Chest Pains

I am a 24 year old male non smoker, drink maybe 2-3 drinks a week. I have had asthma, and BP runs about 132/80 (when I use certain medications like ibuprofen BP goes upto about 145/90 for a couple of days). Pulse around 78. Healthy BMI. Albuterol only.
Anyway I was hoping you could answer 2 questions. About 2 months ago, I started having chest pains on the very left side of the chest. Anyway, a week later the pain moved more to the center of the chest, but still slightly to the left. On a scale of 1 to 10, the pain would be about 5 at its worst. The pain lasted anything from a couple of minutes to a couple of hours. Around this time, a couple of friends convinced me to go to the ER. At the ER they did an EKG, chest X-ray and blood test. All came back normal (I should add that while I was at the ER, and tests were being done, I had no symptoms at all). They said it was probably just muscularskeletal pains. Anyway, the pains continued for a couple of weeks, and I ignored them for the most part. Now 2 weeks ago, I started experiencing what may be described as palpitations, but somewhat more severe than what I've always thought palpitations were. They happened a couple of times a day, only for a second, but it felt like someone had punched me in the heart area, and I would have to sort of sit back and gasp mildly. Now, it the last few days, I've been feeling pain in my left shoulder and arm. Also, it sometimes feels like someone is pressing a finger about 4-5 inches above my wrist on the left hand, although symptom happens very rarely. And there is upper now upper back pain. Thats pretty much been all my symptoms. Should note that rarely do i experience pain in all the areas i have described at the same time, its usually one or the other. Absolutely no other symptoms- not worse breathing cold air, not worse during exercise. And I'm not an overly anxious or stressed out person either, so I doubt its a result of that. I know that heart disease is very rare at my age, but what steps do I take from here? Any more tests needed? And if it is merely muscular, I'd still like to be symptom free!
My other question was, for my asthma i am on albuterol only. In case of severe attacks I take 10 mg prednisone. Usually i only need to take this 1-3 times a year. I just use that single dose of oral prednisone, and dont taper it off, or dont even continue prednsone for a couple of days. Just one single dose 10 mg. Used the same treatment for the last 8-9 years (although I started with 5 mg doses first 5-6 years). I probably should be using an inhaled steroid, but i dont feel the need to do so. Dont use albuterol more than 2-3 times a week, and rarely is there any distrubance to sleep. Can exercise without distrubance. However when asthma attacks do happen 1-3 times a year they are fairly severe, and 10 mg pred works well. My question was, can this fairly low dose of pred, just 2-3 times a year, really have any harmful side effects? Sorry about the long post!

[Kevin Pho, MD]

To answer your questions:
1) Chest pain should certainly be evaluated for any heart etiologies - as you have done in the ER with an EKG and blood tests.  You may also want to consider some kind of stress test to evaluate for coronary artery disease (however, it would unlikely at your age) or an echocardiogram to evaluate the heart structure and heart valves.

2) Regarding the asthma, it is unlikely that prednisone 2-3 times per year would have significant side effects - this you may want to run by your doctor).  Most of the side effects of oral steroids happen after taking it daily for a prolonged period of time.  

That being said, an inhaled steroid is preferred because of the decreased blood absorption.  You may want to discuss this option with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
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