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Heart Disease (Expert Forum)
chest pain, stick-in-the-chest
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
chest pain, stick-in-the-chest
by Angie7, Jul 16, 2005 12:00AM
I'm 61.I've had off and on pain-pressure in my chest area that feels like a "stick-in-the-chest".This stick pain started 4th day after angiogram(angiogram negative.Angiogram was 27 days ago)This morning,I feel chest pressure,a little stick on normal walking.
33 days ago,I had rowing class that gave me a pounding heart beat early next morning.(Prior to this,any heavy exercise in P.M.would cause chest pressure early morning hours.Is this to be concerned about?)I then went to ER.I had nuclear stress test indicating "old"heart attack.Angiogram ordered.10 days ago, my cardio said stress test was a false-positive.How acurate can he be about this assesment?
On follow-up of ER, 24 days ago, my cardiologist gave me echocardiogram,which was negative.He thought I might have inflamation of sac around heart, or spasms. Dr. prescribed naproxen.Pain gone but left me extremely weak, malaise. Stopped it 6th day.Stick pain returned along with pounding heartbeat when walking normally.Now take lopresser,walk slowly.
I use to walk-bike everyday pain-free for years.
My cardiologist is now on vacation. Yesterday, his associate,who gave me angiogram said, my complaints have nothing to do with the heart. Can this be true? His echogram was negative, no fluid-inflamation he said.Suggested seeing internist.
30 yrs ago I would rarely get stick pain at the end of a LONG tired work day.It would last about one or two hours when I would sleep it off.
What could stick pain be?Are my concerns Heart related? or from angiogram complications?Lopressor helpful?Are my death feelings
of concern?
33 days ago,I had rowing class that gave me a pounding heart beat early next morning.(Prior to this,any heavy exercise in P.M.would cause chest pressure early morning hours.Is this to be concerned about?)I then went to ER.I had nuclear stress test indicating "old"heart attack.Angiogram ordered.10 days ago, my cardio said stress test was a false-positive.How acurate can he be about this assesment?
On follow-up of ER, 24 days ago, my cardiologist gave me echocardiogram,which was negative.He thought I might have inflamation of sac around heart, or spasms. Dr. prescribed naproxen.Pain gone but left me extremely weak, malaise. Stopped it 6th day.Stick pain returned along with pounding heartbeat when walking normally.Now take lopresser,walk slowly.
I use to walk-bike everyday pain-free for years.
My cardiologist is now on vacation. Yesterday, his associate,who gave me angiogram said, my complaints have nothing to do with the heart. Can this be true? His echogram was negative, no fluid-inflamation he said.Suggested seeing internist.
30 yrs ago I would rarely get stick pain at the end of a LONG tired work day.It would last about one or two hours when I would sleep it off.
What could stick pain be?Are my concerns Heart related? or from angiogram complications?Lopressor helpful?Are my death feelings
of concern?
Doctor's Answer
by CCF-M.D.-MJM, Jul 16, 2005 12:00AM
Hi Angie,
I won't be able to give you any definitive answers on most of these questions. They are bit more involved than an online forum. If you have an angiogram with out significant blockages, it is possible to have exertional angina from microvascular disease. This requires flow measurements during a heart cath. The usual patients with microvascular disease is an overweight type two diabetic with hypertension.
It is true you can have false positive stress tests. It is also true that coronary arteries can remodel after a heart attack and leave no residual blockage. It depends on your history to decide which event is most likely.
Naprosyn typically does not cause fatigue.
It is possible the pain is non cardiac. The reality is that pain like yours is often difficult if not impossible to explain. The cardiologist ruled out significant disease that would cause pain and probably feels like there is nothing else they can offer at this time.
Your last paragraph makes you pain sound more anxiety/depression related. This is VERY common. From what you have written in your post, my best educated guess is the pain is not cardiac and related to anxiety/depression. The main reason I say this is:
1. negative cardiac work up
2. similar symptoms when you were much younger and very unlikely to have cardiac disease. The feelings of death are also associated with anxiety/depression.
I hope this helps answer your question. You can always get a second opinion to be sure.
I won't be able to give you any definitive answers on most of these questions. They are bit more involved than an online forum. If you have an angiogram with out significant blockages, it is possible to have exertional angina from microvascular disease. This requires flow measurements during a heart cath. The usual patients with microvascular disease is an overweight type two diabetic with hypertension.
It is true you can have false positive stress tests. It is also true that coronary arteries can remodel after a heart attack and leave no residual blockage. It depends on your history to decide which event is most likely.
Naprosyn typically does not cause fatigue.
It is possible the pain is non cardiac. The reality is that pain like yours is often difficult if not impossible to explain. The cardiologist ruled out significant disease that would cause pain and probably feels like there is nothing else they can offer at this time.
Your last paragraph makes you pain sound more anxiety/depression related. This is VERY common. From what you have written in your post, my best educated guess is the pain is not cardiac and related to anxiety/depression. The main reason I say this is:
1. negative cardiac work up
2. similar symptoms when you were much younger and very unlikely to have cardiac disease. The feelings of death are also associated with anxiety/depression.
I hope this helps answer your question. You can always get a second opinion to be sure.
In retrospect, I wish that I never had the angiogram, because I feel worse today, now that I feel this "stick-in my-chest" pain. The angiogram seems to have stirred up an old pain that I rarely had. Prior to my angiogran, I would occasionally feel depressed at the end of the day when I felt tired. Now I feel depression throughout the day when I attempt to walk normally, because walking gives me chest pain.
When my cardiologist says that my nuclear stress test was a false positive, it is hard to believe him, after reading the report myself. The report states.."The study demonstrates a large fixed abnormalityu to the inferoseptal wall of the left ventricle with impaired contractility. This finding is suggestive of an infarct or an area of tight stenosis." Who am I to believe?... What the cardiologist says or what the nuclear stress test report states. I don't understand why the cardiologist thinks the stress test is a false positive.
Has anyone else had these issues?
Microvascular disease could be a cause, even in light of a normal angiogram. The CCF doc is right -- the only way to confirm the diagnosis is through a highly specialized cath. (Try a Google search on "Womens Ischemia Syndrome Evaluation" study or the NHLB's WISE study on women with chest pain and normal angiograms).
I'm taking an ACE-inhibitor and Inspra, two heart medications which have markedly reduced my symptoms from "endothelial dysfunction" or constriction and stenosis of the arterioles, the small vessels.
Keep exercising. Walk, stretch. Give-up rowing if it hurts too much. Build stamina. Rest when you feel the discomfort. Eat right -- this is a big part of remaining symptom-free. I eat lots of whole grains. I also enjoy food and red wine, in other words, everything in moderation.
An antidepressant may help, too. Think of it this way. You have chronic pain and loss of stamina. An antidepressant will help you cope.
There's no cure to date for microvascular disease. The meds help with the symptoms, that's it. There's no cure for atherosclerosis -- CAD -- either. Cardiovascular disease is dynamic. Stents seem and by-pass seem like a cure, but many people in this forum will tell you about multiple therapeutic caths.
Bottomline, Angie, be assertive in your care and keep looking for an internist or cardiologist who takes your symptoms seriously. You may have to do some homework. It's not an easy quest. Don't lose heart. You know your body. Even the best doctors in the most respected institutions make mistakes in diagnosis. Medicine's an art as well as a science.
Hope this helps some.
C