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Forum Name: Cardiology Symptoms

Question: Chest Pain/Tightness


 Med2009 - Sat Jan 21, 2006 4:29 pm

Hello. I am a 22 year old male. I live an active life: 2 marathons in last two years (3:34 & 3:19) & gym 3-4 times/week. My last marathon was in May 2005. For the past few months, I have been battling severe heartburn and abdominal pain. Barium swallow test showed "severe reflux with mild gastritis". Had a gastroscopy that was normal. I also have mild swallowing problems. Currently taking Pariet 20mg once daily & sometimes Gaviscon on top to relieve heartburn. I am a tense type of person with lots of stress and feel that my symptoms do get worse during stressful times.

Along with the GI related issues, I am also having chest pain/tightness & back pain. The chest pain is almost always localized in the left side. The pain radiates laterally to my rib cage and superiorly to my neck and shoulders. I also sometimes feel that my left arm is a bit numb. The chest/back problems are made much worse when I go running. Also, I develop abdominal cramps and belch alot. For these reasons, I have not been able to run for the past couple of months. However, other exercises such as EFX, stepmill, bike, and stepper do not cause chest pain/tightness despite the fact that I do these exercises at fairly high intensity. My breathing has not been affected but I do feel a slight chest pain in my left side when I take a very deep breath. I just had an ECG and am waiting for the results. I have a family history of atherosclerosis on my grandmother's side (my dad's mom) but my parents are fine. My cholestrol test from 2003 was normal.

I am beginning to think that it may be esophageal spasms but the chest pain/tightness is at times present 24 hours a day. Any ideas?
 Dr. Yasser Mokhtar - Tue Feb 28, 2006 3:12 pm

User avatar Dear Med2009,

To evaluate the probability that chest pain is related to coronary disease or not, two things are looked at. The first is risk factors for coronary disease that the patient has and the second is the characteristics of the chest pain.

From your history, other than being a male, you don't have any major risk factors for coronary disease (assuming you are a non-smoker because of your history of running marathons and other vigoirous exercise). The characteristics of your chest pain are atypical as compared to the pain of coronary disease. This means that it is highly unlikely that your chest pain is related to coronary disease.

This chest pain could be related to your severe reflux disease, pariet at the current dose and gaviscon every now and then might not be doing the job. You might need to increase the dose and the freqnecy of taking pariet or may be switch to a different medication of the same category.

Other causes of atypical chest pain include:
- Mitral valve prolapse, a benign condition that only need to be watched.
- Neck spine problems specially that you are complaining of having problems with neck pain and numbness sometimes.
- Esophageal spasms can certainly be the reason behind the chest pain.
- Mild inflammation of the ribs and cartilages can be the reason as well.
- This does not sound like an inflammation of the membrane surrounding the lung but can certainly be.

So, i recommend that you discuss this with your doctor and if thought to be indicated, to have an echocardiogram (an ultrasound of the heart to look for mitral valve prolapse) and an x-ray or a cat scan of your neck spine (to look for neck spine problems such as arthritis), and may be a chest x-ray to make sure that everything is ok.

Thank you very much for using our website http://doctorslounge.com and I hope that this information helped.

Yasser Mokhtar, M.D.

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