Pain when heart beats

[Taxgal]

Doctor,

My mother is 87 years old. She has had some pain in her left arm as well as in her chest. She had a cardiac catherization in December and was told that, although she had some 50-60% blockage, it was nothing that needed to be removed. She was given nitroglycerin and isosorbide at that time to deal with the pains. She later saw her primary care physician, who thought the pain in her arms (she had developed similar pain also in the right arm) was bursitis. He gave her injections (a steroid?) in each arm, and the pain in the arms did improve after that. She decided that she did not want to continue taking the isosorbide, when the arm pains went away. However, she started having a strange pain, mostly when she is sitting or lying down, in her chest (maybe 3 or 4 inches higher than the base of the sternum) when her heart beats. She says that it happens most of the time now when she is sitting or lying down. Do you have any idea what could be causing these pains?

[John Kenyon, CNA]

Hello --

It's an odd symptom, but sometimes happens when one's heart starts beating in a regularly irregular fashion called ventricular bigemeny. It's not really serious, just a regular occurence of a premature heartbeat followed by a normal one. This can, if timed a certain way, cause pain or pressure. This sort of arrhythmia is often seen in association with short-term steroid use, too. Heart pain also often occurs when lying down if the patient has pericarditis, an inflammation of the sac around the heart, which also may have some fluid buildup inside it. This is possible since your mother recently an angiogram, which can sometimes cause this sort of inflammation. Other than these two things it's hard to imagine what could be causing pain in time with the heart beat, that is, if I am understanding the description right. If she simply has pain when she's sitting or lying down then pericarditis is more likely. Of course there are other, more obscure possible causes, such as sliding hiatal hernia, but this probably would have been present for a long time before now.

All the above mentioned things are pretty benign. If the problem persists or becomes more pronounced then it most certainly should be checked, but if it remains stable and only happens in relation to posture, it's probably nothing very serious.

I hope this is helpful. If you have any further information, by all means share it or just follow up with us as needed. Good luck to you and your mother.