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Family Medicine (Expert Forum)
Don’t know where to turn :(
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Don’t know where to turn :(
by bod, Jun 07, 2002 12:00AM
I’m a 25 year old British male living in England, 5’ 9”, 207 pounds. Back in Jan, I made a conscious effort to get myself back into shape. I was nearly 238 pounds and although I’m still pretty fit (I play soccer twice a week), I decided it was time to get my weight down.
I was on the treadmill working quite hard when I suddenly got this very painful searing pain across my chest. I stopped immediately and the pain subdued and disappeared after about 30 seconds. It frightened me but I hit the showers and didn’t really think any more of it. Next evening at soccer practice I felt fine and played at my usual level. I woke at 7am with chest pains around my left rib area and my left arm was completely numb. This really freaked me and I thought maybe I could be having a heart attack so I drove to the hospital and they saw me straight away.
They did 2 ECGs which came back fine, 1 normal blood test and also an arterial blood test. The bloods came back fine apart from they found some increased enzymes in my blood. They did more tests and found out that they came from my liver. They told me my heart was fine but that I was overweight and could really do with getting my weight down. They said my liver problem was likely caused by alcohol but that it was nothing to worry about and that I could speak to my doctor about it.
I was still getting the pains some weeks later so I was referred to my private health (BUPA) for a full check up. My doctor there assessed me and indicated that he believed that there was no serious underlying medical disorder. He was certain that it had nothing to do with my heart. I still play soccer to quite a high standard so agreed with this. He believed that it could be Tietze Syndrome or costochondritis, which did sound feasible as I do get a few knocks and bruises playing soccer.
I went back on May 1st and again my ALT levels were the same. He described them as slightly abnormal at a level of 94. He said that he did not believe it was alcohol related. He said it was likely weight related and that I may have some fatty deposits in my liver which could cause the fluctuation in ALT levels. He examined me and said my liver wasn’t inflamed and he also sent me for an Ultrasound which came back fine.
I get a lot of wind. A lot of the chest pain I get seems to relieve when I burp a few times.
A few days after the Ultrasound I started getting pains on my right side, below my ribs, I get an uncomfortable pain for long periods at a time. Occasionally (once or twice a day) I get stabbing pains but only very briefly. Tonight I got a deep throbbing pain which was quite distressing behind my right breast but after a few big burps the pain seemed to subdue and now as I write this, there is no pain or discomfort at all.
The pains on my right worry me especially as I know my ALT levels are up. I don’t know what consequences there are of having slightly abnormal ALT levels. Doesn’t the Liver heal itself? This is beginning to effect my job :(
I was on the treadmill working quite hard when I suddenly got this very painful searing pain across my chest. I stopped immediately and the pain subdued and disappeared after about 30 seconds. It frightened me but I hit the showers and didn’t really think any more of it. Next evening at soccer practice I felt fine and played at my usual level. I woke at 7am with chest pains around my left rib area and my left arm was completely numb. This really freaked me and I thought maybe I could be having a heart attack so I drove to the hospital and they saw me straight away.
They did 2 ECGs which came back fine, 1 normal blood test and also an arterial blood test. The bloods came back fine apart from they found some increased enzymes in my blood. They did more tests and found out that they came from my liver. They told me my heart was fine but that I was overweight and could really do with getting my weight down. They said my liver problem was likely caused by alcohol but that it was nothing to worry about and that I could speak to my doctor about it.
I was still getting the pains some weeks later so I was referred to my private health (BUPA) for a full check up. My doctor there assessed me and indicated that he believed that there was no serious underlying medical disorder. He was certain that it had nothing to do with my heart. I still play soccer to quite a high standard so agreed with this. He believed that it could be Tietze Syndrome or costochondritis, which did sound feasible as I do get a few knocks and bruises playing soccer.
I went back on May 1st and again my ALT levels were the same. He described them as slightly abnormal at a level of 94. He said that he did not believe it was alcohol related. He said it was likely weight related and that I may have some fatty deposits in my liver which could cause the fluctuation in ALT levels. He examined me and said my liver wasn’t inflamed and he also sent me for an Ultrasound which came back fine.
I get a lot of wind. A lot of the chest pain I get seems to relieve when I burp a few times.
A few days after the Ultrasound I started getting pains on my right side, below my ribs, I get an uncomfortable pain for long periods at a time. Occasionally (once or twice a day) I get stabbing pains but only very briefly. Tonight I got a deep throbbing pain which was quite distressing behind my right breast but after a few big burps the pain seemed to subdue and now as I write this, there is no pain or discomfort at all.
