high blood pressure apparently. It took about another 30 minutes to pull all the wires off me, get dressed and write out a prescription for drugs. I was in complete shock, horrified, upset, tearful... and just to make sure I thought I could drop dead at any moment, he prescribed me a battery of cardiac drugs, just to make sure I survived for the CT scan. The drugs were...

• Prenolol (antihypertensive)
  
• Elantan
  
• Vastarel
  
• Crestor (Lipid disorder)
  
• Tranxene (Happy pill that makes you want to have sex with the kitchen sink)
  
• A.S.A. (Aspilets (Aspirin antiplatelet aggregation))

I was due to meet an OE member that evening and he had to witness my tearful explanation that I'd just been diagnosed with a blocked coronary artery. Obviously I didn't get much sleep for the next few days and my wife was online trying to research a good cardiac specialist in Chiang Mai...

By the third day, I couldn't take it anymore and at six in the evening, found myself running down Ploenchit trying to flag a taxi to Bumrungrad Hospital. I took the elevator to the cardiac unit, went up to the receptionist, told her I was having chest pains (I was, and still am) and in two minutes, I was wired up to a heart monitor. A cardiac nurse quickly assessed I wasn't having a heart attack but said my heart rate was sky high, no doubt because I was ultra stressed, panicked and had just ran like the wind to the hospital.

The cardiologist on duty came to greet me. He didn't even say hello, he just said 'But you're only 38!' and when in his office, I explained the Bangkok Christian Hospital's diagnosis. He did his best to calm me down. He looked at the drugs they'd prescribed and before he'd even examined me, said that the drugs were 'Just too much' and shook his head.

It was a short consultation, he seemed a little annoyed. I noticed him twiddling the electronic key for his Mercedes, which gave me the impression he wanted to go home. After listening to my chest, he suggested an echo scan, which would be more accurate... and then explained that the margin of error on a cardiac stress test was huge. I told him about the CT scan and he said that it was a very accurate option but also a very expensive one. I told him I didn't care, I just wanted confirmation of whatever... He said, OK, lets get it done. 'Now?' I said... 'Yes, now' he said... WOW! No appointment, 15 minutes after walking into Bumrungrad, I was being drugged in order to calm me down, so that the CT scan could be performed...

I sat in reception, looking at three people making phone calls, speaking quickly in Thai about 'Khun Mandrunk' and 'CT scan' and 'immediately'. A nurse gave me a pill and explained that if I didn't calm down, the scan could not be performed, as my heart rate has to be below 65 BPM.

The CT Scanner suite looked state of the art. 30 minutes later my heart rate was still too high. In total, they had to drug me three times. I don't know what the pill was, but I think I floated back to my hotel. While I was in the scanner, it made a noise like a gas turbine spinning up to full power and I could see the inner ring spinning around at high speed. It was like a time machine about to catapult me through to some distant point in time. Remarkable technology.

Fast forward 24 hours and I had my results...

Normal. I haven't got the full results yet because I'm struggling to communicate via email with the hospital and the cardiologist doesn't take direct calls... but his assistant told me that my results were normal, with just a slight stenosis. I also have normal blood pressure. If I understand correctly, a slight stenosis is nothing too unusual at my age, correct me if I'm wrong... but I was diagnosed with a heart murmur when very young, so it could be related to that and congenital... as I said, I've not got the full explanation yet...

... but words can't describe how p!#$ed off I am at the Bangkok Christian Hospital cardiologist. They failed to tell me that the rate of error in a cardiac stress test was very high... they failed by prescribing me totally unnecessary drugs... and they FAILED COMPLETELY to communicate the reality of my situation to me, sending my home with a bagfull of heart drugs and utterly traumatised and as a result, I spent money unnecessarily, lost time, almost cancelled an overseas trip and was sick with worry for days, as was my wife.

My advice is that such hospitals are great for minor conditions... but for anything else, put your hand in your pocket and pay the money to the professionals. I still don't know why I'm having chest pains and I'm a little annoyed at the slow follow up from Bumrungrad, after all, I have paid them a substantial wedge of cash.

Mandrunk, on 20 August 2009 - 10:11 PM, said:

Depending where it is, stenosis can be pretty serious. For example:

Mitral valve or aortic stenosis: Your mitral or aortic valves, both on the left side of your heart, can become narrowed by scarring from infections, such as rheumatic fever, or may be narrow at birth. Such narrowing or constriction is called stenosis. In mitral valve or aortic stenosis, the heart has to work harder to pump enough blood to satisfy your body's oxygen needs. If untreated, stenosis can wear out your heart and can lead to heart failure.

