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Date of last update: 10/20/2017.

Forum Name: Hypertension

Question: Pain between shoulders and lower back upon excitement.

 tom jr - Mon Sep 01, 2008 9:09 am

I'm a 59 year old male in reasonably good shape, 5" 9", 170 lbs. Non smoker, no heart problems, normal blood pressure at rest.

I shoot competitively in large tournaments and have had success in winning. I usually get anxious when shooting and sometimes extremely anxious when shooting a good score. For the past several years sometimes immediately after shooting a good score when extremely anxious I will have pain in between my shoulder blades and kidney area. The pain does seem internal and not muscle related. This only happens when extremely anxious when my heart is beating fast and I feel as if my blood pressure is high. It never happens under excertion or exercising. The pain is never in the front of my chest, or feel pressure in my chest, and have never experienced shortness of breath. The pain has only been experienced under shooting pressure and not in everyday life, but I never get that anxious normally.

Any ideas on what could cause this.

Thanks in advance.
 John Kenyon, CNA - Tue Sep 02, 2008 10:58 pm

User avatar Hello -

What you describe could be due to muscle tension (although you describe it as "internal" in quality), could be orthopedic, or could be due to an increase in blood pressure. It would be really helpful if you were able to check your BP at the time this happens. That may, however, be impractical, in which case there is an in-office test some doctors will perform, to see if the patient is what's known as a "hot reactor", someone whose inner tension and/or anxiety during certain situations will convert into increased cardiac output, increased BP and elevated heart rate. The reason it is important to know if this is the case with a given individual is that it can, in the precence of occult heart disease or a weakened segment of the aorta or other blood vessel, and even possibly cause a heart attack or promote (or cause rupture of) an aneurysm somewhere if one already exists.

If your blood pressure does, in fact, spike dangerously during these periods of anxiety and tension, then you would want to treat the condition as though it were chronic hypertension, because sudden spikes can at times be as dangerous as constantly elevated BP. The fact that you have what seems to be internal or visceral pain between your shoulder blades and also lower in your back, could be atypical angina, could be transient pain related to spiking BP, or could even be caused by increased pressure within a thoracic aortic aneurysm. Of course, as I said earlier, the pain could simply be due to muscle tightness or an orthopedic problem, but the fact that you recognize a rather intense level of anxiety associated with the specific situation, and pain occurs simultaneously, it is well worth learning whether or not you actually do experience BP spikes at those times. If you don't, you probably still would do well to have a cardiological workup for the baseline findings, since you are now at what is generally regarded as a higher risk age-span (and oddly enough, while the risk begins to rise dramatically around age 50, it begins to decline, statistically, later on). The fact that you have no heart history thus far is a fine thing; however, it's impossible to know with reasonable certainty there are "no heart problems" without a timely workup. The symptoms you describe are as good a reason as any to schedule such an exam, which can serve as a very useful set of parameters (for what's "normal" for you, in particular) in the future.

I hope this is helpful and that you will take some steps to at the very least learn whether or not you actually do experience significant BP elevation at the times you describe. That alone would go a long way toward easing the concern.

Best of luck to you.

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