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Forum Name: Cardiology Symptoms

Question: Chest Pain-Only In the Morning


 cheric - Fri Feb 15, 2008 4:15 pm

I am a 28 year old healthy and moderately active female. I'm height/weight proportionate, do not smoke, drink red wine or beer occasionally (I can only drink 1 every once in a while due to migraines) and do not use drugs. I did smoke for about 2 years but quit approx 7 years ago. The only minor health problems I have had were migraines, which are only about once every month or two and can be relieved by medication very easily, and a recurrent knee dislocation due to "too much space" within my joint, which was fixed about 5 years ago with reconstructive surgery. I was told I have overly mobile joints, but other than my knee it hasn't caused me any problems.

I do currently take Wellbutrin XL once/day for major depression, which I have been on for approx 1 year, and it has worked very, very well for me. The only anxiety/panic attacks that I recall having were when I was given phenergan (or anything similar), which caused me to have what I was told was a panic attack - I felt like I was coming out of my skin and couldn't breathe.

Each time I have gone for a checkup everything has been normal, and have been told my heart rate and blood pressure are a little low, but within normal range. Although I would say I have a fairly high stress level because I work and go to school, as well as volunteer, my schedule and workload hasn't changed much in the last 2 years, but for someone like me who likes to stay busy it isn't too bad.

Recently I became very ill w/the flu and went to the hospital b/c upon waking I had very bad chest pains which radiated to my back. The pain actually woke me up around 6am, although I normally wake around 7. The pain was in what I would call almost a sideways tear-drop shape which started from just to the left of the middle of my chest to about the middle of my left breast (or underneath-not below- the area of my breast, rather), where the pain was a little broader in area than near the middle of my chest. Within less than a minute of first feeling the pain I felt as if it radiated to my back, in a similar area, and it felt as if it was one big block of pain that didn't start or stop from one area to the other.

Changing position did not help, so thinking I had heartburn I took an antacid. I didn't have any trouble breathing, though as I've noticed other people with chest pain have. However, every 30 seconds or so I felt like there were butterflies in my chest around the area of the pain, and when I had the "fluttering" feeling I would experience a strange cold/numb/tingling feeling in my chin and gums (on the bottom of my jaw only), which went away when the fluttering did. After waiting about 20 minutes with no sign of the pain getting better, but actually getting worse, and beginning to feel sick to my stomach, I went to the hospital. I waited for about an hour, in which time the pain subsided. By the time I was seen I felt just fine, but was pretty exhausted.

When they initially took my pulse they said it was in the 150's - they asked if I felt like my heart was racing or was having trouble breathing and I said no... right before they called me in I had nodded off in the waiting area, so I was actually fairly relaxed. I told them that was a bit strange b/c I was always told I had a low (but normal) heart rate. Questions they asked - on birth control? no. Pain upon touching the chest? no. Acid feeling/taste in throat/mouth? no. At that point I told them I didn't know if I really should be seen because I was feeling better, but they said it would be good to take an EKG to be safe and give me some fluids and antibiotics since I was sick. They took a chest xray which they said was "a little cloudy" and the EKG was normal. I was told the pain was probably due to bronchitis and sent home w/rx's for antibiotics, decongestant and a pain reliever, but I didn't fill the pain reliever b/c they always make me sick. I called in sick and slept for several hours. I once again woke up with the chest pain. Since they didn't find anything wrong before I thought it would be silly to go back to the hospital. This time it only lasted about 10 minutes or so and slowly subsided as it did the last time. I was up for about an hour or so after that but felt pretty tired again so went back to sleep and slept until the next morning.

I have not had the pain again, however I do recall having this pain, though not as bad, before, but I didn't think too much of it other than heartburn or something. I've had these pains, which are exactly the same in the area they occur, and always in the morning, maybe about once or twice a year since I was a teenager, high school I think. However, it was never ever nearly as painful as this last episode and I didn't experience the strange sensation in my jaw. I don't recall whether I felt so tired before like this time, but then again was sick with the flu.

