Re: chestpains

Posted By HFHSM.D.-rf on August 26, 1998 at 20:56:39:

In Reply to: chestpains posted by Lynn on August 25, 1998 at 10:13:03:






After 9 months of extreme pain from disc problems and nerve damage, I finally made it closer to having surgery to correct the problem.  I had a date set and went in to obtain my medical clearance but didn't pass.  I had been having chest pains for a couple of months so I was set up for an Adensoine test(since I couldn't walk the treadmill because of the back).  It came back normal.  So, I go in for surgery on the 2nd of July and make it all the way into the holding area and was still having chestpains so 10 minutes before going into the operating room, the anesthesiologist decided to call off the surgery.  I was put on a heart moniter and was seen by a Cardiologist and he ruled out anything with the heart so then I was seen by a Gastro., doctor. I had a colonoscopy and gastroscopy and a sonogram done.
The colonoscopy and gastroscopy both came back normal and the sonorgam indicated some pebble size gallstones. Once out of the hospital the Gastro doctor called and wanted to see me about the stones.  I went to his office and he explained about the stones and informed me that before taking out the gallbladder he wanted to do 2 additional tests to rule out Esophagueal Reflux Disease.
I did the PH1 and motility tests and they both came back normal.  Now in talking to the doctor he indicated there wasn't any point in taking out the gallbladder with the stones being so small.  He wasn't convinced that it would help.  
I still have the chestpains, which usually are in the middle of the breastbone and sometimes are very sharp but no shortness of breath.  Sometimes the pain will go down the left arm.  The left side is also the side I have my nerve damage on from the herniated disc.
My primary doctor wants to believe that is probably a muscoskeletal problem but did mention the word spastic colon, but didn't mention any more about it.
The Gastro doctor says he can't help me unless I want the gallbladder to come out. The Neurosurgeon is only taking care of my back and my primary doctor wants to believe that is is muscoskeletal.
I am confused....it's like playing, let's pass the buck.
Any suggestions???
Thanks.
Lynn



Dear Lynn,
I can not provide a definitive explanation for your pain but I can provide some information regarding gastrointestinal causes of chest pain.  In the lists of causes for chest pain, there are a number of gastrointestinal conditions.  Esophageal spasm can produce a sharp chest pain that can be virtually identical to the pain of a heart attack.  Esophageal reflux can also simulate cardiac pain.  Patients with cardiac pain will sometimes provide a history of angina ( pain with exertion) but often it is impossible to distinguish esophageal from cardiac causes of chest pain by history and physical examination.  Under these circumstances, it is best to treat the patient conservatively and to rule out cardiac disease.  If there is no evidence of heart damage, then esophageal studies (the two that you had) are done.  In your case, it appears that the esophagus is not the cause of your chest pain.  
Ulcers can also produce pain that simulates cardiac ischemia.  This possibility has also been excluded in your case.
Acute cholecystitis (inflammation of the gall bladder) can cause chest pain.  Your symptoms do not sound like cholecystitis, as you have described them.  I would be reluctatnt to recommend gall bladder removal for atypical pains.  Our forum is replete with letters from people with gall stones and atypical pains who underwent cholecystectomy.  In many cases, the pains persisted after the surgery.
Although Irritable bowel syndrome can cause chest pains, the usual presentation is abdominal pain associated with a problem in bowel pattern (constipation and/or diarrhea).
Has anyone considered the possibility that your chest pain is related to the disc problems and nerve damage, especially if your problem is with a cervical disc.  You may want to discuss this possibility with your surgeon.  Finally, if the pain is musculoskeletal, then you should have your back surgery.
This information is presented for educational purposes only.  always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: chest pain, esophageal spasm, esophageal reflux, ulcer. cholecystitis
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