What is causing chest tightening, breathing problems and chest pains

[Lindy55]

I had triple by-pass surgery back in February, 2008, and had another angiogram back on September 8, 2008, as I am having alot of chest tightening and breathing problems.  The chest tightening and breathing problems will get worse if I do activities and even with just no activity at all.  In the last few weeks, even just sitting or lying down in bed will bring on chest tightening and breathing problems.  I also have pain just below the rib cage on both sides of the ribs and I notice it is worse on the right side.  Just recently, I noticed if I bend down, I get a sharp pain on the right side below my rib cage.  I am really worried as the angiogram I had on Sept. 8/08, showed my heart was in good shape---no blockages and the by-passes are fine.  I also had other tests on the heart such as echo cardiogram, stress test, prefusion study, etc. and they all showed I was fine.  In 2006, I did have an angioplasty on my left groin area due to blockage but this was cleared up with angioplasty.  I have lost over 20 pounds in the last six months even though I am eating normally and even eating more than I used to.  Back in July, 2008, I started experiencing alot of dizziness and lightheadedness when walking so my doctor has arranged for me to see a ear, nose and throat specialist as he thinks I also have an inner ear problem or problem with my equilibrium.  Recently, an ultrasound on my thyroid showed there is a nodule there and my doctor has ordered further tests to see about this nodule and why I am losing weight for no reason.  Could a thyroid problem be causing the chest tightening and breathing problems and pain?  Since I have such a strong history of blockages and family history of heart disease and artery disease, could I possibly have a blockage in another organ in my body close to the chest or even in my chest.  What could be causing these symptoms?  Could cancer be a cause?

[Lindy55]

Thank you so much for replying to me.  I'm having further heart tests done this week, as well as, a total bone scan. As well, next week,  I will  be undergoing a complete pulmonary function test and an ambulatory oxygen assessment. Next month, I will be undergoing a pulmonary stress test.  I had a CT scan done from my neck to below my lungs which showed up nothing.   I am seeing a ENT the first few days in December(there is a shortage of these specialists here so cannot see him sooner and he will be taking care of the thyroid nodule, etc..  When you said that this might be pulmonary thromboembolism, if a portion of the lung does not get enough blood supply and dies and become non-functional, what tells you if the condition is getting worse ie.  I am having much more chest tightening now especially when I am at rest such as sitting down or lying in bed.  Should I be worried about this chest tightening being with me so much more.  Any small activity, even talking to fast or getting up to quick seems to bring on the chest tightening.  Previously, the only time I got the chest tigtening was if I walked to fast or did other activity for a longer period of time.  I will be having that heart test tomorrow morning ---believe they will be injecting me with something and then I will be doing a stress test and they will be taking pictures.  I will talk to them tomorrow of how these symptoms have gotten worse.  You are so kind to have let me know what could be causing this.  Thank you.

[Fernando Roque, MD]

Hi.  You have been extensively worked up for a possible cardiac cause of that chest tightening/ difficulty in breathing, but all the results turned out fine.  So I think your doctors should look into other possible causes of the symptoms you're experiencing.  First, have your doctors ruled out an underlying lung problem? This is one of the more plausible explanations for your symptoms.  A chest x-ray should be done, if it has not been done already.  You might also benefit from having lung function tests done.  You're right when you said that "a blockage in another organ in your body close to the chest or even in your chest" could be causing the problem.  Specifically, I'm referring to the possibility of pulmonary thromboembolism.  This is a condition where the blood vessels supplying a portion of the lungs get clogged by a clot coming from another blood vessel.  As a result, that protion of the lung which does not get enough blood supply dies and becomes non-functional.  Having previous blood vessel surgeries and angiograms might increase your risk of having this condition.

A thyroid problem (e.g. overproduction of thyroid hormones) can also lead to a similar set of symptoms.  Investigating this is also appropriate.  Finally, there is always a possibility of cancer as the underlying cause of all your symptoms.  However, I think a lung or thyroid condition should be ruled out first, since these are more common diseases.

[Lindy55]

Would you be so kind as to reply to my posting when you have the time.  I would sincerely appreciate it.  Thank you.