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Forum Name: Cardiology Symptoms

Question: 6 month chest pain...... and still going???????


 dcm8299 - Mon Nov 03, 2008 5:31 pm

Hey there! I am a 37 yr old white male about 5'91/2 and about 195 lbs. I have spent a good portion of my life quite active so my weight is decently distributed with substantial muscle tone. I have smoked for 20 years at about 15 cigarettes per day. About 6 months ago I started having some mild chest pain (never before had I experienced this). I consulted a family practitioner. He ordered an excercise stress test, and some blood work (CBC while fasting, urinalysis, cholesterol). Further, I asked for a CXR as well. Results were seemingly normal. There were no ischemic events from the stress test. As a matter of fact, the EKG was normal as well as the nuclear imaging results according to the Cardiologists reports. The length of the excercise was about 12 minutes at 6.0 mph with an incline of 18% before injection of the radionucleotide. The blood work was seemingly normal as well. The total cholesterol level was 203 with the HDL being 38 and the LDL being 144 (might have those numbers juxtaposed). The family practitioner was not concerned. The CXR was also negative. No abnormal findings. The FP palpated my chest for possible tenderness (costochondritis) with some tenderness associated. This was ultimately his diagnosis. More info, my blood pressure was 116/68 at first visit. It did spike to 118/88 at the second visit prior to the results but after talking to the FP and my worries kinda eased it did immediately drop to 116/76 within 15 minutes.
Let me just say, my anxiety level and stress level are probably at an all time high for me. Generally speaking, I'm a pretty easy going kinda guy. I am not on any kinda meds nor did they prescribe any. Although, as of last nite, I have started taking ibuprofen (4 x 250 mgs./day). My FP did tell me he did notice somewhat of a low platelet count during the blood work. My father's side of the family seems to be a bit hypertensive. My paternal grandfather died of a brain aneurysm, my uncle has had cardiac issues but is probably due to his compulsive drinking and smoking. And my father, who is a urologic surgeon and who concurs with the FP, has been a bit hypertensive. My mother's side of the family has a history of colo-rectal cancer as both my grandmother and aunt passed from this. My maternal grandfather died of emphysema after many years of chain smoking. [b]NOTE:[/b] I had to stop the ibuprofen because I had a single episode of blood in the stool and has never reoccurred after the discontinuation of the ibuprofen.
My symptoms began about 3 weeks before my marriage in early July after a short bout with a cold type sickness. I was having chest pains in the middle of my chest however they only occurred when I twisted my torso in either direction (ex. like turning towards the backseat while driving etc..). It has gotten somewhat worse since then. Now, it doesn't require any upper body torso movements as it happens spontaneously with/ or without excercise. And the pains are no longer focused on the middle of my chest. Fast forward a couple of months later to present and I'm still having chest pains that kinda migrate into the center of my back and both shoulder blades. It feels musculoskeletal but I can't say so for sure. Suffice it to say, it makes me VERY UNEASY. And probably causes higher levels of anxiety and stress. All I can say is that I've had a nuclear stress test done, blood work, CXR, and then a CT scan of the chest with contrast (done in early September) and they've all come back normal and negative. Stretching of my upper torso from side to side or touching my toes seems to alleviate the discomfort but it returns a few minutes later. The raising of my shoulders can sometimes mimic the pain. I gotta tell you it' driving me a lil crazy. I've also recently noticed that when I take a deep breath or yawn, I sometimes may get a lil discomfort in the middle of my chest. Due to the blood in the urine, I have a colonoscopy scheduled for the middle of this month. And I'm thinking about seeing a Cardiologist. Any thoughts on any necessary tests or areas I should focus on?? Thank you for your time.
 John Kenyon, CNA - Thu Nov 06, 2008 10:21 pm

User avatar Hi there -

You've done all the appropriate things to rule out cardiological causes of the chest pains, and from your description of them they do sound distinctly musculoskeletal in nature. The original diagnosis of costochondritis may have been right or at least close, the only qualifier to that being the fact that your pain now can migrate to the back, which may implicate a thoracic spine problem instead of costochondral inflammation.

