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Heart Disease (Expert Forum)
Continued Chest Pains
Answered by
Cleveland - OH
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Continued Chest Pains
by Toneman, Mar 26, 2006 12:00AM
I'm a 48 yr old male that started having mild chest pain 13 months ago and went through a complete cardiac workup with an echo, thallium stress and blood work all came back normal.
I went back to the family doctor who put me on a PPI for GERD that resolved most of my symptoms but the mild chest pain continued. I also had a recent ultra sound of my abdomen due to some elevated liver enzynmes found during my annual physical. Liver was fine but they found what they called a significant amount of sludge and gravel in my gallbladder.
I had my annual cardiac work up with my cardiologist last week and repeated the echo, thallium stress and bloodwork from last year, all of which came back normal agian yet the mild chest pains continue.
My cholesterol numbers are total 199 HDL 40 LDL 83 TRI's 380. My blood pressure is controlled at 115/60 and I have no family history of early onset CAD. I walk 2 miles a day at my target heart rate or even above without any problems or symptoms. I am 50 lbs over weight and have lost 30 lbs in the last 4 months. Also, I do not smoke.
I know the accuracy of a thallium stress test is 85% and my cardiologist does not want to do a cath based on my recent test results and the lack of any other symptoms. She feels the risk is greater than the likelyhood of finding anything significant.
Am I at a point that I should stop worrying about this being cardiac related and move on?
These pains are fairly mild and don't affect my daily life too much but are a constant worry and concern.
Any input would be greatly appreciated.
Jon
I went back to the family doctor who put me on a PPI for GERD that resolved most of my symptoms but the mild chest pain continued. I also had a recent ultra sound of my abdomen due to some elevated liver enzynmes found during my annual physical. Liver was fine but they found what they called a significant amount of sludge and gravel in my gallbladder.
I had my annual cardiac work up with my cardiologist last week and repeated the echo, thallium stress and bloodwork from last year, all of which came back normal agian yet the mild chest pains continue.
My cholesterol numbers are total 199 HDL 40 LDL 83 TRI's 380. My blood pressure is controlled at 115/60 and I have no family history of early onset CAD. I walk 2 miles a day at my target heart rate or even above without any problems or symptoms. I am 50 lbs over weight and have lost 30 lbs in the last 4 months. Also, I do not smoke.
I know the accuracy of a thallium stress test is 85% and my cardiologist does not want to do a cath based on my recent test results and the lack of any other symptoms. She feels the risk is greater than the likelyhood of finding anything significant.
Am I at a point that I should stop worrying about this being cardiac related and move on?
These pains are fairly mild and don't affect my daily life too much but are a constant worry and concern.
Any input would be greatly appreciated.
Jon
Doctor's Answer
by Cleveland Clinic, Mar 26, 2006 12:00AM
, Mar 26, 2006 12:00AM
Jon,
Thanks for the post.
Am I at a point that I should stop worrying about this being cardiac related and move on?
I wouldn not pursue too much more of a work up in someone with your demographic beyond what has already been performed. Im not sure what to tell you. If you continue to pursue the issue, someone will eventually cath you, but its probably not the right thing to do with your lack of risk factors, atypical symptoms, and completely negative noninvasive evaluation. Instead of asking me the above question, you need to ask it to yourself. If the answer is "no" then perhaps you need to figure out what is driving the excessive anxiety and stress.
Good luck
Thanks for the post.
Am I at a point that I should stop worrying about this being cardiac related and move on?
I wouldn not pursue too much more of a work up in someone with your demographic beyond what has already been performed. Im not sure what to tell you. If you continue to pursue the issue, someone will eventually cath you, but its probably not the right thing to do with your lack of risk factors, atypical symptoms, and completely negative noninvasive evaluation. Instead of asking me the above question, you need to ask it to yourself. If the answer is "no" then perhaps you need to figure out what is driving the excessive anxiety and stress.
Good luck
Went through the same as you. Thallium ECG stress in December- fine. etc..
Still having random chest pains, went for GI work-up. GI scope showed some reflux and erosion, but nothing major. Max doses of PPI's anyways.
Anxiety over all of this landed me on Xanax (low dose). In addition started on 2 bp meds, lipitor, nexium, zantac.
I honestly was feeling worse and worse the more meds loaded on.
Gall bladder pain for sure.
My GI then turned into a mess, and I had muscle cramping from lipitor (also some GI effects).
I've started to pull myself off the meds slowly. (other than lipitor which I was told to stop asap)
I'm SLOWLY starting to feel a bit better GI wise.
I guess I tell you all of this because I think I turned myself into my own visious cycle...
Chest pain- anxiety - GI got worked up - loaded up on meds for all - felt worse GI/ no change cardiac fears - more tests - no more answers - throw more GI Meds at it - gall bladder pain - more worries - more anxiety - more xanax etc....
So. I have a new approach. 6 months ago I felt pretty good other than some shooting pains and chest pain. No question I was under a LOT of stress at that time. GI was fine.
So, I'm pulling back on all meds. Lipitor is done (going to keep eating healthy, maybe try niacian in time). Tapering off of Xanax (I think even at a low dose daily for 3 months I got a slight physical addiction). Slowly pulling back on the PPI's (rebound effect was horrid after stoping 80mg nexium cold turkey). Went to 40, to 20 prilosec, and working just toward zantac.
Now, I still have a big fear about my heart and that is a big (most) of the anxiety now. I'm going to push for a 64 slice CT scan (3D). If they won't give me a referal, I'm going to a center in NYC that will do it for 1200 bucks.
I honestly believe if I get a all clear on my heart, and wean off these damn meds I'll feel better and better. Bottom line is last July I felt great.
Once I clean my system out of all the meds. I'm going to talk to my IM about a low dose of something for the BP and maybe try niacian, and go back to OTC stuff for heartburn. I'm convinced I hosed up my whole system.
Try not to fall into the trap I did.
Again, thanks!
Just try to move on and look for another cause of your chest pains like stress and anxiety.