Angina Symptoms?

[dplp]

I've had the following problems for 5 months now:

1.  Frequent Jaw, Arm, shoulder and chest pains. Primarily at rest or when I am stressed at work.

2.  Noticable PVC's - never had these before. Had a stress test with echo a month ago. Lasted 17 minutes Bruce protocol, some single foci pvc's, much worse at rest. Stress ended due to being tired.  HR 172.

3. PVC's continue to get worse.  1000-2000 daily. All single foci, sometimes they knock the wind out of me.

4. Yesterday under a VERY stressful situation at work I felt a tingling and pain throughout my entire neck into my cheeks.  Only lasted 10-15 seconds but it scared me, had PVC's pick up in intensity. This prompted my post.  

36 y/o male. High Cholesterol. I can go to Spin class at the gym and go 45 minutes without chest pain. I have tried Prilosec and Klonopin per my IM doc.  Neither helped at all so we quit. I do get some jaw and cheek pain at times when exercising, however it is in different locations and is not associated with any other chest pain. I get occasional chest pain when stressed at work, NEVER at exercise.

Questions.

1. Chance that Angina/CAD is presenting in me differently?  I get symptoms under mental stress or rest. I've read is can present differently in younger men and women.

2. If I just had PVC's or these pains I wouldn't be as concerned. But with the PVC's and the jaw/arm/chest aches and pains I'm concerned it is heart related. It's the COMBO along with yesterdays neck/jaw cheek pain under stress that has me worried.

3. Other tests you would order?

Thank You.

[Cleveland Clinic]

dplp,

Thanks for the post.

New onset anginal symptoms from obstructive CAD can present differently in any patient. However, anginal symptoms tend to progress over time, and in the setting of coronary obstruction are precipitated by activity or stress. In the setting where symptoms are atypical, exercise testing can help discern whether CAD is the cause of symptoms. In your case, a negative exercise test with your constellation of symptoms make it highly unlikely that your chest pain is from CAD. Beyond the diagnostic significance of stress testing, the amount of exercise performed in a stress test is also prognostic. If you went 17 minutes on a stress, that in itself is a good sign.  While its impossible to make full recommnedations for testing with the limited history, on the surface I probably would not pursue any other cardiovascular testing. With respect to your PVCs, a beta blocker trial might be helpful.

good luck

[Duchess47]

If you only get these pains with stress then It sounds totally stress related and not abnormality with heart.  I have a physical issue with my left shoulder, arm, neck area that gets considerably worse with stress.  Stress itself causes you to constrict and tighten up.  I use ativan when I feel stressed.  It relaxes your body and thus helps the pain.

[dplp]

Yeah,

That is what I was thinking, but it's strange that this could be going on for 5 months straight due to stress, that said if it was my heart it's strange that would go 5 months straight.

I had a grandfather die at a very young age due to heart disease, but he was a drinker and heavy smoker.  The rest of my family is healthy.

This is kind of a sense check for me as my wife and I are making some life decisions.  I also want to really start training hard for a Triathalon but don't want to take risks and right now I'm a bit scared of my heart.

[Rambus]

Wow 17 minutes on Bruce protocol? You must be supremely fit!

[peter piper]

I was just diagnosed with severe aortic insufficiency. I have been experiencing extreme fatigue to the point of soreness in my left arm - the blood pressure in that arm is also significantly lower than my right with a weak pulse. At night when I lay down, I have some cramping and pain - not seen during the day. My jaw gets so sore that I have to rest when I eat - even soft food. My neck gets very sore as well. I am not saying that the symptoms are directly related to my condition  - I have actually been wondering why I do NOT see them mentioned in any literature that I have read thus far.

I just wanted to let you know that a person with my diagnosis has had similar symptoms. Best of luck to you.

[dplp]

Thanks for the replys.

I was a bit off in my stress ECG, onlyh went 15 minutes, stopped at a grade of 18% and max mets of 17.5.

During the test my jaw pain went away and would come back.  Different locations though.

Had ZERO chest pain during the test, none.  

Strange thing is sometimes when I get the PVC's I will get some jaw or shoulder pain around the same time.  It's this combo weirding me out.

Went cycling today for 25 miles, HR was 80% or more for 1.5 hours.  Not a hint of chest pain, some jaw and shoulder pain though and a few PVC's.  PVC's are now back about 4 hours later a few singles, a couple bigeminey etc.  Jaw pain is moving around all night, right side, left side, cheeks, temples, shoulder. But it seems to move around.

I hope I'm just clenching my jaw and these are muscle spasms.

Seems to make senese that muscle spasms would go away during exercise as blood is flowing like mad and nothing is constricting until later?

Never "short of breath" during exercise (other than really hard efforts).

Very frustrating.

Don't want to be the statistic, but also understand without chest pain during execertion it would be very rare.

I get the PVC's and a lot of these pains when under stressful situations at work though.

Tried a beta blocker yesterday - that sucked.  Could NOT get my HR above 83% when exercising.

This sucks.

[dplp]

Got a copy of my report - stress echo

time - 15:30

Max Mets - 17.5, 18% grade, 5.0 mph

10% grade, HR 169 (92% of max)

BP - normal increases

I'm not a runner, and I'm 5'10, 215 lbs.  I do do some cardio, and I have a crazy exercise tolerance and handle pain well (though didn't get any chest pain).  I could stand to loose 20lbs of fat, but I've always been a good athelete. So, I get nervous that I can "trick" the test.

ST/HR slope was normal - no clue what this means.

VERY few PVC's during exercise, some noted during recovery.

NO ECG problems during test (s3? s4?) anyways, all were normal.

IF I could just get rid of even one either the PVC's, or the jaw/shoulder pain I would just move on.  

I'm worried the PVC's and other pains are my hearts way of saying... hey, something ain't right.

Sorry, I'm learning on the fly here.

[dplp]

oops

18% grade at 5mph, not 10%.

[dplp]

Al,

You said you had the jaw, arm, and other pains WITH angina.

Are you saying that you would have chest pain and other pains.

OR just the other pains.

I don't get chest pain.  But I get jaw, left arm, and other pains.  Both at rest or exercise.  Yesterday the left side of my face was tingling and sort of numb for a bit.  I was simply standing in line to get on an airplane. Went away with no ill affects.

Other strange thing.  When I wake up, my PVC's are very limited as are my jaw, shoulder, and face pains.  As the day goes on... they get worse.

[dplp]

I guess that is a bit reassuring.

I've subsequently now had a 64 slice CT scan of my heart.

They say everything looks great.  No calcium at all, and I'm assuming no soft plaque.

No chest pain, or if I get it it is at the nipple line or below, never that upper chest stuff.

I'm guessing I'm stressed out with some serious muscle tension issues.  I'll push one more time, but it's the jaw pain and pvc's and shoulder pain that flip me out.  That seems like stress is a likely cause.

Man, and I just took some time off work.  Wish that cleared it up.

[Duchess47]

FYI,  I have had pain in all of those same areas. Since it was at it's worst when exercising, lifting weights et.,  I was very concerned.  Pain in left side from neck down to hand and fingers.  Sometimes extrememly bad.  Well, I just want to let you know that it turns out that I have tendonitis aggravated by shoulder impingment syndrome.  In other words this pain is not cardiac but sure felt.  I have been suffereing with it for over a year and it just became so bad I went through a battery of testing. The MRI of the shoulder finally showed the problem.  So, not all pain is cardiac, maybe see an orthopedic doc. now that heart is o.k.