Severe Chest Pain Sternum area...only at rest

[ycool44]

My wife has had severe chest pain around the sternum that last for about 30 minutes to an hour in duration. This has been going on off and on for about five years and the pain only occurs when at rest usually in the middle of the night. We're back to square one after having negative results of a heart catherization yesterday. She has had seven episodes in the last three months. She had polio as a child in the 50's and has many post polio symptoms that few doctors know anything about.She does have a hiatial hernia and GERD and a very acidic stomach for which she takes Prevacid twice a day. She's had heart stress tests, MRI's, gall bladder cat scans, echo cardiograms, liver biospy and scans,ultrasounds, extensive blood work ups, heart catherization, and many endoscopys. With thought she may have variant angina since the pain was in the center of her chest and only occurs when shes at rest, usually in bed with her wedge pillow . Her heart is very good with only 5% blockage. She was given Isordil and had a bad reaction that brought her blood pressure to low .Our family doctor and the emergency room doctor are thinking a gastroenterlogy problem again and think her pain is burning in the chest area. My wife gets heart burn very rarely and knows this isn't heartburn pain. We are wondering about other tests to determine if it's some type of esophageal spasms causing such severe pain. We live close to the Cleveland Clinic and are considering and desering a second gastroenterologist opinion. The pain is so severe and frustrating for a spouse to be of help. Thanks so much . I hope I supplied enough information. Basically all the heart related testing is negative and theire leaning in the gastro area.

[Kevin Pho, MD]

With a negative heart catheterization, a cardiac cause of the chest pain would be very unlikely.  There has been a pretty thorough evaluation already with the tests you have mentioned.

To further evaluation for a GI cause, you can consider a 24-hr pH study conclusively looking for GERD, as well as esophageal motility studies.  

Another consideration would be a gastric emptying scan looking for gastroparesis.  

If these tests are negative, then it would be unlikely that a GI cause is present - given your other negative tests.  

These options can be discussed with your personal physician.

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

[LvdByGod!]

I HAD SUCH BAD BURNING PAIN IN MY ESOPHAGEAL AREA (UP AND DOWN THE CENTER OF MY CHEST)... THAT IT WAS SO BAD THAT I DIDN'T KNOW WHAT TO DO...IT FELT LIKE I NEEDED HOSPITALIZATION...IT DIDN'T FEEL AT ALL LIKE THE HEART BURN I WAS ACCUSTOMED TO...MAKE A LONG STORY SHORT...IT WAS HEARTBURN SO SEVERE THAT I NEEDED PREVACID AND NOW I TAKE ONE NIGHTLY FOR 5 YEARS NOW AND IT HAS NEVER HAPPENED AGAIN...IT WAS A COMPLETELY DIFFERENT FEELING THAN THE "NORMAL HEARTBURN FEELING"...

I'M NOT SAYING THIS IS YOUR PROBLEM BUT I THOUGHT I SHOULD LET YOU KNOW WHAT HAPPENED TO ME JUST IN CASE IT COULD BE...

PREVACID SEEMS PRETTY HARMLESS TO ME ((NO SIDE EFFECTS)), HAS YOUR DR RULED THIS OUT BY PUTTING YOU ON IT FOR A WHILE TO SEE IF IT HELPS???

I PRAY YOU FIND OUT SOON AND CAN ELIMINATE THE PAIN....SANDI

[LvdByGod!]

THAT IS YOUR WIFE...SORRY

[ycool44]

Yes she's on two Prevacid a day. We're thinking an esophageal spasm of some sort. We pray every day and Our Pastor prayed with us to give the doctors the ablity to find this problem. Thanks

[TJV]

  Your wife may want to try switching PPIS , another may work better (such as nexium) .  Or adding a zantac may help as well .

   The pain may very well  be acid caused. To determine if this is the case-- a Berstein Test ( acid perfusion test)  is useful to determine if acid is the cause of chest pain.  Or a  24 hour ph test  to see if acid reflux episodes correlate with chest pain.

The test for esophageal spasms is a manometry test ( motility test)  There are 2 kinds of esophageal spasms, diffuse and nutcracker esophagus .

  Diffuse -- They are difficult to treat and along with PPIS,  drugs like nitrates , calcium channel blockers,  tricyclic antidepressants etc, are used.     Botox is another option , and in extreme cases surgical myotomy .

  As for Nutcracker Esophagus -- In those with both GERD and nutcracker esophagus   GERD most often is the cause of symptoms , and not the motility disorder ,   as the clinical relevance of nutcracker esophagus is questionable.   And  may involve   a dysfunction of the visceral pain sensory mechanisms.   Anitidepressants could be useful  to numb pain sensations,

the same drugs as above are tried too, but are rarely useful.

   If the chest pain doesn't correlate with GERD -- and the manometry is negative, your wife could consult a physiatrist (rehabilitation specialist) for muscular causes such as chostochondritis...  Has she had an ultrasound and has the gallbladder been checked?  

  Stress is another possible cause, only when everything else is ruled out.  Good luck

[ycool44]

Thanks for all the comments thus far. She has had her gall bladder checked with ultra sound. She's had all of the basic tests that are possible. We'll be consulting with the doctor on some other  possible testing. Thanks so much again to you all.

[surgeon]

another test for gallbladder, when there aren't stones, is a HIDA scan. The nature of the pain and the occurance at night are certainly suggestive of gallbladder. The HIDA scan, while not 100% reliable, is a good indicator of non stone-related gallbladder disease.

[medical_questions]

You're praying to the same God that let this happen to your wonderful wife in the first place? Hmmmm, okay.

[ycool44]

We're now leaning towards esophageal spasms of some sort. Hope that further tests will finally resolve this health issue. I've done a lot of read on spasms and the testing although chest pain radiating to the jaw and back are the only symptoms. God Bless everyone for their support.

[ycool44]

Well it's now 4/17/05 and my wife has had two major chest pain occurances since her heart cath. She was put on 2.5 MG of Norvasc to control spasms if that's what's going on but to now avail.Sees the doctor this week to determine what our next steps may be. It's really hard seeing her go thru some much pain. Last nights episode lasted over three hours.

[LvdByGod!]

ok satan...go away...that was so mean!