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Gastroenterology (Expert Forum)
Seeking help/other ideas for cause of chest pain
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Seeking help/other ideas for cause of chest pain
by corn29@excite.com, May 04, 2005 12:00AM
Hello,
For over 1 1/2 years I've been experiencing chest pain. It is usually located behind my breast bone and towards my left side of my chest. It all started in Aug 2003 and since then I have been able to manage it a little better. Usually the pain is chest tightness sometimes with shortness of breath and dizziness.
There is no correlation when the pain comes or goes -- it is totally random. Night/day, well-rested/sleepy, hungry/well-fed, stressed/calm are not factors!
At first my family doc thought it might have been a reactive airway problem (I live at altitude, the area has been in a bad drought for 4-5 years now, and been in the general area of some pretty big forest fires - she stated a lot of non-traditional asthmatics have been suffering from similar problems recently). I had a VQ scan and 2 PFTs. I even have a flow meter at home. Nothing conclusive came from these tests.
So then the GERD approach was taken. Prescription Prilosec was given - had problems with a strong metallic taste in my mouth so switched to Nexium. Had an EGD done and 24 hour pH test done. Of course, during the 24 hr pH test, I didn't experience any chest tightness while the probe was in me. Again, nothing conclusive came from any of the above.
In Jan 2004, had a really bad episode. Went to emergency room, and the ER nurse gave me some nitro -- that made the pain go away -- and freaked everyone out that I had a heart condition. Discharged from hospital after 24 hours and referred to cardiologist. Since then, taken some kind of nuclear scan of my heart and 2 stress echo tests where I ran for 20+ minutes with a max heart rate of 180. Heart doc not impressed that the nitro helped me out in the hospital (explained how nitro works on all types of smooth muscle) and since told me he quits his practice if I have coronary heart disease.
In between all of the above, had a few chest x-rays and CT scans. Gall bladder checked w/ sound. Nothing seen in any of the pictures.
I'm 30 years old and otherwise fit. I've been caffeine free for 2 years (that was tough), I eat a low fat diet, and drink alcohol moderately. Which makes this all really frustrating as some of the docs I have seen have pretty much given up on me when tests come back negative. I assure you, I'm not making this up. The chest tightness/discomfort is very real and affecting the quality of my life.
Suggestions are greatly appreciated!
For over 1 1/2 years I've been experiencing chest pain. It is usually located behind my breast bone and towards my left side of my chest. It all started in Aug 2003 and since then I have been able to manage it a little better. Usually the pain is chest tightness sometimes with shortness of breath and dizziness.
There is no correlation when the pain comes or goes -- it is totally random. Night/day, well-rested/sleepy, hungry/well-fed, stressed/calm are not factors!
At first my family doc thought it might have been a reactive airway problem (I live at altitude, the area has been in a bad drought for 4-5 years now, and been in the general area of some pretty big forest fires - she stated a lot of non-traditional asthmatics have been suffering from similar problems recently). I had a VQ scan and 2 PFTs. I even have a flow meter at home. Nothing conclusive came from these tests.
So then the GERD approach was taken. Prescription Prilosec was given - had problems with a strong metallic taste in my mouth so switched to Nexium. Had an EGD done and 24 hour pH test done. Of course, during the 24 hr pH test, I didn't experience any chest tightness while the probe was in me. Again, nothing conclusive came from any of the above.
In Jan 2004, had a really bad episode. Went to emergency room, and the ER nurse gave me some nitro -- that made the pain go away -- and freaked everyone out that I had a heart condition. Discharged from hospital after 24 hours and referred to cardiologist. Since then, taken some kind of nuclear scan of my heart and 2 stress echo tests where I ran for 20+ minutes with a max heart rate of 180. Heart doc not impressed that the nitro helped me out in the hospital (explained how nitro works on all types of smooth muscle) and since told me he quits his practice if I have coronary heart disease.
In between all of the above, had a few chest x-rays and CT scans. Gall bladder checked w/ sound. Nothing seen in any of the pictures.
I'm 30 years old and otherwise fit. I've been caffeine free for 2 years (that was tough), I eat a low fat diet, and drink alcohol moderately. Which makes this all really frustrating as some of the docs I have seen have pretty much given up on me when tests come back negative. I assure you, I'm not making this up. The chest tightness/discomfort is very real and affecting the quality of my life.
Suggestions are greatly appreciated!
Doctor's Answer
by Kevin Pho, MD, May 05, 2005 12:00AM
, May 05, 2005 12:00AM
You have had a pretty comprehensive evaluation, looking a pulmonary causes (PE), GI causes (EGD and 24-hr pH study) can cardiac causes (stress tests and nuclear scans).
The good news is that many of the major causes of chest pain would have been ruled out with these tests. Of course, you are still having the symptoms.
You can consider further cardiac testing. One option would be variant angina - caused by vasospasm of the coronary vessels. This can be diagnosed in the cardiac catheterization lab, where provocation tests can be done (i.e. using ergonovine to see if vasospasm is present). Ergonovine can also be used during a stress echocardiogram.
This cause is a relatively uncommon condition - but certainly can be discussed with your cardiologist.
If every single test is negative, you can consider more psychogenic causes like anxiety. However, I would ensure there is no organic disease before attributing the cause to this.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The good news is that many of the major causes of chest pain would have been ruled out with these tests. Of course, you are still having the symptoms.
You can consider further cardiac testing. One option would be variant angina - caused by vasospasm of the coronary vessels. This can be diagnosed in the cardiac catheterization lab, where provocation tests can be done (i.e. using ergonovine to see if vasospasm is present). Ergonovine can also be used during a stress echocardiogram.
This cause is a relatively uncommon condition - but certainly can be discussed with your cardiologist.
If every single test is negative, you can consider more psychogenic causes like anxiety. However, I would ensure there is no organic disease before attributing the cause to this.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Member Comments (4)
by ozark, May 05, 2005 12:00AM
you could have esophageal spasms....they can mimic heart atteck and usually relieved by nitro....hope this helps
by willtme, May 12, 2005 12:00AM
Possibly costochondritis or a muscoskeletal problem associated with your sternum. This is especially likely if the pain can be pinpointed or if it moves around the sternum. It is less likely if it is diffuse chest pain.
by alpha417, May 29, 2005 12:00AM
I'm also experiencing those same symptoms. Constant chest discomfort; sometimes burning, sometimes a dull aggravation. had ekg, stress test, nuclear dye test, lungs were checked, chest x-rays, probe down my throat (some acid reflux was found) This problem started November 2004. Woke up one morning with what felt like presssure in my chest which lasted all day. After all the test, nothing was found, but symptoms are still present. Any suggestions?
by sera10, Jun 11, 2005 12:00AM
I had reflux & strange chest pain that came & went. When I had thea chest pain it would feel like I couldn't breathe. Had the same tests you had & all negative except for the reflux test with the wires to the stomach. After 2 years was finally dx'd with Celiac disease. Still have mainly atypical symptoms.