Since this last episode I have experienced sort of what I would call a racing heart beat, but only after I eat and it feels like my heart is thumping hard. It doesn't seem to follow any pattern, though - sometimes it happens in the am or pm, and thinking it was what I ate or drank, tried to eat/drink the same things again but it did not always occur. Some days I don't get it at all. Within I guess a half hour or so it subsides. Sometimes when having this racing feeling I feel a little lightheaded, sometimes not - but each time I get that weird feeling in my jaw and gums again. Again, I don't notice anything about my breathing; I feel like I can breathe just fine. This happens once, sometimes twice, every day or two. Prior to being sick this hasn't happened.

The pain I had before was, on a scale of 1-10, maybe a 3 or 4, if I were to say my knee dislocating was a 9, a bad migraine is a 6, and a typical headache or body ache is a 1. The pain I had this last time was about a 6 or 7. It was a 6 starting out, got worse so I guess peaked at a 7, then subsided gradually.

Something about this episode as opposed to the last episodes bothered me, and the more I thought about it the more worried I became. I went online and researched chest pain, as well as these boards, but nothing described exactly what I felt. Everything I read about chest pain describes sharp, burning, dull, crushing, etc. - none of that seems to fit right, but it's hard to describe because I just haven't felt anything like it before. Sharp to me is like when my knee dislocated. Dull is maybe like body aches the next day after working out. I don't know that I would know what burning or crushing is but I don't think it was that. The pain just really hurt... it didn't throb or feel stabbing, it was just...there, and wouldn't go away. It didn't change when I moved or changed position, walked vs. sat down or laying down, or change with breathing. It was either there or it wasn't.

The reason I am now really concerned is because I don't think it was similar to what I read the pain associated w/bronchitis is, since the pain didn't change w/breathing or coughing.

Now I'm afraid of having it again, but I don't want to get myself worked up over nothing, or go to the doctor and sound like a crazy person when it may just be something really simple. Since I am so young and pretty much in good health, and am not having any trouble when exercising, I don't know that it's likely that it's cardiac in origin but I guess I just want to know if it's possible, and if I should or shouldn't bother going to see a doctor about.

We do not have a history of heart attacks or anything on either side of my family, but I do know that 2 uncles on my mom's side had some sort of valve issue and both had murmurs. I think my great-aunt had something similar, but don't remember if it was exactly the same thing; I do know she had to take some medication for it, though. One of my uncles had surgery to repair whatever it was that was wrong and as far as I know he has done pretty well ever since, but I think he still takes medication. Other than that, other issues that run in my family but may not be of any relation to what I'm experiencing are: ovarian cancer (my mom), knee/joint issues, migraines and a couple females on both sides have thyroid problems.

Sorry for the long post - I guess I just had to get it all down on "paper" to sort through all these concerns floating around in my head that I can't figure out. Is there anything serious this could be, or am I just worrying about nothing, or something that isn't that big of a deal?

Thank you for your time and any advice you can give!
 Dr. A. Madia - Fri Feb 29, 2008 10:14 am

User avatar Hi Cheric,

It seems that you have had an episode of chest pain, which does not fit into any of the well recognised patterns or diagnoses. One can be certain of a few things though. 1) You do not have a Pneumonia or Pluirisy, as your chest X ray does not show it to be so. 2) You don not have a Heart Attack as your EKG has been reported to be normal, though you did have a fast pulse.

Also other serious caused of such a pain are already ruled out such as Pnemothorax, tuberculosis etc. One cause-dissecting aortic aneurysm is not objectively ruled out here but it is extremely unlikely because the pain of it is on the extreme and your clinical condition would be far far serious if it was so.

In my opinion your pain seems to be due to some pull of an intrathoracic muscle during your sleep, which will not show up on any of the tests conducted to diagnose a chest pain.

Another likely hood is a Pre Herpetic pain, a pain which precedes the development of a Herpes Zoster rash. In this case the pain is followed by the rash on the same area in a matter of 5-7 days. It is a viral condition and easily treatable with antiviral antibiotics.

However if the rash does not come up, I would stick to my earlier diagnosis of a musculoskeletal chest pain, and you would need only some pain relievers, on as and when needed basis.

Apurva.


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