Angina Pain

[Ekidd]

My soon to be wife started experiencing severe back pain and underwent the stress test, thalium stress, and passed all test and was told it was not her heart. In December 2003 she was experiencing severe back pain and nausa she was takent to the ER the ER doctor was telling her is was not her heart up until the EKG should abnorminal. She then underwent an emergency  Cath in December 2003 followed up by a double bypass surgery in December 2003.     In May of 2004 started experiencing chest pain and underwent another cath in which a stent was inserted into one of the bypasses.  Again in September another sten was inserted with little relief of chest pain.  In March of 2005 she started experiencing more severe chest pain once again,  a cardio cath was done and it was determined that one of the bypasses that had been stented multiple times had closed off.  A redo was completed in April 2005. In June of 2005 another cath was completed to check the redo bypass and it was stated that the bypass site was bottle necked or narrowing.  Now January 2006 she is experiencing increased angina pain and the cardiologist is asking her to undergo the ECP.  Which is to start in 3 weeks.  Are there other options for a 42 year old female who live a semi healthly life style. Is there any type of treatment that can prevent this from re-occuring.
  

[CCF-M.D.-MJM]

Hi ekidd,

I am sorry to here about this problems.  The first thing to do is make sure that she has maximal medical therapy.  This should include statin, aspirin, blood pressure medications if her blood pressure has room like an ace inhibitor or beta blocker.  A good cardiologist should have already done all of this though -- it is pretty standard.  Hopefully tobacco is not an issue.

It is probably worth a second opinion at a tertiary care hospital to make sure everything is being done.

ECP has been shown to help reduce angina.

I hope this helps.  thanks for posting.

[NitroOnTap]

If the ECP shows promise of helping the Angina, I say go for it. I had a quad bypass in Sept 04. By Nov 04, it failed. The LIMA is still open and about 50% of one of the vein grafts is open. They tried to stent which failed. They will not redo the bypass due to the fact that my veins are too small and would fail in a short time.

So now I am on a Nitro Patch for 14 hours from evening to morning since I woke up avery hour with chest pain. The other 10 hours I use Nitro Tab when needed. I get chest pain with any exertion such as fixing dinner, taking a shower, etc. They will not let me work at all and put me on disability. I use about 100 doses of Nitro Tab and a patch 14 hours a day per month.

If there was any possibility that ECP could help me I would gladly do it rather than put up with the Angina pain. Just my 2 cents.

[Filip]

sorry to hear all this, I wish we all lived in a different era where all medical problems would be quickly solvable so that everyone could do what he wants w/o being bothered by these

anyway, all this angina pain you all have/had, is it always in the middle of the chest ? I'm taking out the jaw/shoulder/arm/neck/back pain, only the chest pain, is it always behind the breastbone or can it be over the heart itself ? before doing any surgery or taking any pills, the pain lasted more than 30-60 minutes sometimes or always less than that ? how often accompanied by shortness of breath ?

thank you and take care

[Ekidd]

This is in response to Filip,  yes the pain stays in the center of the chest. They will not do another surgery becasue the first two did not work.  THe pain last from 5 minutes to several hours.  However, there is not a change in teh EKG or enzymes when this occurs.

[Filip]

thanks for the answers

did she ever had shortness of breath w/o any pain ? or arm/shoulder pain w/o chest pain ?

a more general question, when you're having chest pain from angina, if you press onto the breatbone does the pain become stronger ?

[tickertock]

I am having a bad flare up of costochondritis right now, if I didn't know what it was and hadn't been diagnosed with it I would be at the ER right now. Pain that becomes worse when you press the breast bone or ribs is pain usually consistent with a muscloskeletal problem and rarely if ever of cardiac origin. It can be quite severe, it is always best to have this confirmed with your doctor to be on the safe side. Hope you feel better soon, I know how distressing and anxiety provoking a pain like this can be.

[Filip]

was it always in the middle of the chest behind the bone ?
any arm/shoulder pain ? what tests did you do to find out that it's that and not something cardiac ?

thank you

[tickertock]

It's mostly to the left of center, occasionally I get shoulder and arm pain as the inflammation tends to affect the nerves that travel to the shoulder and arm. I have a connective tissue disease that costochondritis is secondary to. I have had this pain for the last 12+ years, sometimes its everyday for weeks, other times it can give me a break up to months. Had just about every heart test besides a cardiac cath. Echo,exercise stress test, ECGs, holter, chest xrays, and blood tests.

[Filip]

never read about this, just to make sure what I'm wishing for, since you had it for 12+ years, doesn't sound like something very serious or is it ? what do you do to keep it under control (this or the tissue disease) ?

not sure if you still remember, did it start gradually 12 years ago or because of an accident ? is it mild/moderate pain or can it be worse ? goes away with painkillers ?

sorry for so many questions, I'm just anxious to rule out any cardiac causes

[tickertock]

No its not serious , but can be very severe and debilating occasionally, other times its just nagging enough to make you know its there. It just came out of blue  one day never had chest pain before then, but had other pains and symptoms associated with the CTD. I wasn't diagnosed with the CTD til 2001. I take an aspirin everyday to keep down inflammation, when its very severe I'll take a co-dyramol tablet, I never take painkillers unless I have to. Hope you get a definitive diagnosis soon, what I have might not apply to you at all. Maybe a visit with a good internist might help you get to the root of the problem. Good luck.

