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Family Medicine (Expert Forum)
non cardiac chest wall pain
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non cardiac chest wall pain
by pem0608, Jan 09, 2003 12:00AM
Thanks in advance for this service. I will provide as much information as possible, hopefully this will not be too long winded. I do not expect a diagnosis, but would appreciate any suggestions on how to proceed.
Around the end of October I began experiencing a strange sensation in my chest. This also coincided with my blood pressure which had been "high normal" moving into "low grade hypertension." I am male, 31, 5'10'', 231 lbs. I am now 218 due to diet. I did reduce my blood pressure some with diet, lifestyle changes, but I am now taking beta blockers and continuing to lose weight.
I will describe the pain shortly, but I wanted to let you know I did see a cardiologist. I had normal blood tests and EKG. I was scheduled for a stress test and echocardiogram. Stress test was fine. Echo was fine, only finding was mildly dilated left ventricle, which is essentially still within the high normal range, and also within possible margins of error. Cardiologist says everything OK, no need for follow up. I did not have any tests that actually look for blockages, but they seem satisfied that this is not necessary. I was not taking beta blockers prior to or during this evaluation.
I also have a diagnosed hiatal hernia with resulting GERD, which is mostly controlled with PPI's. (Protonix at this point, occasionally I have to switch to Nexium as I seem to build up a tolerance, I then switch back as needed.) My GERD symptoms have always been classic heartburn in my upper center chest, lower throat. During endoscopy, gastritis was also observed.
The pain in my chest is difficult to describe. I will try to be as clear as possible. The main sensation is a mild pressure, and somtimes a pulling sensation in my upper left chest, above my brest, below collar bone,and sometims left side above the ribs. It can also be in the crease of my arm, but not under the arm. Occasionally it may feel like it is in the shoulder, but not usually. It is always on the left side, never in the center, and it never crosses the center over to the right. It feels above the ribs, but if I was sure of that I would not be concerned. Often, a change in position will cause the symptoms to disappear. It is not brought on by exertion, but will sometimes occur when I stand up, and immediately subside when I sit down. Sometimes it develops into a more classic "ache" usually in my left side above the ribs and around the crease in my arm. I tend to believe this is muscle related, but I cannaot explain why it comes and goes, and has not subsided after 3 months. I can't say for sure if aspirin releives this sensation. I have tried some topical rubs, which don't seem to provide long term relief, they may help a little for a short time, same deal with hot showers.I am certainly not in terrible pain, but the location concerns me. I do not believe this is GERD related, other than I was in the habit of sleeping on my left side often due to reflux. I looking for ideas. Thanks.
Around the end of October I began experiencing a strange sensation in my chest. This also coincided with my blood pressure which had been "high normal" moving into "low grade hypertension." I am male, 31, 5'10'', 231 lbs. I am now 218 due to diet. I did reduce my blood pressure some with diet, lifestyle changes, but I am now taking beta blockers and continuing to lose weight.
I will describe the pain shortly, but I wanted to let you know I did see a cardiologist. I had normal blood tests and EKG. I was scheduled for a stress test and echocardiogram. Stress test was fine. Echo was fine, only finding was mildly dilated left ventricle, which is essentially still within the high normal range, and also within possible margins of error. Cardiologist says everything OK, no need for follow up. I did not have any tests that actually look for blockages, but they seem satisfied that this is not necessary. I was not taking beta blockers prior to or during this evaluation.
I also have a diagnosed hiatal hernia with resulting GERD, which is mostly controlled with PPI's. (Protonix at this point, occasionally I have to switch to Nexium as I seem to build up a tolerance, I then switch back as needed.) My GERD symptoms have always been classic heartburn in my upper center chest, lower throat. During endoscopy, gastritis was also observed.
The pain in my chest is difficult to describe. I will try to be as clear as possible. The main sensation is a mild pressure, and somtimes a pulling sensation in my upper left chest, above my brest, below collar bone,and sometims left side above the ribs. It can also be in the crease of my arm, but not under the arm. Occasionally it may feel like it is in the shoulder, but not usually. It is always on the left side, never in the center, and it never crosses the center over to the right. It feels above the ribs, but if I was sure of that I would not be concerned. Often, a change in position will cause the symptoms to disappear. It is not brought on by exertion, but will sometimes occur when I stand up, and immediately subside when I sit down. Sometimes it develops into a more classic "ache" usually in my left side above the ribs and around the crease in my arm. I tend to believe this is muscle related, but I cannaot explain why it comes and goes, and has not subsided after 3 months. I can't say for sure if aspirin releives this sensation. I have tried some topical rubs, which don't seem to provide long term relief, they may help a little for a short time, same deal with hot showers.I am certainly not in terrible pain, but the location concerns me. I do not believe this is GERD related, other than I was in the habit of sleeping on my left side often due to reflux. I looking for ideas. Thanks.
Doctor's Answer
by Forum-M.D.-DT, Jan 09, 2003 12:00AM
Thank you for visiting the Family Practice Forum.
It sounds like your cardiologist has done a very good job of evaluating your heart. You mention that you had "gastritis" on the endoscopy. Has the endoscopy been repeated to see if this has resolved with the use of PPIs? I really think, in my experience, that Nexium works better than Protonix for treatment of GERD and Gastritis.
Has there been an evaluation of the pancreas? Gallstones and/or alcohol consumption can cause pancreatic inflammation. This is another possible cause for your symptoms. Speaking of gallstones, has your doctor ordered an ultrasound of the gallbladder to see if there are gallstones present? Gallbladder pain can be an "intermittent" pain, as you have described.
In summary,
1. Consider a more consistent use of Nexium
2. Consider further evaluation of the pancreas (blood test)
3. Consider a gallbladder ultrasound to evaluate for possible gallstones.
It sounds like your cardiologist has done a very good job of evaluating your heart. You mention that you had "gastritis" on the endoscopy. Has the endoscopy been repeated to see if this has resolved with the use of PPIs? I really think, in my experience, that Nexium works better than Protonix for treatment of GERD and Gastritis.
Has there been an evaluation of the pancreas? Gallstones and/or alcohol consumption can cause pancreatic inflammation. This is another possible cause for your symptoms. Speaking of gallstones, has your doctor ordered an ultrasound of the gallbladder to see if there are gallstones present? Gallbladder pain can be an "intermittent" pain, as you have described.
In summary,
1. Consider a more consistent use of Nexium
2. Consider further evaluation of the pancreas (blood test)
3. Consider a gallbladder ultrasound to evaluate for possible gallstones.
Respectfully,
Patrick
It feels like I pulled a muscle or bruised the bone while wrestling for fun (which I did do by the way). It hurts to breathe, cough, sneeze, and seems as though it has subsided some. It also is sore to the touch.
Kepa
My name is jarid and i am 19 years old and weight of 215 lbs. i to have the same problem in my left chest wall. i was just in the hospitl today and they could not tell what the cause of the pain was. i described the pain to them and how it feels like i was having a heart attack and how the pain shoots down my arm and makes it week. i have tryed everything from going to doctors to medications. do you have any sugestions on how to fix the pain or ease the pain. if so please email me at ***@****. any help would would help me out a great deal. thanks