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Forum Name: Cardiology Symptoms

Question: Constant Chest Discomfort


 norby - Mon Mar 07, 2005 9:11 am

Hi. I'm a 41 y/o male about 20lbs overweight and in relatively OK health. Over the past few years I have been paranoid about heart problems. I suffer from Acid Reflux but many of the symptoms were similar (in my mind) to having a heart attack. I did a treadmill test about 2.5 years ago and about 1.5 years ago I remained so concerned that the Dr. did an angiogram. The findings on both were negative and there were no blockages or any obvious problems.

I have controlled hypertension and a mild Hiatis Hernia. I had annual blood tests last week and all was fine.

I still have considerable fulness of the chest that comes and goes, I have discomfort when I'm excercising and now I suffer from fatigue and light headedness that effects my day to day living. I do belch considerably and often feel generally unwell.

I have reduced my excercise because I'm always concerned that it's heart related. I can't seem to get that out of my mind. Its all a very vicious circle and I don't know where to turn. Doctors think I am just 'crazy' now.

I don't drink or smoke and generally an extremely positive outgoing person but this is starting to change me considerably and "behind the scenes" I suffer quite a lot. I seem to be able to keep a bold positive face in public.

I am an executive in a multi national company and under considerable stress and travel extensively around the world (amost every 2nd week).

Sometimes I get home and wonder how I got through the day. I don't know what to do now!
 Dr. Yasser Mokhtar - Thu Mar 17, 2005 4:35 pm

User avatar Dear Norby,

To determine whether or not chest pain is due to coronary disease, major risk factors of the person suffering from the chest pain are looked at and the characteristics of the pain are looked at and then the probability of this pain being due to coronary disease is then determined.

As for risk factors, you are a male and you have controlled hypertension. Your chest pain sounds atpyical as compared to that of coronary disease. So, your probability that you have coronary disease is low. On top, you had a negative stress and a coronary angiogram. So, you had the gold standard test to detect coronary disease and it was negative, so you definitely don't have coronary disease, so there is no need to worry whatsoever about having coronary disease.

Chest discomfort can be caused by hiatal hernia and acid reflux disease. Have you ever tried antiacid medications to see whether or not they can improve your chest discomfort.

My bias is, if a person continues to have chest pain that proves not to be due to coronary disease, i always exclude neck spine problems, so i recommend that you have a neck x-ray/ct scan to make sure that you don't have neck spine problems.

Travelling around the world every 2 weeks is no doubt a very exhausting task and no wonder you feel tired.

If the x-ray/ct scan of the neck tunrs out to be normal and the trial of the antiacids was not succecssful, these could be panic attacks and i would suggest that you try a small dose of a tranquilizer to see whether it helps.

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

Yasser Mokhtar, M.D.
 norby - Fri Mar 18, 2005 6:10 am

Thanks!. They were very re-assuring words. I appreciate it.

I have tried antiacids on and off. At the moment I am on a 2 week course of Nexium to see if that help. I was overseas until today and two night I was kept awake with considerable chest discomfort. It comes like an attack last 3 to 4 hours and then seems to go. All the while my anxiety builds up as to what the problem is. What I am concerned about is it is almost always present in some form.

When I get these 'attacks' I have the pain, then belching starts and then I become somwaht removed from the conversation around me for a while. If I'm lucky it goes away pretty quick.

Anyway, I really do appreciate your reply! Cheers.
 Dr. Yasser Mokhtar - Fri Mar 18, 2005 7:32 am

User avatar Dear Norby,

What you are describing sounds more of gastric origin rather than of cardiac origin.

When was the last time you had your hiatal hernia evaluated? It might be getting worse. The ultimate treatment of a hiatal hernia is surgical but unfortunately it is not an easy surgery and many times, surgery does not relief the chest pain and sometimes, surgery is not successful.

This chest pain could also be due to esophageal spasms. Have you tried any anti-spasmodics?

i recommend that you have your hiatal hernia re-evaluated by a gastroenterologist to see whether or not it is getting worse and the best way to deal with it.

Also, i suggest that you discuss the possibility of trying a very small dose tranquilizer with you doctor to help calm you down during the attacks which might help a lot in controlling your symptoms as well.

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

Yasser Mokhtar, M.D.

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