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Forum Name: Ischemic Heart Disease

Question: Tenderness in chest, trouble breathing


 norlan - Sun Nov 21, 2004 5:49 pm

My brother is a 44-year old, active and athletic person with no previous medical problems. He was doing his usual 2-mile jog one day in early October last month when he suddenly felt pain in his chest followed by extreme fatigue. He said his chest felt "tender," and he had trouble breathing, like oxygen was stuck in his chest, not the normal easy flow of in and out. When he stopped running, he felt a little better; however, these conditions still persist, and it's been over a month. He's also been feeling fatiqued, weak and dizzy. His heart rate races especially after a meal. He has trouble sleeping. He has not been able to return to work since that day.

He checked with his doctor who ran an EKG that was normal. His cholesterol and heart pressure were also normal. The doctor was perplexed and suggested he may have a viral infection in his heart and that he should take Advil. My brother says the tenderness in his heart is slightly better with Advil, but it's still there. His fatique and weakness have not improved.

I'm not a doctor, but I think his symptoms are serious and the doctor should be doing more for him than just have him take Advil. What else should my brother do:

- See another cardiologist for a second opinion?
- What other tests can he take to try to locate the specific heart problem?
- Are the above symptoms related to the heart? Could it be something else totally unrelated?
- What else should he be doing to find out what's wrong and have it treated immediately?

I am terribly worried.
 Dr. Yasser Mokhtar - Sun Nov 21, 2004 8:51 pm

User avatar Dear Norlan,

Determining the origin of chest pain and whether or not it is of coronary origin (the most feared and one of the most serious causes of chest pain) depends on the risk factors the person experiencing chest pain has for coronary disease and the characteristics of the chest pain that the person has.

i need to know more about your brother's risk factors. i know that he does not have high blood pressure and diabetes, you said that his cholesterol was normal. i need to know what was the hdl (known as good cholesterol) and what was the ldl (known as bad cholesterol). Is there a family history of coronary disease at an early age in first degree relatives? Does he smoke?

The characterisitics of your brother's chest pain have some typical (little relief when he stopped jogging) and some atypical characterisitics (lingering on for so long and feeling of tenderness) of chest pain caused by coronary disease.

i think from the story that you provided that the chest pain that your brother is having is most probably not coronary origin. Chest pains have lots of other causes. The list is long. i think that your brother has to be seen by his doctor once more to be re-evaluated.

If you are still worried about whether or not this is coronary related, a stress test could be done.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 norlan - Sat Nov 27, 2004 8:23 pm

Dear Dr. Mokhtar,

Thank you for your response. To answer your questions, his hdl is high at above 60, and his ldl is low at below 90. He is not a smoker nor drinker. Our father died suddenly in bed at age 72. After an autopsy, they think it's anteriosclerosis. He had high blood pressure.

My brother lives in the Boston area where there are excellent medical facilities. Is there a place he can go where they can keep him for a few days and run a battery of tests on him to find out what he has or doesn't have?

I've just read on the Internet about a condition called Adrenaline Fatigue. (He experiences extreme fatigue where it's an effort for him just to talk. Even reading is too exhausting and wears him out). Should he be tested for this condition?

Thank you for your help.
Sincerely,
Norlan
 Dr. Yasser Mokhtar - Sat Nov 27, 2004 10:50 pm

User avatar Dear Norlan,

Thank you very much for the update.

From what you said, i think that the chest pain that your brother has is not secondary to coronary disease.

i can not say what is the reason behind his extreme fatigue, but i think a few simple tests should be done first before he goes to the big shots in Boston, like thyroid funtions, electrolytes, kidney functions, liver functions, blood sugar level and complete blood count for starters.

Living in Massachusetts could expose him to contracting an infectious disease known as lyme disease which is known to have chronic fatigue as one of its side effects. So, he has to be checked for it as well.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 norlan - Mon Nov 29, 2004 9:52 pm

Dear Dr. Mokhtar,

Thank you for your advice. It's a start. I do appreciate it.

Sincerely,
Norlan

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