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Forum Name: Valvular Heart Diseases

Question: CHEST PAIN for the past 9 months


 shaz29 - Mon Apr 23, 2007 3:56 pm

Hi I'm a 32 yr old male, ex-smoker (smoked 10-15 a day for the last 12 years). My cholesterol is 5.2.. no family history of heart problems.. anyway my problem started last August, i felt a sharp pain in my chest and got very worked up about it and this made my heart beat go very fast which worried me more, so i called 999 and was taken to the local A&E, there they did some bloods, xray, BP, and ECG and told me that my heart is fine and it was just chest wall pain, the dr said it could be costochondritis. MY visits to the A&E continued over the following months.. all in all i must have had 20 visits and 20 ECG's for this pain. Also had a d-dimer test whic camre back positive so had to have a VQ scan to see if i had PE, fortunately it was not the case. Anyway in January tis year i had an ECHO done and the cardiologist said its fine, he then booked me for a treadmill test which i had last month, i got the results for this last week and the cardiologist told me that its one of the best excercise tests he's seen in his life, he said i have close to zero chance of hav ing heart disease and that my pain is chest wall pain and that me worrying about it all the time makes it worse. He told me to get my life back to normal and get myself back to work (i have been off sick from work since this started). He said he will arrange for an endoscopy in case its something to do with my stomach, but he says its DEFINATELY not my heart thats causing the pain. I'm sat here typing and i have the pain across my chest, its like a dull ache, also got it across my back, if i press on muscle on my chest it feels sore, i have been using diclofenac gel on my chest but doesn't really do alot. My question is, what do you think? The tests that i have had, are they enough to say that i'm not at risk? I really need to know so that i can get myself back to work next week. I'm on 10mg propranolol everyday to keep my heart rate down because i get palpitations because of the anxiety. (these can't cause me any harm can they? my heart rate drops down to 40-50bpm at resting rate, is this safe?)

Thanks in advance

Shazad Mokhtar
 Marceline F, RN - Tue Apr 24, 2007 1:39 am

User avatar Dear Shazad Mokhtar,
It certainly sounds like you have had a very thorough workup that seems to have ruled out cardiac problems as the source of your pain and discomfort. In diagnostic decision trees, we typically consider several options when it comes to chest pain. Cardiac is the first one we consider because of the potential for high threat to life with a cardiac problem. Gastric problems can cause chest pain, as well as pulmonary ones. You mention that you are experiencing anxiety. Are you on any medication to help you control the anxiety? Believe it or not, anxiety can also cause chest pain symptoms. You did not mention what kind of lifestyle you have, or what kind of work you do. The fact that the pain is reproducible (meaning that when you touch the chest it feels sore) may indicate muscle pain or strain. It sounds like your heart tests are normal, thankfully! Please talk to your primary care physician about your anxiety. There are several medicines available to help you feel more in control.
 shaz29 - Tue Apr 24, 2007 8:42 pm

Thanks for the quick response, i work as an IT consultant, its just an office based job, my lifestyle used to be very active, i was regularly going to the gym, i'd say 5 times a week, then this pain started and i havent really been able to get back into the routine, I have been to the gym recently but as soon as my heart starts beating very fast i get scared (even though i know that its beating fast because of the excercise), i'm finding it difficult to get out of my head that i don't have a heart problem, any slight tingle or pain in my chest and i get all worked up and think that i'm about to have a heart attack.. as for the anxiety i take beta blockers (propranolol).

Shazad
 Marceline F, RN - Wed Apr 25, 2007 3:01 am

User avatar Dear Shazad,
A couple things come to mind after reading your feedback.
If the fast heart rate you are experiencing is related to stress/anxiety, then
1. You may consider exploring with a clinical psychologist, or a mental health support clinic in your area the triggers for your underlying anxiety. On the surface, it seems like perhaps in your recent past you had an onset of a disturbance to your equilibrium that is now easily fed by stressful issues in your life, causing a flight or fight syndrome in your body. The best way to tackle and eliminate (hopefully) the reaction is to eliminate the cause.
2. If the Betablocker (which you had mentioned in your first post was Rx for your rapid heart rate) is not sufficient to control your anxiety, your primary care physician may wish to consider other anxiolytics to replace or supplement the current therapy.

If the heart rate you describe is now simply your body responding to the return to physical activity after a hiatus, then recognize that you may wish to start your routine a little less rigorously, and build up stamina and endurance.

In either event, if the cardiological workup was negative, and you passed your stress test with flying colors, then try to trust them for their expertise and attempt to put your fears to rest about your heart.
 shaz29 - Wed Apr 25, 2007 9:27 am

Hi Marceline,

The cardiologist recommended that i see a clinical psychologist like you have suggested, he sad he will arrange an appointment with her for me.. hopefully she might be able to put my mind at rest.

The betablocker i take is called propranolol, i take only 10mg tablet each day, it seems to keep my heart rate around 60bpm.. the cardiologist said i don;t even need to take them, but theres no harm in taking this is there??