The pains on my right worry me especially as I know my ALT levels are up. I don’t know what consequences there are of having slightly abnormal ALT levels. Doesn’t the Liver heal itself? This is beginning to effect my job :(
Doctor's Answer
by Forum-M.D.-DT, Jun 08, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
First I would like to summarize the symptoms and test results you described.
1. Searing Pain Across the chest
2. Left Rib pain and Left arm numbness
3. 2 NORMAL EKGs
4. Increased "enzymes" in the blood
5. Elevated ALT
6. Normal liver ultrasound
7. Symptoms improve with belching and excessive "wind"
In summary, based on what you are telling me, the most likely causes for your symptoms are Gastroesophageal Reflux Disease (GERD). The pain involved with this syndrom (syndrome) can indeed cause the symptoms you are describing. It is reassuring to know that you have had a NORMAL EKG, however, a treadmill stress test would be a better test to help "rule out" any underlying heart disorder. I would recommend you have this test done. Also, there are other possibilities for elevations in the ALT such as Hepatitis. If the doctor has not done a blood test to check for hepatitis, this would be the next test I would consider ordering. Based on what you are describing, I HIGHLY DOUBT you have any liver "damage". Certainly you should avoid alcohol as it can irritate the liver and can also worsen the symptoms of GERD.
The second dianosis which really seems to make sense here is that of "Chostochrondritis". This pain differs from true "cardiac" pain in that it can be reproduced based on palpation (pushing) on the area.
I would, therefore say:
1. GERD is a likely diagnosis
2. Chostochondritis is also a likely diagnosis
3. Have a "cardiac stress test" to help rule out any underlying cardiac problem
4. Have a blood test to check for Hepatitis
First I would like to summarize the symptoms and test results you described.
1. Searing Pain Across the chest
2. Left Rib pain and Left arm numbness
3. 2 NORMAL EKGs
4. Increased "enzymes" in the blood
5. Elevated ALT
6. Normal liver ultrasound
7. Symptoms improve with belching and excessive "wind"
In summary, based on what you are telling me, the most likely causes for your symptoms are Gastroesophageal Reflux Disease (GERD). The pain involved with this syndrom (syndrome) can indeed cause the symptoms you are describing. It is reassuring to know that you have had a NORMAL EKG, however, a treadmill stress test would be a better test to help "rule out" any underlying heart disorder. I would recommend you have this test done. Also, there are other possibilities for elevations in the ALT such as Hepatitis. If the doctor has not done a blood test to check for hepatitis, this would be the next test I would consider ordering. Based on what you are describing, I HIGHLY DOUBT you have any liver "damage". Certainly you should avoid alcohol as it can irritate the liver and can also worsen the symptoms of GERD.
The second dianosis which really seems to make sense here is that of "Chostochrondritis". This pain differs from true "cardiac" pain in that it can be reproduced based on palpation (pushing) on the area.
I would, therefore say:
1. GERD is a likely diagnosis
2. Chostochondritis is also a likely diagnosis
3. Have a "cardiac stress test" to help rule out any underlying cardiac problem
4. Have a blood test to check for Hepatitis
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I don't know if this information will help at all, but it sounds EXACTLY what happened to me.
I was working out and doing some curls and the chest pain hit me HARD, I lost my breath, pain down my arm etc.. Afterwards, I did the same thing with the doctors and they found nothing.
I ignored it, but I kept having numbness in my arm here and there, occassional chest pain with deep breaths and it seemed to be worse with body movement.
After upper body x-rays, treadmill tests and a 24hr 'recorder' test with my cardio and even an EBT test (full body scan)... nothing, not even a trace of calcium deposits in my blood stream. Valves are pumping right, cholesterol is fine, cardiogram looks good, etc..
Then, I was at my chiropractor (he checks my lower back pain) I explained my symptoms to him. He had me stand against the wall, he rubbed around my ribs in the back and said, "..looks like you have a few ribs out of place.." After 'popping' my ribs back, I felt GREAT! I can't believe this didn't show with all the other tests I did, but apparently, I popped a few ribs slightly out of place and THAT seemed to be the cause of my chest pains. Here it is 3 years later and I still have to visit my chiropractor every few weeks, if I go a month or two without seeing him (which I tend to do), I start getting those symptoms again.
I'm not saying you have the same problem, but here's something for you to explore as well. I still get my heart checked out annually and all is still good and I'm in good physical health.
Hope this info helps...
Dan B