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Forum Name: Cardiology Symptoms

Question: costochondritis or heart attack?


 pixietwin - Thu Aug 28, 2008 11:29 am

I hope that I receive a response because this situation has had me worried. I am 38 female, 260 lbs, 5'7" with type two diabetes well controled. A1c of 5.8

Here is my story so you can see what recently happened and if you think this is a GI incident, costochondritis or heart related.

Last Sunday night at 2:30 am I woke up with what I thought was horrible gas trapped in my upper GI (I had eaten a huge tub of movie popcorn on Saturday afternoon. that evening I felt yucky from all that ruffage and just wanted to get it out of my stomach so I could feel better- and I made myself throw up (tried 7 times in one sitting because I was hoping to get that rich stuff off my stomach. I had felt fine all day Sunday so I thought that this discomfort below my breast line was trapped gas from the popcorn. I had three Phazyme pills and two rolaids. Got to sleep but then woke up at 4 am with it back again. It was painful and constant..like a gnawing pressure/moderate discomfort.

Of course, I became alarmed when it didn't go away- constant. Woke my husband up and we were both concerned but thought it was just bad gas. I went to my chiropractor at 10 that morning hoping she could give me a manipulation to get this 'gas pocket' to moving. She did my regular adjustment but also used her clicker along the upper ribcage below my breasts which were already very tender. This made it worse but she said it sounded like I caused trauma with the throwing up - made sense. The whole time in the car for the hour drive I was in pain...couldn't get comfortable. Any pressure on my back from sitting, reclining or laying down hurt more. I felt a tiny bit better by leaning forward but this also caused pain with my breast pressure on my ribcage. My back was a bit sore before the chiropractor but better after the adjustment. By 1 p.m. I had to go see the local doc to get a pain pill. I described it and she said it was costochondritis. Now, my blood pressure was 150/90 which is high and my pulse was 123- I have big time white coat syndrome. I had been in constant pain for almost 12 hours, how could I not be stressed? She gave me Celebrex and Tramadol (which hardly helped at all). The Tramadol seemed to take an hour to kick in and gave a small amount of relief for an hour or less. I also took a muscle relaxer which helped some. At no time yesterday did I get 100% pain free.

Went to bed at 10 and slept for 12 hours thanks to the muscle relaxer. Woke up Monday a.m. with no pain at all. Is this typical that costochondritis can sometimes last a day (in my case 18 hours?). Doc assured me it was not a heart attack - I did not sweat, run temperature, want to throw up or feel the pain move. It was constant gnawing hurt in the same unilateral area for 18 hours. She did not run any blood tests, just went off information I told her to give me a diagnosis.

It was the worst feeling I've ever had. Does a heart attack produce 18+ hours of chronic pain and then when it ends you feel totally fine again? I just don't want to worry that this was a heart incident and I've got damage by not going to the ER. Today is Thursday and I feel fine again. I'm taking 5 days of prednisone which has made my BS soar and a rapid heartbeat but I've been told that those will go back to normal when I stop. I am still taken 2 anti inflammatory pills a day but have not had to take the Tramadol since Monday. Thank you
 pixietwin - Mon Sep 01, 2008 8:31 am

If a member of the medical staff would please reply, I sure would appreciate it.

Thank you
 John Kenyon, CNA - Wed Sep 03, 2008 12:49 am

User avatar Hello -

FIrst, my apologies for not having gotten to your question sooner. We've all been trying to catch up here. Hopefully you are feeling better by now.

To answer your questions, costochondritis can, indeed, last 18 hours and sometimes a good deal longer. While heart issues were ruled out, to answer that part of your post, it is possible for a coronary event to cause pain for that length of time as well, then go away, but it is rather unusual, and given all the other findings, I doubt very much that this was a heart-related episode.

Tramdol is an excellent pain reliever, but for costochondritis, the first choice of medication is usually a non-steroidal anti-inflammatory medication like ibuprofin or naproxyn, because costochondritis usually responds better to one of these due to its being an inflammatory process.

It sounds to me as though the initial discomfort may have been caused by the popcorn itself (rather than gas,although that could have added to the discomfort), since popcorn is peculiar in its being slow to digest or even move along the GI tract, especially in large quantities. The attempted forced vomiting probably irritated things even more. This all sounds rather like what might be expected after ingestion of a large volume of popcorn. Costochondritis could, of course, have been a secondary result of the forcefulness of vomiting, so that everything may have occurred in a cascading fashion.

The heart rate/high blood pressure is consistent with White Coat Syndrome, so probably had little to do with the episode itself.

I hope this is helpful and that by now you are feeling a good deal better. Please do follow up with us as needed. Best of luck to you.
 pixietwin - Wed Sep 03, 2008 8:41 am

Thank you for getting back with me. As I said previously, I have not had any negative symptoms after that one day. Thankfully I feel totally back to normal. I had no idea that a coronary incident EVEN COULD last 18-20 hours of constant pain without causing severe damage that would be noticeable after (weakness, etc). I guess that is good to know at least. I believe you are right and feel better with your agreement that this was not heart related. The one thing this has taught me is to be careful with our bodies and little things can cause big problems! Before your response, I was worried that it could have been a coronary but I am going to stop stressing over that now :-)
 John Kenyon, CNA - Fri Sep 05, 2008 10:47 am

User avatar You're very welcome and I'm so glad to hear you've had no further symptoms since the initial episode.

It's worth emphasizing, just for informational purposes, that occasionally a coronary event can behave as we discussed, and that especially in diabetics, it can happen and pass without any noticeable symptoms at all, usually in uncontrolled diabetes.

Your particular incident, with the symptoms evident, really doesn't sound like it was cardiac-related, and again, I'm glad the whole thing passed without further incident. Best of luck to you.

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