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Forum Name: Miscellaneous Cardiology Topics

Question: Left sided chest pain on and off since March 2007


 lindel - Mon Nov 17, 2008 6:49 pm

Hello heres a little history first I'm 28 yo female currently pregnant at 20 weeks. ESince I was 20 I had some fluttering feeling in my chest had an echo said it was mitral vavle prolapse. really didn't start having horrible chest pain till March 2007 at age 26 a month after I had 2nd c section. After about 3 days of chest pain one night I felt like I couldn't breath and my doctor believed I had a panic attack. Never expirence that before. So therefore I went for futher testing in July of 2007 had an echo and stress test done said it was normal and I don't have mitral vavle prolaspe. Still having symptoms had thyroid checked because had a bit of hyperthyrodism in pregnancy but never medicated and levels were normal after pregnancy. Even had radio iodine uptake test done and was normal. Sometimes I did get symptoms of heart burn so in April of 2008 went to a GI doc. she put me on priolsec 20 and pepacid 20mg @ bed. Wanted to due a EDG but never was able to because I was dealing with going for acl surgery and rehab with that. Then I got pregnant in july 2008. the GI doctor thought maybe a hiatal hernia because I feel so short of breath all the time and was expirencing it quite a bit while driving. Also in May of 2008 seen the cardiologist again did another stress test and was normal. Wore a holter monitor in past never picked anything up. My pregnacy is dealing with hyperthyroid again but the endoc. doc says the levels are acceptable and checks them once a month. I am 20 weeks pregnant and been having horrible left sided chest pain. Sometimes its on the side by my armpit sometimes at top of left breast. Its so scary. I do get back pain at times when it happens. Is it anxiety or is there something wrong with me. I'm so short of breath. I still take the pepacid and tums but it never relieves it. I did have my cholesterol tested in Nov 07 It was normal but the good cholesterol was low is what they told me. My blood pressures been good just this past saturday it was 100/68. I feel horrible so short of breath and have chest pain.
 John Kenyon, CNA - Tue Nov 18, 2008 10:46 pm

User avatar Hello -

What you describe does not sound like it's heart related, which is, of course, consistent with the findings of your cardio workups, so I think we can safely set that aside. That doesn't make the discomfort go away, however, so the trick now is to find out what the underlying cause of the pain is and treat that. It certainly could be anxiety, as this sort of pain (in this location) is quite often associated with chronic anxiety, as is the sensation of shortness of breath.

I do have a few questions which may help narrow down the field of possible causes: could you describe character of the pain in a little more detail, as well as how long it lasts? Also, does the pain occur when you attempt to draw a full, deep breath? Does it happen when you move your upper body in certain ways? These are very important considerations.

Anxiety, hiatal hernia (especially during pregnancy), and other upper GI problems, all are possibilities, as well as several inflammatory issues involving the ribcage and chest wall. None are life-threatening, but they all hurt, and that's nothing anyone wants or needs. If we can narrow down the scope of this, we may be able to point you toward what's causing this and hopefully you can get someone to treat it appropriately. We pretty much know what it's not, but we need to figure out what it is. Please follow up with us here. Thanks, and good luck to you.
 lindel - Fri Nov 21, 2008 12:26 pm

The pain is quite consistent. It doesn't change based on postion. It doesn't get worse when I take a breath. The pain is more of a stabbing to aching pain mostly left sided either side of left breast and sometimes it is felt under left arem area. Also at times I feel the pain above the left brest and it feels like a deep muscle pain. The pain will be present for a couple days to a week then disaapear for awhile. The first time I ever noticed the deep muscle pain I described was the day I had the c section I told the nurse they did a cardiac with CPK all normal and of course check for PE with the surgery. After that and the Panic attack related episode in March 2007 it has never truly went away. One more thing that may be of intreset is that my heart rate at times get tachycardic. For example in MAy of this year I had acl surgery and in recovery my heart rate was in the 120s, Also in July 2008 had to get a knee manipulation under anesthia and I m on the table and the nurse is saying my hr is 153. Even after my surgeries when the give me pain meds. it still gets elvated. Thats when the cardiologist was suspecting the thyroid but there always normal levels when I'm not pregnant. I do have a huge goiter but it has remained unchaged for 3 years in size now. My family history has thyroid both hyper and hypo. They had already checked me for SVT and nothing came up. Sorry if I have rambled on I'm just so frustrated with this situation
 John Kenyon, CNA - Tue Nov 25, 2008 1:40 pm

User avatar Hi -

I certainly understand your frustration with this. There are at least two underlying conditions which could, separately or jointly, contribute to the symptoms you've described. One is the anxiety problem, which is a constantly shifting galaxy of symptoms which often gets "stuck" in the area of possible cardiac symptoms, probably because this is generally considered one of the "worst" things that could happen. Also, the adrenaline released during periods of intense anxiety or a panic attack can cause many otherwise benign symptoms which indirectly affect the heart and nearby structures. Some people experience marked sinus tachycardia (as seems to be the case with you) without actual SVT taking place. Others, again like you, report recurrent, usually left sided, chest pains that are non-specific relative to cardiac symptoms, or are totally unlike cardiac pain, but do draw one's attention to the heart because of the nominal location. This is a very common complaint, and it is, of course, very real pain, but the cause of it is obscure, metabolic/musculoskeletal, and so will not set off any red flags in a cardio workup.

Then there is that family history of thyroid problems, which could be affecting this as well. Family thyroid history is often mixed, with some affected members being hyperthyroid and others being hypo. This will need to be followed periodically to be certain aren't developing new problems in that area as well.

It is all very frustrating, but the good news is that it is benign stuff. That doesn't necessarily make it go away, but knowing that can, at least, make it easier to adapt to it, and when we adapt to anxiety-based symptoms, given their tendency to shift and change anyway, they often will go away, almost as though they have a consciousness of their own (it is actually our own subconscious at work) and realize what they've been doing has lost its ability to alarm. Unfortunately they often move to some other area of concern, and this pattern can repeat indefinitely. It's a challenge, for sure, but one that can be managed and overcome, with patience and sympathetic healthcare providers.

Please stay in touch with us, follow up as needed, and keep us updated.

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