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Forum Name: Gastroenterology Topics

Question: hiatal hernia, possible cause of chest pain?


 jbq - Thu Jun 17, 2010 10:27 am

I'm a 29 yr old male and I run 15 to 20 miles per week. I weigh 155 lbs and am 5'-11". I have been running races for 3 years, approximately 12 per year. Race distances range from 5k to half marathon. Within the past 6 months, I have been noticing a strange chest pain that has me concerned. At varying distances during many of my runs, I will get a short, but sharp chest pain right in the middle of my chest, approximately 1 to 2 inches higher than my nipple but dead center. It doesn't tire me and doesn't make me feel the need to stop, but it startles me and definitely is not something that has always happened. It feels like a pulse, drop, or spasm os some sort, but dissipates quickly. It has happened at various training paces and often occurs at different distances through the run. I've had it happen anywhere from 1 mile in to 8 miles in. It does not happen every time, but does happen most times regardless of my pace. It generally only happens one or two times within minutes of each other and then no more regardless of how much farther I run after. The symptons vary from subtle to intense. My race pace is 5:55 min/mi for 5k to 6:58 min/mile for half marathon, so I assume I am relatively well conditioned.

I was recently diagnosed with a hiatal hernia and some esophageal scar tissue from acid reflux after an EGD was performed. That was performed as a result of difficulty swallowing that was increasing over the past 5 years. The chest pain I described previously started happening just shortly before my EGD and seems to be increasing in frequency. Could this be associated with my hiatal hernia? Sometimes I have to burp shortly before or after the episode and have some minor heartburn, but I do not always notice those symptoms.

I have also posted this on the cardiology thread with additional lipid profile and family history information to see if they have any input.

Thanks,
 Dr.M.Aroon kamath - Sun Jul 04, 2010 11:51 am

User avatar Hi,

Cases of sudden cardiac arrest (SCA) occuring while participating in a strenuous tests of endurance lasting about three hours or more have been reported. There seems to be a temporary, increased chance of dying during - & for 24 hours following the exertion.

Exertion-related deaths do appear to occur at a low frequency, even in well-trained athletes. Data from the London Marathon, with 650 000 completed runs, show that cardiac arrests occur even in the most experienced runners.(Sports Medicine: 2007 - Volume 37 - Issue 4-5 - pp 448-450).

It appears that a long-distance marathon runner's life-style is no insurance against the progression of coronary atherosclerosis.

Presence of one or more of the known risk factors for coronary disease (diabetes mellitus, cigarette smoking, obesity, high total cholesterol, low HDL-cholesterol, hypertension, high stress levels, or a family history of heart disease) perhaps increases the risk. Also, some may have unrecognized, sub-clinical underlying cardiac disease such as idiopathic left ventricular hypertrophy or hypertrophic cardiomyopathy (HCM) etc.

Objective evidence(studies measuring cardiac troponin I concentrations following high intensity excercises) indicates that some myocardial damage can occur during extreme exercise.This may be related to the degree of effort, overall training volume etc.

Chest discomfort of any kind which appears during exercise and then disappears (however fleeting it may be), should be viewed with suspicion.

Angina in athletes often does not present itself with classical features. May instead present as pressure or squeezing sensations in the chest,& tightness in the chest. It has been observed that a good number of people who have heart attacks while exercising experience a fair number of small warning signs during the days or weeks leading up to the attack.

Stress testing: Some experts believe that stress testing may detect only about 20-25% of the likely victims of sudden, exercise-related cardiac death. But, it may have increased usefulness in those with risk factors.

It is paradoxical that exercising should increase the risk of dying at the same time that it is invaluable in reducing it!

You seem to be experiencing an atypical chest pain, the cause of which is unclear. Although you have an hiatus hernia, it may not be wise to attribute your symptoms entirely to that as it is definitely related to your marathon sessions. Discuss with your doctor about the probability of cardiac origin of this pain and get investigated fully.
Best wishes!
 jbq - Tue Jul 06, 2010 10:58 am

Thank you for the reply Dr. Kamath. From the sounds of the reply, you don't suspect a gastroenterological origin for the symptoms I described. I have made an appointment for this Thursday morning with my doctor to discuss the situation and hopefully initiate a process of diagnosis, although I suspect it will take quite some time. And I do have elevated LDL blood cholesterol levels (130 to 159 generally), although my triglycerides (55) and HDL (65-73) have always been good. I also have a family history of heart disease as my father (non-smoker, 6'-2", 210 lbs) died at 51 from a 98% blockage that he was completely unaware of. Needless to say, the heart issue is always in the back of my mind as a result. I guess I am just hoping that being as physically active as I am, eating healthy, and young would make it a very unlikley scenario that this is of a cardiac origin. I will post again if a diagnosis of the symptoms is determined.

Thanks for your time.
 Dr.M.Aroon kamath - Mon Jul 19, 2010 1:48 am

User avatar Hi,
I believe, I did not in any way indicate that it is primarily cardiac cause. I only wanted to highlight that one should not "neglect" a cardiac cause. I had said "You seem to be experiencing an atypical chest pain, the cause of which is unclear. Although you have an hiatus hernia, it may not be wise to attribute your symptoms entirely to that as it is definitely related to your marathon sessions". Gastroenterological causes are by far more common than cardiac causes for symptoms such as you describe.Thank you for the update. Please remain in touch. Good luck!

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