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Chest Pain after exertion
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Chest Pain after exertion

Hi,
I am a 42 y o male with no family or personal history of heart disease.

My problem is that I experience chest pain that is sometimes accompanied by belching after exercising. It started about 6 mos ago to varying degrees of discomfort. About 3 weeks ago, it was so uncomfortable that I went to the ER. I was given an ekg, and stress ultrasound (got my HR to 197bpm). Results came back negative. I didn't experience any pain during or even after the test. But since, the pain returns after I exercise. My doc reassures me that nothing is wrong with my heart but I am becoming obsessed because it really is bothersome. I have suffered from anxiety BUT my anxiety is usually because of the pain. When I am pain free-I am happy and carefree. Then I exercise and it all starts again.

Should I get further tests? Holter? Dye test?
9 Comments Post a Comment
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2116031_tn?1334575909
Don't mean to alarm you but I ignored my chest pain after exersion for a number of days last year. I thought I was in the best shape of my life at 52 and did not fit any of the usual risk profiles, but when I finally did get checked out at my local doctor it led to a ride in an ambulance followed by an angiogram followed by emergency triple bypass surgery. So any/all chest pain must be taken very seriously.
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976897_tn?1379171202
I sometimes wonder about the standard tests given to determine heart conditions. If they are so good, I wonder why so many people die of heart attack. Yes, not all people who die of heart attack have received tests, but I would like to really know the proportion that have.
Let's look at the echo stress test. What does it do. Basically they stress the heart with drugs to get it working hard and racing, then they look at the structure and motion of the heart walls. If a section of heart muscle is moving abnormally, then this is an indication of a problem. However, if heart muscle continues to move normally, is this a strong indicator that there is no ischemia? no of course not. Everyone seems to experience pain from the heart at different levels of disease formation. Some people die of heart attack and never felt any symptoms, believing they were very fit. Some people feel discomfort with blockages at 70%, some at 80 and above. Some feel discomfort with a 20% blockage but these are ignored. When a patient feels discomfort up to and including 70%, is it likely to affect wall motion of the heart? no. The real key is the pain, but this is ignored and the emphasis is the image on a machine. A EKG doesn't always show ischemia either. For over a year I was complaining of chest pains and tests kept revealing there was no heart issue. They kept blaming my Stomach, but couldn't come up with a diagnosis of that particular problem. After 18 months, I had my first heart attack. All I can do is give you my first set of symptoms for those 18 months, and see if you can relate to them. If you can, I would certainly demand they do an Angiogram to prove the point one way or another.
At first I experienced a strange throat sensation, like an annoying tightening. I was 46 years old, and had never experienced this before. Doctors kept telling me it was heartburn, like at 46 I didn't know what heartburn felt like. The throat discomfort was evident in cold air and during exertion. After a few months, chest pains would appear just after the throat discomfort kicked in. Standing still or sitting down would make the chest pains go away within about 20-40 seconds. If I carried on and ignored the pain, I would start to feel light headed and hear a rushing in my ears, then nausea would follow. I'd have no choice but to sit down then. STILL they insisted it was Stomach issues (go figure). Over the next few months, the pains increased, but thankfully they still went away at rest. 2 months before my heart attack I started to feel really bad chest pains after eating anything. I would sweat, vomit and go very dizzy. The pains would usually start about 5 mins after eating and last 15-20 mins. I was given an EKG and stress echo again, but nothing revealed itself. I was given yet more stomach pills. Too scared to eat, I went to my regular Doctor and complained because I was losing weight. He organised an appointment with  a gastroenterologist, to scope my digestive system. On arrival he asked me "do the pains start and stop or last a very long time", I replied "they come and go". He then asked "how long do they last", I replied "anywhere between 20-30 seconds if induced with exertion, and 15-20 mins after eating". Immediately he said "I'm not going to scope you, this is definitely a cardiac problem and I will get you an appointment to see a good cardiologist". Just two days before the appointment I collapsed in agony, and the pains were not induced by exertion or eating this time. My Wife called 999 because I was as white as a sheet. I was rushed into theatre and given an angiogram where they found a lot of blockages.
So far I've had 10 stents and a triple bypass. So if your pain is from exertion and goes away if you stand still or sit down within a minute or so, then I would seriously insist they do a more invasive test, such as an angiogram. If they find nothing, GREAT, but at least you know and will stay alive.
I would just like to emphasise how the weather really made a difference to my symptoms. During summer months, I could go several days with no symptoms. When Winter cold air returned, the symptoms would come back immediately. Rain made symptoms better (I have no idea why). So the environment has a huge impact on heart disease symptoms.
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1701959_tn?1399378594
You've had a heart work up though.....  including a stress test so your heart sounds healthy to me.  They would probably not run any other tests to be honest.  Did you also have an echo?
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Avatar_m_tn
Yes, they did a stress test with an echo and everything came back fine. They are blaming the chest pain on anxiety. I am just wondering if I should ask for an angiogram to be thorough. The cardiologist said that I would feel pain during exertion if there was an issue. I never do. I always feel the pain AFTER exertion. Sometimes 5 minutes, sometimes an hour.
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Avatar_m_tn
Thank you for sharing your story.

I cannot quite relate exactly. My pain usually starts after cessesion of exercise and tends to last a long time. If your gastroenterologist had asked me the same question, I would have said that they can last all day. The cardiologist I saw told me that I should not worry about pain after exercise, only pain during exercise, especially if it goes away right after stopping. My concern, of course, is still the chest pain.

I was just able to make another appt with a cardiologist and will insist on an angiogram just to be sure.
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976897_tn?1379171202
I doubt if your problem is due to blockages if the pain starts at the end of exercise and lasts a long time. This is not what you would expect from ischemic issues. When you had the stress echo, you would have had your heart worked hard by drugs, and you are laying still. You had no issues. Perhaps this is a muscular issue which can be painful, especially when inflamed.
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159619_tn?1318997813
You will have a very difficult time finding a cardiologist willing to do a cath after a normal nuclear stress tests and echo. This sounds more muscle or joint related to me.

If you have pain with exertion you should see a doctor ASAP.

Jon
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Avatar_m_tn
Thank you Jon. I'm just frustrated by the chest discomfort.
Greg
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Avatar_m_tn
Thank you Ed for the comment.
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