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Unusual Chest Pain
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Unusual Chest Pain

I am a 37 year old man, 170, with no history of heart problems.  About 3 weeks ago, I began to feel uncomfortability and pain in my chest.  I had felt slight stabs and "pricks" of pain (or sensation) in my center-chest area, slightly to the left of my ribs, for a few days, but after having sex with my wife one night, I experienced sharp stabs of pain that seemed to pulse with my heart beat.  I didn't feel this during sex, but afterward when standing pright and still.  The pain was relieved when I sat down.  Over the next few days, almost every time that I stood up and stood still, the pain began, although less intenese--  a slight stab that seemed to pulse with my heart.  When I was standing and speaking, it was worse.  If I lay down or sat, it went away almost immediately.

I was very concerned about this, and had 2 EKGs and a stress EKG performed, as well as a few blood tests.  Everything came back fine.  I also began to notice that my body position played a key role in when I felt this pain.  When I swim and get my heart rate up in the pool, I feel fine.  As long as I am in the water, I'm ok; but as soon as I get out and am standing still, the symptoms began.  When I am working around the house, walking, or shoveling snow--moving or bent over--I feel fine.  If I stand straight up and still, it may begin again.  During the stress test, I was hunched over a bicycle.  Although my heart rate got up to 170, I felt fine, and felt fine afterward lying down as my heart rate fell.  But when I was dressing and standing more or less still, the pain returned.  I finally learned that the pain seems worse AFTER exercise (not during), but ONLY if I am standing still.  Walking and moving around, laying down, hunching over, or bending over and putting my hands on knees while standing will immediately relieve the pain. I can also stop or lessen it by breathing a certain way.  The pain is worse at the "bottom" of my exhale, when my lungs are empty. If I hold a full breath in, it is better.

A few times, I believe I have noticed an uncomfortability or "pressure" while or after eating, if I am sitting upright.  Usually, standing still for a long period, especially talking, will bring it on, and walking around lessens or eliminates it until I stop and stand still again.

In retrospect, I realize I have felt these symptoms lightly and occasionally over the past couple of years--  once when standing upright in a metro train for long periods.  

I have developed a tendency over the past three years to make myself throw up after a large meal so as to keep my weight down. I may do this 3-4 times per week.  I don't know if it could be related to this(I have immediately stopped this).  When eating a few times, I have felt a more indigestion-like feeling.  But usually, when standing, the pain is NOT like heartburn, but more like slight stabs or shooting. Is this angina, or chest wall pain,or something else? It is now subsiding, although I feel it some every day.
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With a negative stress-EKG, it is unlikely that the heart is the cause of your symptoms.  

As you can imagine, there are a variety of other causes for chest pain.  The two more common causes would be musculoskeletal causes or GI causes.  GI causes can include GERD, inflammation of the upper digestive tract, or an ulcer.  An upper GI series or upper endoscopy would be the more comprehensive tests to evaluate these disease.

As for musculoskeletal causes, costochondritis is the most common cause of chest pain.  Rib films and a chest X-ray can be considered to evaluate the bony structures.  You may want to discuss whether a course of anti-inflammatory medications or a referral to a physiatrist (rehabilitation physician) or physical therapy can be of benefit.  

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.

Thanks,
Kevin, M.D.
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