Re: Chest Pain

Posted By HFHSM.D.-rf on July 10, 1998 at 21:43:34:

In Reply to: Chest Pain posted by Steve Eddy on July 07, 1998 at 17:22:33:






My wife is 38 y/o and has been treated for several years for unexplained anginal like chest pain. Last fall she was admitted twice with unretractable pain that was only controlled with narcotics. All cardiac tests which have been repeated several
times have been normal. The only abnormal blood work has been a high sed rate. which was not repeatable.
Eventually a biliary scan was done with EF and the gall bladder was found to have a abnormally low EF. It was removed laprascopically.
This resulted in brief inprovement. On second hospital admission another scan was done and found sluggish flow in the bile duct.
Extensive upper GI workup has not resulted in any abnormal findings that would contribute to the pain.
We eventually went to the NIH to be seen for a Syndrome X cardiac work-up. These test revealed a structurally normal heart, so a cardiac source of the pain was ruled out.
The explanation at that time was abnormal pain perception in the brain. She was treated with Elavil and Beta-blockers. She has been doing well until recently
when she was admitted again for uncontrollable chest pain, this pain got 100% better after vomiting x3 with the las emesis being green bile looking substance.
Could this problem be an abnormality with the bile duct?
If so how do we convince the DR. to ppursue this angle further. We have become frustrated with this because
there is seemingly no source or answer to her pain.
__


Dear Steve Eddy,
I do not think that the pains result from a dysmotility of the bile duct but I wonder if dysmotility of the esophagus (esophageal spasm) or possibly the stomach (gastroparesis) could be the cause of the pains.  I lean towards an esophageal cause rather than stomach because of your description of the vomiting.  Patients with gastroparesis usually vomit food eaten more than 4 hours previously.
To investigate the problem I suggest that you request an esophageal motility study, possibly with a provocation test.  A dditionally, a gastric emptying test would complete this round of investigation.
HFHSM.D.-rf
*keywords: chest pain, esophageal spasm, gastroparesis
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