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Forum Name: Cardiology Symptoms

Question: 5 days with upper left chest pain


 rybakgirl - Fri Sep 19, 2008 7:07 am

Good Morning,

First off let me say that this condition is reoccurrent and happens every few months or so. This time however, it is much worse. It is a dull, achy pain that lasts all day except when sleeping. I have been extremely tired, napping 1 - 2 hours everyday this week. When I take a deep breathe, cough, sneeze or excert myself the pain gets worse. I can't lay on my back, left side or stomach. I can lay on my right side and few ok. I have also had periods of lightheadedness and on the first day felt nausea and started to sweat. My pulse rate increases also. I happen to be in a local pharmacy and took my blood pressure on one of those machines and it was 141/94, few minutes later, 137/93, few minutes later 129/87. I have spoken to my doctor about this before and he kinda shrugs me off because I have an anxiety disorder. This is not anxiety, I know my body too well. I just don't know if I should see a cardiologist or some other specialist or let it go. Thank you in advance. By the way, I am 38, female, 5'6", about 170. I am a smoker.

Kim
 John Kenyon, CNA - Thu Oct 02, 2008 10:08 pm

User avatar Hello -

While women certainly can (and do) develop heart disease, I don't think this is what's going on in your case. It's unfortunate that your doctor doesn't look beyond the anxiety problem, which is so often the case (especially when the patient is a woman), as this can cause a problem to be missed.

The fact that your pain is both position-sensitive and movement aggravated takes it almost completely away from the potential for heart problems. It is very likely either a musculoskeletal problem (Tietz' syndrome, an inflammation of the connective tissue between the ribs where they connect to the sternum), a recurrent repetitive motion (lifting?) injury, or perhaps a chronic pleurisy problem, where the outer lining of the lungs (the pleura) becomes irritated or inflamed, causing sometimes excruciating pain that can be felt in the affected side of the chest, sometimes radiating up into the shoulder or the base of the neck. This is not generally serious, especially when chronic, but pain is pain, and should be dealt with. Pleuritic pain usually responds very well to non-steroidal anti-inflammatory drugs such as ibuprofin or naproxyn (Advil or Aleve over the counter).

The one way this could be remotely connected to your heart would be a chronic or recurrent peridcarditis, which is similar to pleurisy but affects the sac surrounding the heart instead. Often lying flat on one's back provokes the pain, while sitting up causes it to go away. While this is less likely than pleurisy or chest wall muscle problems, it is possible, and again is not generally dangerous, although in rare cases it can get severe enough to cause some cardiac compromise (by pressure inside the sac or due to adhesions between the sac and the surface of the heart). This doesn't sound like what's going on, put pericarditis is a remote possibility. By the way, it is usually treated with the same medications used to relieve pleuritic pain.

I would definitely seek out another doctor who is willing to look past your history of anxiety (and yes, many anxious patients really do know their bodies better than most), to determine if there is an inflammatory problem that can be easily treated. A simple listen to the chest with a stethescope and a good ear can determine if there is a friction rub either in the pleura or coincident with the heart's beating. Even if nothing is audible, a trial of ibuprofin or naproxyn would likely relieve the discomfort.

I hope this is helpful. Please follow up with us as necessary.
 rybakgirl - Fri Oct 03, 2008 5:39 am

Thank you doctor for replying. My EKG done in my doctors office a week ago showed a long heart beat. He sent me to a cardiologist and she sees what he is referring too, it is 3 spikes, up, down, up. She doesn't feel it is signifcant and nothing to worry about. She did hear a murmur and 3 years ago I had an echo done and it showed minor leakage in my valves but again she doesn't think it is significant. She had me do my scheduled echo and wants me to have a cardiolite test done. If she shes nothing significant is it necessary to do the cardiolite? I am chalking it up to muscle strain, pull or something other than my heart. Thank you for responding.
 John Kenyon, CNA - Fri Oct 03, 2008 3:02 pm

User avatar Hello again -

You're welcome. Your EKG with the "long" waves (usually referred to as "deep" or "tall" waves) can be a normal variant, or sometimes reflects some degree of thickening of the heart muscle (which also can be normal or benign) and sometimes even indicates an unusual positioning of the heart, which is almost always benign and normal for the patient in question. It definitely warrants the follow up echocardiogram, just to see if there is any visible structural reason for the deep waves. If not, the Cardiolite stress test might be called of. If not, I would just go along with it, as it will either show nothing, in which case you can really relax, or, on the off chance it shows something (very unlikely), then at least you'd know what it was and what it would require to keep it from becoming a problem.

Again, if the echo is negative, the Cardiolite test might be moot, but if the doctor urges you to do it anyway, it's really not a big deal (inconvenient, I suppose, but that's about all). This will all help you to feel better about everything. Please let us know how things turn out.

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