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Neurology (Expert Forum)
Chest pain
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Chest pain
by Heather2001, Jun 10, 2001 12:00AM
Hello.
In december 2000 I went to the ER with severe pains in my chest and back. After having an EKG, chest X-Ray and blood work (all which was normal) I was diagnosed with viral pericarditis and was sent home with instrctions to take a recommended dosage of advil. While the advil releaved some of the pain, by the end of January I returned to the ER. At this time another chest X-Ray and EKG was done (both which were normal). The docter listened for the pericarditis but didn't hear it. Assuming that it had not complelty cleared up I was put on Toridol for 5 days. An appointment was lined up for me to see an Internal MEdicine Specialist for the next week. Upon visiting with him anotehr EKG was done, along with blood work, chest x-ray and echocardiogram, all which turned upp normal. I was diagnosed with a heart murmur, but nothing to explain the pain I was having.
In MArch I went to my family doctor who diagnosed me with intercostal never inflammation. He diagnosed this simply by noting htat the pain I was feeling ran from my breast bone, around the left side of my body, to my back. I also felt pain under my left breast. I work at a supermaket which involves lifting bags of groceries mainly with my left side, which my doc explained may cause the pain. It is now June and I am still feeling pain in my chest, sometimes when I move the worng way, other times when I am lying still. Do you recomment returning to my doctor to order more tests, or does this sound like intercostal never pain to you? I should also note that I am an active 20 year old female that has no history of illness or alergies. I would just like your take on this situation. Thank you for your time.
In december 2000 I went to the ER with severe pains in my chest and back. After having an EKG, chest X-Ray and blood work (all which was normal) I was diagnosed with viral pericarditis and was sent home with instrctions to take a recommended dosage of advil. While the advil releaved some of the pain, by the end of January I returned to the ER. At this time another chest X-Ray and EKG was done (both which were normal). The docter listened for the pericarditis but didn't hear it. Assuming that it had not complelty cleared up I was put on Toridol for 5 days. An appointment was lined up for me to see an Internal MEdicine Specialist for the next week. Upon visiting with him anotehr EKG was done, along with blood work, chest x-ray and echocardiogram, all which turned upp normal. I was diagnosed with a heart murmur, but nothing to explain the pain I was having.
In MArch I went to my family doctor who diagnosed me with intercostal never inflammation. He diagnosed this simply by noting htat the pain I was feeling ran from my breast bone, around the left side of my body, to my back. I also felt pain under my left breast. I work at a supermaket which involves lifting bags of groceries mainly with my left side, which my doc explained may cause the pain. It is now June and I am still feeling pain in my chest, sometimes when I move the worng way, other times when I am lying still. Do you recomment returning to my doctor to order more tests, or does this sound like intercostal never pain to you? I should also note that I am an active 20 year old female that has no history of illness or alergies. I would just like your take on this situation. Thank you for your time.
Doctor's Answer
by CCF-Neuro-M.D.-RPS, Jun 10, 2001 12:00AM
Dear Heather:
Sorry that your having chest pain. It might be a better post to talk to the cardiology posting rather than neurology. Just based on your age, a heart attack is not the most likely diagnosis (I know you didn't ask, but it helps to know these things), unless there is a family history. Pericarditis is also rare in your age range and I would tend to doubt the diagnosis, but I wasn't in the ER so I can't tell you much. Costalchondritis, which is an inflammation in the joint between the sternum and rib is a much more likely diagnosis. This would be especially true if you could reproduce the pain with manipulation of the joint-such as turning, lifting, pushing on the spot etc. An anti-inflammatory medication such as Advil should help the situation. However, we do know that this condition can reoccur and whether this is happening to you is unknown. A pulled muscle in the same area can also produce what you describe. The same medication will help this also, but it will take much longer to recover and is more prone to reoccur with stress on the muscle. I can't tell you whether to return to your physician, but if it does get worse or there is no improvement, this might be prudent.
Sincerely,
CCF Neuro MD
Sorry that your having chest pain. It might be a better post to talk to the cardiology posting rather than neurology. Just based on your age, a heart attack is not the most likely diagnosis (I know you didn't ask, but it helps to know these things), unless there is a family history. Pericarditis is also rare in your age range and I would tend to doubt the diagnosis, but I wasn't in the ER so I can't tell you much. Costalchondritis, which is an inflammation in the joint between the sternum and rib is a much more likely diagnosis. This would be especially true if you could reproduce the pain with manipulation of the joint-such as turning, lifting, pushing on the spot etc. An anti-inflammatory medication such as Advil should help the situation. However, we do know that this condition can reoccur and whether this is happening to you is unknown. A pulled muscle in the same area can also produce what you describe. The same medication will help this also, but it will take much longer to recover and is more prone to reoccur with stress on the muscle. I can't tell you whether to return to your physician, but if it does get worse or there is no improvement, this might be prudent.
Sincerely,
CCF Neuro MD
I have costochondritis, it sounds like you do, too. Here is a forum where you can get some info on it if you'd like. http://groups.yahoo.com/group/costo I am still researching a bit about it because I am finding out it is recurring and often chronic. :o( I have stopped all that my rheum has recommended and felt relief, but still had inflammation and tenderness upon examination. I have had this for over a year now. I am scheduled to get steroid injections, but the advil does help with the pain as much as the prescriptions I have tried. I'd rather get nsaid injections and I am going to ask if that is possible. I hope you have a full recovery.
This, I hate to say is a common complaint in my office.Your type of job does preclude to this type of inflammation,which more than likely is caused by a misalighnment of the midback. It can be easily reduced by any competent chiropractor. Go see one soon and get back to enjoying your life free of tests and the rest of it!!
ChiroDoc
In regards to costochondritis, can this occur without tenderness? My chest isn't tender at all, which leads me to belive that I do'nt have costochondritis. When I don't feel the pain in my chest I have almost a "hollow" feeling in my chest. It's quite hard to describe actually.
My grandfather had a mild heart attack, but other than that there is no history of heart problems in my family that I know of.
The whole situation scares me, so much that I often avoid going out in fear that my chest will begin paining for no particular reason. Do you think I should request a referral to a chiroprator, or go back for another chest x-ray/exam?
You know what your MD can and will do. Asking for a refferal will lead you, I hate to say, nowhere. This is because MDs are generally undereducated about the workings of Chiropractic. Get a referral from a friend. You may be greatly suprised. The last thing. Your MD has already shown you that it's a costal nerve that's causing you the pain. It's just that they don't have the tools to fix it. It's as easy as that....
ChiroDoc
Echos are very sensitive. On my echo it showed mild mitral valve prolapse with mild regurgitation (leaking) and tricuspid (another valve) regurgitation. These aren't even a concern to the cardiologist because they are mild, but as I said the echo is so sensitive it picked it up. I have a family history of heart trouble, too. My mom died of congestive heart failure, her sister died in her 30's from heart probs, her bro. at 42 with a stroke, my sister at 39 had a mild heart attack. I have an arrhythmia, but I believe I can rest in the results of the echo. I think you can, too. Don't let