[Filip]

glad to hear it's not serious
I have a chest CT scan in 3 hours, wish for the best but still think of the worst :(

you had pains for so many years and only 5 years ago they found what's wrong ? how old are you now if you don't mind ?

[Filip]

btw, does it heart more when you make certain movements (arm, torso, neck) ?

[tickertock]

I am a 41 year old male, I am diagnosed as having ankylosing spondylitis(sometimes it can awhile to diagnose). Definitely turning or twisting the body , arms and neck can cause it to hurt more, certain positions can also ease the pain, this almost certainly rules out a cardiac cause.

[tickertock]

Best of luck with the scan, I would almost bet its nothing serious, keep us updated.

[Filip]

thank you, I will

btw, never did CT scan before, do I get to know the results on spot or do I have to wait for them to be sent to the doctor who ordered the scan ?

[tickertock]

To the best of my knowledge, the results will be sent to the doctor that ordered the scan and he will give you the results.Good luck.

[Filip]

got my CT scan results, the doctor had to run to an emergency exactly when I was suppose to have the appointment so all I got was a copy of the results w/o anything else ... I'll try to make another appointment ...

anyway, most of the notes are OK except :

"mildly increased soft tissue in the azygos region" and
"few small benign appearing central mediastinal lymph nodes"

nothing about the heart, lungs, ... I hope they looked fine since they are not mentioned

any ideeas ?

[tickertock]

Glad you got results back, I can't comment on the results as I am not a medical doctor but I would assume if it was anything to be worried about they have notified you accordingly, anytime the see word benign listed on report I would assume it's nothing to be worried about, double check with your doctor if no more than for a peace of mind. Take care.Hope you continue to feel better. As a side note as a sufferer of chronic chest pain for years it becomes a time when you come to terms that you have to move on and try to forget about it, after years of chest pains I have realised that if it was anything sinister it would have progressed and caused much greater distress and consequence. Do a google search and type in the words "benign chest wall pain" and see what results you get, you might find the reading there very interesting. Good luck.

[Filip]

thanks for your thoughts

your chest wall pain is close to the skin ? I mean, did you ever tried to use one of those anti-inflamatory gels over the skin and did it help ?

[tickertock]

I was prescribed Voltaren gel once for it but never used it, I am kind of sensitive to creams and rubs in general, I would say that my pain is close to skin, sometime when I have a bad flare up it even hurts for my shirt to touch or rub against the spot.

[Filip]

what kind of aspirin to you take ? 81mg, 325mg, something else ?
ever tried Voltaren pills ?

since I put a lot of weight in the last few years I also have been having back pain, usually low back pain, did an MRI, small issue between L5 and S1, 1-2 slightly rotated toracal vertebrae, when this chest pain started I initially thought of those as the cause, did not take any anti-inflamatory pills though, but whenever I have pain because of the spine (low or upper side) the first thing that hurts is around the spine itself, after few weeks of chest pain w/o any upper back pain I thought it's not the spine but maybe something more serious therefore went to cardio and did all these

what other symptoms did you have before the chest pain ? random pinches, tingles, aches ? cold sweats ? hot flashes ? with your diagnostic, the only anti-inflamatory you take regularly is only aspirin ?

[tickertock]

I take 325mg of aspirin daily only. I have tried voltaren and Naproxen but they tend not to agree with me and voltaren raises my blood pressure.

I have experienced all the symptoms you mentioned above. I think an anxiety attack from the initial twinge of pain can aggravate the cold sweats and hot flushed feeling, hell to live with to say the least but have to keep going.

[Filip]

do you exercise ? any kind of exercises you are not allowed to do ?

[tickertock]

I am not restricted to exercise, in fact exercise is essential/beneficial for my problem. I mainly stick to walking for about 45 minutes 4 to 5 times weekly, of course when I get a bad attack of costochondritis , I really have to rest and relax my muscles but that is usually only for a day or two then I start out with just a 15 to 20 min walk til I feel better, had a complete cardiovascular over many many years,all negative, heart essentially normal.

[Filip]

do you get shortness of breath or arrythmias ? because I can't correlate these with spine/bone related issues ...

I think I'll go to get a second opinion at a second cardiologist, it doesn't make sense to let's say go to the bathroom, contract all abdoment muscles for a few seconds only (to do ....) then suddenly feel sob, something stuck in your neck, ... which would last for hours sometimes

[tickertock]

Luckily I don't suffer from SOB, I use to have sinus tachycardia and PVCs. tachycardia well controlled with the beta blocker atenolol, PVCs are a rare occurence nowadays used to have them in 1000s daily for months at a time, this is longest break I had from them in about 14 years, I guess one day they'll return with vengence , can't say I'm looking forward to it , then again who knows they might never return with such frequency ,keeping my fingers crossed anyway.