Given the pain you've been experiencing, I think you need to get the heart specialist's diagnosis and prognosis. At the least I'd expect some medication and lifestyle changes.

I had no success at all dealing with Samitivej by email even over a simple matter like a test result not given to me during an annual checkup. You're just dealing with admin people. You need to talk to the doc. The problem is his written diagnosis might be far too technical to be meaningful to the average patient.

You can put yourself on statins, simvastatin is the UK NICE recommended one, they're cheap and will help keep cholesterol out of the picture. As for 'But you're only 38!', well I was only 37 when I was diagnosed with hypertension. I've been on BP medication since then.

I'm going to try and get a CD of my CT scan... I just don't know what to think or who to believe now. Where do you go in Thailand to get to see a doctor that actually knows what they're doing, or will be willing to follow up without you chasing after them?!

Blood pressure and doctors is a funny thing, there's a condition recognised as "white coat hypertension", ie those people who find visiting a doctor sufficient stressful to consistently raise their blood pressure.

Edited by Stocky, 21 August 2009 - 12:13 AM.

Not mentioned in this thread as yet, is the posible connection of your 'slight stenosis,' to an incipient angina condition. In this format, your chest pains can occur at any time but usually after some form of exertion, when there is a decreased blood oxygen supply to the heart muscle area. If that's the case, then depending on your condition, you will be provided with a magic pill to swiftly dispose of the discomfort, or simply be recommended to formulate a change of lifestyle.
The fact that you have not mentioned any transfer of pain to your neck and arm/s is a very positive sign. ie. not at 'wobbler' risk.

High blood pressure can happen at any age. But as mentioned in another post, even the prospect of going for a BP test can bring on an increase.
The Mrs recently went for her yearly check-up, payed by her Company, and returned home in a panic. Her BP was sky high. Then it dawned on me. It was her 'period' time. A sure fire way of bombing it up for a few days. She returned the following week and things were back on an even keel.

Lifestyle changes you should consider;

Cut down on smoking and drinking.......[sorry about that!]
Eat more fruit and veg.
Cut down on the salt.....and sugar.
Light exercise daily.....just walking for a few mins is good.
Your BP is normal. To help keep it that way, get stuck in on the garlic.You can get it in capsule form from any good supplement store or mall.

Good health..........

skydiver777, on 21 August 2009 - 01:50 PM, said:

And most importantly: "No shagging!"

...ooh, arh, you need one of those beeping BP wrist monitors like the incredible hulk has. He can't have a shag because he'll turn into a huge green monster and split the bird wide open.

Always best to get a 2nd opinion when smth serious crops up - think you did the right thing and I understand the fear/panic. Anyways good to know u are ok. Did they get to the bottom of the chest pains?

No. I'm still waiting for some feedback from the Bumrungrad cardiologist. The broken English of a nameless secretary saying I have a normal scan with slight stenosis isn't good enough. I want to know more details i.e. is it likely to be congenital? Is it due to scarring? Is there any indication in the scan why I'm having these shooting pains around my heart when I move etc etc... What can I do to protect myself from further damage? What might I have to do in the future to manage the problem?...

So many questions.

I have an unusual condition

24/7 chest pain

had a bone scan also dozens of other test and scans (In American Hospital)

in my case the following

advanced arthritis in the area of the sternum

i had an early injury to the chest as most people can in their youth even just playing sports
not a big deal if you get a bruise
also was in a car accident or 2 where i was just the passenger and was wearing the restraints
any injury can cause arthitis later in life

also they say is very common for people to injur or strain a ligament/tendon (?? i forgot which one) near the sternum too

either of these type simple injuries can cause the same symptoms of heart attach
i know
i have had one before
felt very similar in many ways
scared the crap out of me at first

now when i get severe chest pains i have to think about it
if any other symptom other than pain that feels directly from the heart i go to the hospital
pain in the arms or racing heart etc. ...... i know what to look for

if only a feeling like cramps from hell that feels also like an attack i take aspirin and wait a few moments to see if there are any other symptoms or not

pretty much know now when its just that
but you can bet your A**
any doubt or any other symptoms (even gas) at that moment and i am in the ER like a shot
since i had the one already

Mandrunk, on 21 August 2009 - 08:54 PM, said:

Shiiiit Mandrunk, that's heavy!! Really sorry to hear.

