Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Chest pain/Vascular

Forum: The Heart Forum
Topic: Heart Disease


For several months now, I've had what feels like chronic heartburn. It occurs mostly after meals when I attempt any physical excertion, walking, mowing etc. Although, I can get it at anytime when I'm attempting above normal excertion, digging a hole, struggling with something heavy etc. Taking an over the counter med like Pepcid before hand doesn't seem to reduce the effects so I don't think it's really heartburn. I also went to the eye doctor in June who found a blown blood vessel in my eye and called it "vascular". I'm on Tenormin (100mg) and my BP is normal. My Cholesterol is 204 and I'm 20-25 lbs overweight. The last 2 days, my left foot is tingling although not numb (which may just be a pinched nerve.) Does any of this seem to relate to one particular problem?

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Dear Mark,

There are many causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Once this is ruled out the work-up can proceed at a more leisurely pace. I don't think the eye problem is related to your other symptoms.

Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause. A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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