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Forum Name: Cardiology Symptoms

Question: Increasin Chest Pain for 12 years


 scooter777 - Sun Mar 16, 2008 2:15 pm

I am a 42 year old obese male that has been diagnosed with diabetes in Dec 2007 and hypertension 2 years prior. I used to smoke for 20+ years but quit almost 3 years ago.

Approx 12 years ago(was normal weight and no medical conditions) I started to get chest pains on the left side front of chest on a regular basis. Family doctor at that time sent me for stress test and halter monitor...All was normal..thought to be muscle related. Pain continued for another 2 years and got worse..Doctor then sent for another halter monitor and nuclear stress test....was told all was normal...Pain dissappeared for almost 2 years. Moved to another city and started seeing another doctor...Chest pain started again however this was more of a burning and instead of being on the front of chest it was about 6 inches under the left armpit at the side of chest. Would seem to get worse with excercise or stress. Sent for more stress test and halter..told all normal. Continued to just live with pain and thought it was muscular....It got worse again and went to ER. They ran ekg and chest xray told all was normal....Pain still continued. Doctor sent me to a cardioligist who did another stress test and told me all was normal but to stop smoking(which I did) and to loose weight (which I did not). He was actually surprised at how long I could go on the tread mill. He said for my size I was in good shape.
One day while sitting waiting for the family doctor I looked through my file and on top was report from cardiologist it mentioned LVH. I asked the family doctor about this and she said it was nothing to worry about..looked it up on the net and it did not sound too good.
3 years ago while a nurse in the hospital was doing pre-op for surgery to have 1/2 my thyroid removed(nodule - turned out to be not cancer) she was doing and EKG and asked if I had ever had a heart attack. I told her not that I was aware of. They called up the cardiologist I had seen and compared with previos EKG. There was a difference. They did a Echo before the surgery to make sure everything was OK. Tech said all was fine but had a hard time seeing with the amount of fat at my side under arm. About 6 months later started having more of the same pain in Side(severe) went to ER. EKG was abnormal but same as one previous to thyroid surgery...said that even though EKG did show a previous MI that they believed it was not true. Scheduled me to come back for Stress Test. Had stress test students were training at the same time so they did an echo right after I got off the tread mill. On tread mill the cardioligist noticed the slight abnormally in EKG but said it was nothing and I needed ot excercise more. Echo did not show much as too much body fat.

I have been afraid to excercise as my chest hurts so much I think I am going to die of a heart attack

Decided I wanted to go back and see original cardiologist that the doctor sent me too. He looked at the new EKG and said although it had changed since he did it originally it was nothng to worry about.....Checked BP and with the altace it was within normal range LDL is great HDL is low.

that was about 2 years ago...The pain continues however the other night something different happend. Normally when I get up in the morning I have no Pain until I have been awake for about 2 hours....I was sleeping the other night and was awoke 2 times with crushing pain in the middle of my chest. It lasted for about a minute each time. Since then pain under arm(6 inches down has been worse)

I hate to keep going back and keep being told it is nothing..what about this LVH stuff

Thanks
 Dr. A. Madia - Tue Mar 18, 2008 6:13 am

User avatar Hi,

Chest pain occurring on exertion is more likely from the heart rather than occurring randomly. From your history one thing is clear that you have been having chest pains for 12 years without a clear diagnosis as to the cause. You have been subjected to stress tests which have been normal. However every test has a limited power of diagnosis and a certain percentage of abnormality may go un-detected.

Over a period of years your EKG went from normal to doubtful/abnormal. meanwhile Diabetes is detected last December, one does not know since when it has been there. You have LVH. Its Left Ventricular Hypertrophy meaning the thickness of your heart mucscle has increased beyound the normal range. This happens when your Ventricle is pumping the blood against a high resistance, in your case your High BP. Your HDL is low [which should be higher the better]. You have been smoking for 20 years. You have a family history of heart disease [father]. You are overweight.

So in medical parlance you have many 'Risk Factors' for development of blockages in your heart arteries, in addition you are having chest pains and crushing ones lately. In addition diabetes is such a disease that could result in your kind of situation that is a series of EKGs would be normal and one day a doctor would find the EKG shows a previous or a current heart attack.

Internet is a medium wherein one can only opine from the information provided, there is no way for the professional to check things for himself. However from the data presented, as a medical professional I would opine that you have a battery of risk factors operating in your system, you have been having frequent severe chest pains, your EKG shows doubtful changes and has changed over a period of time. You are in my opinion a kind of candidate who would need a further coronary work up to get to the root of the matter, especially since your Echo and stress tests are not giving much information due to the limitations of the tests, and due to the obesity.

Take care,


Apurva

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