I have a parallel experience but with a good outcome. In retrospect I think it was the stress of keeping up with the fan mail and celebrity obligations from my books... but I was getting a tight sensation in my chest. I'd get it after climbing a big mountain or other marathon activity which was a really big shock because I'm only sixty two.

Anyway, in England last year I mentioned it to my GP who said it described angina and fixed me up with a stress ECG, same as you, and an echocardiogram. They couldn't find anything much though but put me on aspirin and Simvastatin (to control cholesterol)and told me to come back in a year, if not dead by then.

Back in Bangkok I had a chat with a cardiologist at the Bumrungrad who I was impressed with. He thought I was probably okay but agreed to do a CT scan to check for arteriosclerosis. When I went into the scanner, my heart rate accelerated so that all he got of my heart was salami slices of a jelly. I was also impressed though that he only charged for his consultation and waived the big fee for the abortive scan.

Then in England a few weeks ago, I had a letter calling me for a cardiac follow up. They did an echocardiogram and pronounced my heart to be a hundred percent. (Thankfully they cannot diagnose its propensity to be too easily broken by slim Thai ladies!)

I suppose my lesson from all this was to take chest pains seriously but to be aware that there can be many causes, including stress.

In Thailand too there is a huge tendency to over-prescribe drugs and I think they can be very weak on communicating strategy with the patient, something that goes beyond linguistic difficulties.

I've also been wondering about trying somewhere in Bangkok cheaper than the Bumrungrad but now you've got me thinking.

I hope they've killed a chicken and checked its gizzard for you.

Choke dee khrap!

All I can say is hang in there and I hope you're okay.

Andrew Hicks

Dear Mandrunk,

You are the one who is panicking

Firstly you urgently need to follow stress control lessons.
I don't know where in Chiang Mai or Bangkok you could find such people, but believe, google or whatever and do this NOW, IMMEDIATELY.

I did that 6 months after a myocardial infarct and it was the best thing to do after having sex.

Now as far as Bangkok Christian Hospital goes, they did the right thing, cardio stress test on chess pain complaints. Nothing wrong with their diagnosis also, clearly you are the one who went bizerk when the man said "blocked artery", it happens to millions of people like you and me who smoke too much, eat too much, stress too much, don't exercise enough

The next step indeed is angioplasty or is 64 CT scan better technology nowadays? 10 yaers ago angioplasty was the way to go, expensive and slightly dangerous because invasive, but it was the only way to SEE the blocked arteries.

I had a friend who got breathless running up the stairs in his house, went for a check, was directed to a cardiologist, did stress test, was advised to check at hospital a few days later, did angioplasty and got a stent implemented during same procedure. This is probably what you should go through withouh the panic.

I was less fortunate, got a heart attack in the middle of the night in my Pattya hotel (without any warnings like chess pain any time), luckily the hotel's night guard called an ambulance and i was transferred to Pattaya Memorial 1km down the road. Luckily again had good travel insurance who took over, got me transferred to Bumrungrad (and I do have a SAD story on Bumrungrad), they did angioplasty to identify the blockings in my arteries( on request of the insurance company), the latter again had a cardiologist fly over from my home country to Bangkok who decided when/how to tranfer me to my home town university hospital. His job was to deliver me there. Against Bumrungrad diagnosis I had 2 stents implemented.

So cool down and figure out what to do next concerning the stenosis, your situation is not life threatening NOW.
Might be angioplasty might be something else, we are 2009 isn't? I survived 4 angioplasties, the 2 last to check the stents, I had 1 experimental coated stent implemented and checking stenosis after 1 and 2 years was part of the free stent implemenation.
Nothing painfull with angioplasty, if you like technology it's interesting to look at the monitors during the procedure

camerata, on 21 August 2009 - 02:15 PM, said:

Just bury the poor guy! No shagging poor man!

Most interesting subject.
In the past, I used to be engaged in the medical profession. Don't want to give any professional advice or guidance, just some comments.
First of all, what you relate does not clearly allow to say that anyone did anything wrong. Medical exams and diagnoses do allow for different opinions and treatment.

