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Forum Name: Cardiology Symptoms

Question: Chest pains


 jimswife - Sun Feb 15, 2004 3:20 pm

I am a 47 yr woman with a history of cancer and diabetes. I recently went into the ER with chest pains. EKG and x ray were normal, but cardiac enymes were a positive 7. The test was taken a second time to rule out a false positive. If the blood test would have remained the same they were going to keep me overnight for observation. The results were a positive 5 and I was sent home since enymes were coming down. I was given a stress test and it came back normal. I still feel minor chest pains and pressure and I told my primary physician. She order a nuclear stress test and said if that comes back normal then it is not your heart.
My chest pains do not come on with exercise. My mother has heart disease and her father had the same.
At this time I am also seeing my physician for lumps in the neck lymph nodes....there is no diagnosis yet. I am becoming physically tired more often and have body aches and pain. I have such heaviness in the lower head, neck and shoulders and believe it may be related to the lymph nodes.
 Dr. Yasser Mokhtar - Tue Feb 17, 2004 11:55 pm

User avatar Dear Jimswife,

Thank you very much for using our website.

Chest pain is usually worrisome for coronary disease. Coronary disease has factors the presence/absence of which can usually predict fairly well the probability of the person complaining of chest pain having or not having coronary disease.

These risk factors include family history, smoking, hypertension, diabetes, high cholesterol, sedentary life style and obesity. You did not mention if your mother ever had a heart attack (and if yes how old was she then), whether you smoke or not, whether you excercise regularly and how much do you weigh. You mentionned that you are a diabetic and you had cancer history but you never said what kind of cancer.

Chest pain caused by heart disease usually has certain characteritics. The coronary pain is usually a sharp pain, but can be perceived by patients as pressure, burning or stabbing sensation. It usually occurs on exertion, lasts for a few minutes and is relieved by rest. Its location is usually behind the breast bone and can move to other places like the left arm, the back or the neck. If severe enough it can be associated with nausea, vomiting and sweating, but these symptoms are so non-specific and they are not an indication that the pain is of coronary disease but just the pain might be severe.

The answer to all these questions makes it most of the time easy on the physician to decide the origin of the chest pain and whether it is cardiac in origin or not (from the heart).

Obviously if the only source of chest pain was the heart, it would have been very easy for doctors to diagnose all patients who present with chest pain, but there are other sources and the symptoms are sometimes vague enough so that doctors resort to other resources to try to diagnose the source of the pain.

Your visit to the emergency department was a good step but i am not sure what is the enzyme that was high and then came down.

You had a negative stress test and your doctor went even a good step further with the nuclear stress test. How were these tests done? Were they treadmill stress test or a chemical test and if on the treadmill how long did you last and why they stopped the test?

While awaiting the results of the nuclear stress test. If the lymph nodes that you have turn out to be of cancerous origin and you need a major surgery, most probably your surgeon will not be satisfied with all this (chest pain in a diabetic patient and needs a major surgery) and he will ask you to see a cardiologist or be formally evaluated by a cardiologist who might or might not you to have a coronary angiogram which is a specialized type of x-ray where a dye is injected directly into the coronaries under x-ray vision to see whether the coronaries are diseased and if yes how much and whether or not surgery is needed.

These minor chest pains also can be caused by spread of the cancer to the sac surrounding the heart although it does not sound like it, but it would not be unreasonable to have an echocardiogram (ultrasound of the heart) to make sure that there is no fluid collection around the heart.

Once more, 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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