While a cardiology consult would probably help put your mind at ease, you've pretty much had all the tests you'd have with that already, with the possible exception of an echocardiogram, and it looks like you're clear of any heart problems. Your pains were originally duplicable by upper body twisting, which would confirm musculoskeletal problems, and now they can sometimes be relieved by upper body stretching, which is an inverse confirmation of the same thing.

I think that while the cardiologist may help ease your mind some, you'll be best served by having an orthopedic consult next or at least after the cardio workup.

You definitely don't sound like a heart disease candidate based on your supplied information. I hope this helps and please keep us updated as to how things go.
 dcm8299 - Mon Dec 01, 2008 2:53 pm

Thank you so much for your prompt response. It's been almost a month since I last posted and your response. Since then the pains have continued encompassing bilateral chest pains, generally speaking middle to upper back pains and now I can feel a lil bit of left jaw pain just under the palate. It seems to come and go and never for long or never intense. It feels almost like a cramp on the left side of my jaw. I also feel somewhat light-headed and kinda fuzzy eyed on occasion, it also comes and goes. I've recently had an endoscopy and colonoscopy done to rule out GI problems and the results returned pretty normal as per the gastroenterologist. I am scheduled for an Echocardiogram on Friday the 5th of December. In my first meeting with the cardiologist, after he went throught my H&P and going over my symptoms, he said that he didn't think it was cardiac related but suggested to maybe schedule an echo. By the way, at the time, a resting EKG was performed and came up normal as well. I'm becoming truly frustrated. Any ideas??? What kind of information will an echocardiogram provide?? Thank you so much!
 dcm8299 - Tue Dec 02, 2008 10:27 am

Thank you so much for your prompt reply before. It is now December 2, 2008 and the chest discomfort with radiating pain to the center of my back persists. I have also experienced some left jaw discomfort just underneath my chin along the jaw line. It usually doesn't last long maybe a few minutes and kinda feels like cramping. I do experience on occasion some left arm discomfort and have been experiencing some bouts of lightheadedness or kinda like fuzzyness in my head. I've done further testing to look into some more possibilities. I've visited the GI doctor and ahve had an endoscopy and colonoscopy performed, each of which were seemingly normal. I must admit two small polyps were found and subsequently removed. According to the GI doctor, there was no esophagitis. The GI doctor has recommended that I go on Aciphex 200 mgs. 2X/day and also that I take a Zantac at night after dinner. Also, I am taking a GAS-X pill 2x/day. (Note: The lightheadedness and the 1 time bout of nausea which lasted for about 1 minute didn't start til yesterday.) Further, I did go see a cardiologist. Resting EKG at the office demonstrated normal sinus rhythm. According to the cardiologist after reviewing test results and listening to my H&P, my problems didn't seem to be cardiac in nature. Although he did suggest that I may wanna do an echocardiogram just in case. Do you have any suggestions???? Cuz I am at a loss here and completely frustrated!!! I appreciate your help. Thank you.
 John Kenyon, CNA - Tue Dec 02, 2008 1:16 pm

User avatar Hi -

While it is less than likely that you have a structural heart defect, one can have more than one thing going on at the same time, and sometimes certain structural heart defects (of the sort that can easily be visualized via echocardiogram) can announce themselves with these sorts of symptoms. If it weren't for the lightheadedness in addition to the pains I might not be quite so interested to see an echo performed, but given the particular set of symptoms, I think it extremely wise to rule out any sort of cardiomyopathy, especially any thickening of the free wall of the left ventricle, or thickening of the septum that reduces the volume of the left ventricle, which are two of the more common sorts of structural problems that might produce these symptoms. If this comes out negative then all to the good, and you (or at least I) can probably relax a bit, but the most serious possibilities should be ruled out (or in) first. I'm glad your doctor, while skeptical, is still willing to do the echo. I look forward to hearing about those results. Please update us when you've had that done. If there is any significant structural abnormality on the inside of the heart (including any valve problems) this will show them up.

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