Your complaints (as I understand long-lasting continuous chest pains for months on end) are not exactly typical for coronary artery disease, but further exams like an exercise test are useful. Further exams and advice can go from there. An exercise test though, while very useful (and the first thing I would want myself) can give so called false positive and false negative results. What I mean is, sometimes the test is OK, nevertheless there is heart disease. Sometimes, the test is abnormal, but further tests show there is no disease.
Anyway, you had a CT scan performed which apparently showed 'slight disease'. It may be important to ask your cardiologist what this exactly means. Narrowings of the coronary arteries are expressed by percentages. A slight disease suggests that you may have a narrowing of an artery less than 50%. Usually this type of narrowing does not result in complaints, and believe me, there are thousands of people walking the streets with this kind of problem (most are unaware of it). Standard treatment for this initial stage of coronary heart disease is medical (taking medication). You know you have a narrowing, it will likely progress with time, so there is stringent need to control high blood pressure and high cholesterol, stop smoking, get a normal weight, get advice on exercise.
Of course, knowing you have a problem, can lead an increase in anxiety, being afraid something is going to happen, each time you feel the slightest discomfort in your chest. You may need medication or therapy for this separately, if this is a problem.
If you have a problem trusting treatment in Thailand, you may consider getting the CT scan images from the hospital, and show them to other physicians you possibly are more comfortable with. You should consider that the persistent chest pains you are feeling have another reason, and that the present findings, while useful, are not related to this problem.

thalenoi, on 23 August 2009 - 08:28 AM, said:

The point is, Mandrunk doesn't fit the profile. He's under 40, doesn't smoke, doesn't have an ounce of fat on him, cholesterol is normal, etc. So the stress test clearly showed a problem of some kind, but a diagnosis of blocked coronary artery was reckless and caused him a lot of worry. The CT scan points to slight stenosis, so he just needs to get a full diagnosis from a heart specialist and appropriate treatment.

I was at Bumrungrad yesterday. They told me there is a "Stop Cancer" event on (I think) August 28 and 29. If you buy their Healthy Living Club card plus a checkup package then you get an extra 10% off the checkup in addition to a 6,300 baht coupon for the checkup. The card is valid 3 years and had discounts for x-rays, physio, medicines, tests, etc. You can make use of the checkup anytime in the next 12 months. Sounds like a good deal to me. The cost of the Executive Checkup is currently 6,300 baht, so the card coupon pays for it all.

That's a really good deal, cam. I need to check that out next time i'm in LOS.

Stocky, on 20 August 2009 - 11:58 PM, said:

I spoke to my Mum last night. She told me that my father had his first coronary event (collapse and hospitalised for weeks) when he was 38, the same age as I am now
I've not seen or heard of him for 14 or 15 years now and he'll be in his mid 60s now... as far as I'm aware, he's still alive.

I had email acknowledgement from Bumrungrad over the weekend but no word from the cardiologist yet. I'll start harassing them by phone tomorrow.

Mandrunk, on 24 August 2009 - 03:35 PM, said:

Any "family history" of heart problems makes it a lot more serious. You need to get some treatment.

I was just reading the following thread on Webmasterworld.com from a webmaster that suffered a heart attack at 38 years of age...
http://www.webmaster...nse/3868634.htm

I'm now beginning to question which of the cardiologists was being reckless, the Bangkok Christian Hospital, or the one at Bumrungrad for scoffing that I'm only 38.

Well, this guy gives no details at all. He may be a 200-pound blimp who lives on burgers and fries. 38 is early for a coronary blockage due to plaque, but congenital stenosis would be a different matter altogether.

Sorry but "webmaster" does conjure up an image of a nocturnal porker whose only form of exercise is five fingered.

In my experience, the doctor that didn't prescribe you a metric s###-ton of medicine after the first consultation is the one that did the right thing. The first doc should have left you off the medication and performed whatever tests needed to be done to get a more accurate reading. I mean, if you're given 7 different medications and your problems went away, which was the proper one? What if the medicine kept the problem from showing on the scan?

Well, I guess Mandi could always go back to the UK for treatment...

Man collapses with ruptured appendix... three weeks after NHS doctors 'took it out'

After weeks of excruciating pain, Mark Wattson was understandably relieved to have his appendix taken out. Doctors told him the operation was a success and he was sent home.

But only a month later the 35-year-old collapsed in agony and had to be taken back to Great Western Hospital in Swindon by ambulance. To his shock, surgeons from the same team told him that not only was his appendix still inside him, but it had ruptured - a potentially fatal complication.



Umm... which side is the appendix, nurse?

http://www.dailymail...s-took-out.html

I've finally got a response from Bumrungrad... I called a couple of hours ago to chase it up but my cardiologist there was busy with a patient and they said he'd call back later. I just got a call from a nurse, so he obviously didn't want to talk to me but the diagnosis she'd got from him, which she relayed to me, was (ad verbatim)...