The underlying cause of my anxiety is me thinking that i have a problem with my heart, i have had nearly 20 ecgs. numerous blood tests, xrays, VQ scan, and echo and stress test.. all of these tests have come back normal.. in your experience would you say that i'm definately in the all clear after all these tests?? Another thing, the results and report from my ECHO and treadmill test, am i entitled to a copy of these? if i am then how do i go about getting these?



Shazad
 Marceline F, RN - Wed Apr 25, 2007 9:59 am

User avatar Dear Shazad,
First of all yes, you are entitled to a copy of your test results. I would like to caution you however, with your deep concerns about your heart health, it might be wise to hold off getting those results in your hands until/unless you have another healthcare professional who is requesting to see them. The verbiage in the test results narrative may open up more of a can of worms for you and feed your anxiety with more undefined/obscure terminology. If you believe, however, that seeing the test results for yourself may alleviate your fears, then I recommend you ask the cardiologist who read them to sit down with you when you pick up a copy and go over it point by point. It sounds like somewhere in your life experiences some shocking possibilities came to your mind about heart problems that has lit a fire of fear. If some near 20 plus tests have cleared you of any definite heart problems, then it seems safe to pick up your life and go on, and not let the fear of possibilities hold you back.
Secondly, yes a heart rate of 60 is fine. But if the intended purpose of the Inderal is to help your anxiety, somehow it has failed in that task, and it may be of value if you are needing medicinal support to explore other anxiolytics in its place.
I applaud you for setting an appointment to explore mental health options!
 shaz29 - Wed May 09, 2007 7:25 am

hi I recently saw a cardiologist, the following is what he has written.. is there anything to be concerned about?



"He has had very persistent and sharp left sided chest pains of sudden onset, seldom persisting for more than several minutes and fairly typical of inter costal neuralgia, with duller chest wall discomfort and tenderness persisting once the sharp pain is relieved. He has lost weight but stopped training, in fact stopped working and has at times been somewhat bed bound so this has had a major impact.



I understand that he has had a recent VQ scan and CXR and that these were allegedly normal so underlying rarities such as chest wall tumours which crop up occasionally seem reassuringly unlikely. He seems very concerned and pre-occupied about havig heart problems so I have given him a thorough cardiac MOT. This may have been exacerbated by the finding on ECG of left axis deviation, probably in association with partial right bundle branch block, these are ECG changes seen in association of atrial septal defect and cardiac ultrasound today reassuringly has excluded this remote possibility which I any case would be painless. We do occasionally see somewhat bright pericardial shadows posteriorly and he has shown this to some extent although I do not think his pains are likely to be due to pericarditis but they have been present virtually on a daily basis without remission.



He also is tall ad slim habitus but has neither features of either skin or joint hyperextensibility nor features of Marfan's syndrome and his aortic root appears to be normal on ultrasound. I think he can be reassured about his heart and given his concern and the impact this has had on his life. I am arranging for a reassuring excercise ECG and shall then encourage him to re-start training. I think he can discontinue pain killers and anti-inflammatories but in the very short term I would be interested to see whether Flecainide 50mg bd has any impact although this may be too small a dose to impact on neuralgic pain, with the intension of continuing this only in the short term and if there is clear improvement in his symptoms.



I shall re-assess in 2 months if his symptoms are worsening and the weight loss persists then I would consider a chest CT scan, hopefully he will get his life back to normal and return to work in the near future.



My provisional diagnosis is that is most likely to be inter costal neuralgic pain. Incidentally he is seeing a physiotherapist and I think deep breathing and general return to fitness and improved posture may also be of benefit"



The above is what he wrote after seeing me in january... just wanted to know whether I should worry about the pericarditis that he mentioned or whether there is anything else I should be concerned about?



Thanks in advance



Shazad
 Marceline F, RN - Thu May 10, 2007 3:30 am

User avatar Dear Shazad,
Your cardiologist has beenvery thorough to investigate all potential cardiac related caused of your chest pain. He mentions the possibility of putting you on Flecainide. This medication is a class IC antiarrhythmic that has had some success in improving myotonia. Myotonia is a neuromuscular disorder characterized by the slow relaxation of the muscles after voluntary contraction or electrical stimulation. I suggest that you ask your MD for further information about the use and risk of Flecainide for you. It does seem unlikely that you have any substantiated concerns about your heart. You may have the intercostal neuralgia that was mentioned, and it may be of value to pursue that thinking at this point, and find a way to get back into your usual patterns of life. Have you considered consulting a neurologist? This specialist may have other ideas that may help you.
 shaz29 - Thu May 10, 2007 2:43 pm

Thanks for the reply, the thing that was bothering me was the buit where he mentioned the following:

We do occasionally see somewhat bright pericardial shadows posteriorly and he has shown this to some extent although I do not think his pains are likely to be due to pericarditis but they have been present virtually on a daily basis without remission. Does this mean there is something wrong with my heart??
 Marceline F, RN - Fri May 11, 2007 4:18 am

User avatar Dear Shazad,
It sounds like your cardiologist is convinced that you do not have a problem with your heart. I am not sure about the ambiguity of his comment that has you concerned, but I believe the emphasis of the statement is on the issue of the pains being present on a daily basis, not that there are pericarditis concerns on a daily basis,. You might consider asking him directly on this comment for clarification to put your mind at ease.

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