"Everything normal, don't worry. If you want report and images to show another hospital, please go to 7th floor"

I then asked about this 'stenosis' that was apparently disclosed by the CT scan, to which she replied...

"I'm sorry, I don't understand"

camerata, on 24 August 2009 - 04:00 PM, said:

My father was/is a life long smoker. I don't know if his heart problems were caused by an unhealthy lifestyle, or genes... but if it was the smoking, I'm guessing that means I won't have inherited any genetic issues?

Mandrunk, on 26 August 2009 - 04:12 PM, said:

Well, there's no money in a telephone diagnosis for them. If you turn up there I'm sure they'll be happy to treat you and charge you. If you're in pain and can't do a normal stress test without getting dizzy, something is not "normal".

Quote

If it was only the smoking. But I would think it's unusual for smokers to collapse 38.

I've been mulling this over for a week or so now, digesting whatever information I have...

• One hospital gave me a cardiac stress test and told me it indicated a blocked coronary artery and needed confirmation with an expensive CT scan, and prescribed me lots of totally unnecessary drugs there and then. They also said that if I lift anything heavy, I shouldn't raise my arms any higher than my shoulders and restrict myself to only very light excercise... sending me home traumatised and confused.
  
• The other hospital performed a CT scan, told me everything was normal, don't worry... but won't discuss the details of the scan with me unless I go to Bangkok and pay them some more money.

The two diagnoses could not possibly by any more different. I went jogging with my wife a few days ago. She's a healthy 33 year old but I can still out jog her, by a long way.

However, the fact remains that I'm still having pains in my chest, right next to my heart. I've tried to think of everything in an attempt to make a diagnosis myself... everything from arthritis in my rib cage, to parasitic infestation in the muscle in that area...

I simply don't now what's causing it. I've spent a wedge of cash and I'm still no closer to finding out what's causing the pain. I guess my only two options are to fly to Bangkok to get a copy of my CT scan and go to another doctor... or, just ignore the problem and hope it goes away.

What are the local options CM or CR ~ a third opinion?

Mandrunk, on 03 September 2009 - 05:10 PM, said:

I think that is pretty usual. The specialist needs to see the scan results and examine you and then decide what to do. You need to get a proper diagnosis about the pains. If it isn't the stenosis, what is it? You can always make an appointment with one of the top specialists at the same hospital (recommended by many):

Dr. Visuit Vivekaphirat
Speciality: Medicine, Cardiology(Heart)
Language: Spoken: English,Teo Chew,Thai
Qualifications: Medical School:
- M.D. Mahidol University, Thailand, 1978
Board Certifications:
- Diplomate The American Board of Internal Medicine, 1984
- Diploma of Thai Board of Internal Medicine, 1985
- Diplomate of American Board of Cardiovascular Disease, 1987
Fellowships:
- Cardiology, USA, 1988
Special Clinical Interests: Coronary Intervention, Peripheral Intervention

You'll probably have to make an appointment in advance.

They may decide it's not stenosis and refer you to another specialist. But the fact that you couldn't handle the max heart rate on the stress test indicates it may not be muscular or joint-related. The pain means something serious is going on somewhere.

I can recommend you my physical medicine doc if they say it is not heart-related. If it were me, I wouldn't be doing anything too strenuous until there's a proper diagnosis.

Stocky, on 03 September 2009 - 05:29 PM, said:

For specialist medical situations, I don't think the offerings are very good... certainly, the research me and my wife did a couple of weeks ago only seemed to indicate it's better to be in Bangkok.

camerata, on 03 September 2009 - 06:09 PM, said:

Noted, thanks.

I forgot to mention something... I had a Tetanus Toxide booster a few days ago. They took my blood pressure and it was a perfect, optimal 120/80... just like it was at Bumrungrad. As you know, they always take your BP at Thai hospitals, even if you're only there for an Aspirin... and every time, I'm told I have normal BP... the only time I can remember in my whole life that I've been told I have high blood pressure, was at the Bangkok Christian Hospital last month. I think that is significant enough to mention here.

Further to this tetanus booster, I had it because I got bitten by a stray cat again, bloody thing, and it's 11 years since my last booster... but I've had a bad reaction to it, my arm really hurts, I feel like crap and both of my hands hurt in the flesh of the palm between my thumb and finger... of course, now my mind is working overtime, thinking up more possibilities this may indicate heart issues... I'm spending most of my time reading medical publications these days.

I think I'll go to Bangkok again. I'm not going to make any progress without spending more money and seeing another specialist.