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Chest Pain
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Chest Pain

Hello.

In december 2000 I went to the ER with severe pain in my chest and back. After having an EKG, chest X-Ray and blood work (all which was normal) I was diagnosed with viral pericarditis and was sent home with instructions to take a recommended dosage of advil. While the advil releaved some of the pain, by the end of January I returned to the ER. At this time another chest X-Ray and EKG was done (both which were normal). The docter listened for the pericarditis but didn't hear it. Assuming that it had not complelty cleared up I was put on Toridol for 5 days. An appointment was lined up for me to see an Internal MEdicine Specialist for the next week. Upon visiting with him another EKG was done, along with blood work, chest x-ray and echocardiogram, all which turned up normal. I was diagnosed with a heart murmur, but nothing to explain the pain I was having. I have not heard from this doctor since.

In MArch I went to my family doctor who diagnosed me with intercostal never inflammation. He diagnosed this simply by noting that the pain I was feeling ran from my breast bone in the middle of my chest, around the left side of my body, to my back. I also felt pain under my left breast and in my left armpit. My chest was, and still isn't tender to the touch. I work at a supermaket which involves lifting bags of groceries and some heavy items which my doc explained may cause the pain. It is now June and I am still feeling pain in my chest, sometimes when I move the worng way, other times when I am lying still. Some times I am awaken at night by the sharp pain in the side of my chest. Other times when I don't have the pain I feel a sort of hollowness in my chest, which may simply be a feeling that occurs when the pain which i have become used to is not there. Do you recomment returning to my doctor to order more tests, or does this sound like intercostal never pain to you? HOw can you explain the hollow feeling? I should also note that I am an active 20 year old female that has no history of illness or alergies (allergies). My grandfather had a mild heart attack about 15 years ago, but he is fine now. My blood pressure has been normal when checked. I would just like your take on this situation. Thank you for your time.

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Avatar_n_tn
Dear Heather,

There are many causes of chest pain.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out the work-up can proceed at a more leisurely pace.

Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
17 Comments
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Avatar_n_tn
Hi ~

I, too, suffer from chest pain and occasional flutters and rapid beats.  This is the "first" time that I've ever seen anyone else note a "hollow" sensation in the center of their chest.  I describe one of my pains just like this.  I also can get "stabs" on the left side, a burning/heavy sensation in my left breast more toward the bottom as well as near my left arm pit.  I have also experienced chest tightness and heaviness in the center.  BUt, the "hollow" kinda constant aching feeling in the center of my chest can go on all day sometimes.  I was originally told I had MILD Mitral Valve Prolapse with trivial regurgitation (3 years ago).  Since then, I've seen two different cardiologists who both tell me, although I do have a trivial regurg with the mitral valve, I do NOT have prolapse.  I am convinced that all of my symptoms are related to my nervous system being wacked - ultra-sensitive.  This all came about for me three years ago when I became dehydrated due to a flu virus.  My life has been awful ever since.  I can't have any caffeine or sugar.  Caffeine sends me right into tachacardia and any sugar brings on a host of symptoms, like flutters, chest pain, tingling/numbness in left hand and foot, nausea, and sometimes clamminess.  It's all adrenaline related for me.  No one has been of ANY help.  The doctors say it may be anxiety related, but I totally disagree as I never had this before even during my most anxious of times, and, it simply isn't normal that I can't have even a cookie without all of these symptoms arising - so where exactly does the anxiety come into play when my symptoms relate to what I stick into my mouth rather than stressful moments?  ANY input would be so greatly appreciated.  Thank you.

Emerald.  (36 years old female/mother of two boys)
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Avatar_n_tn
Hi,

My symptoms are similar to yours all started a year ago when I got sick and got severly dehydrated also, I went to the ER because I thought I was having a heart attack or stroke and they could find nothing wrong but the dehydration, they gave me some IV's and I felt fine after. Now I still get the palps and chest pains and they make my body over react to them. They said it was anxiety related, I also cannot drink anything with Caffeine or eat much sugar or its starts the symptoms. I take an Ativan .5mg
under the tongue to relieve the symptoms when they occur. This is the only relief I have found.......
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Avatar_n_tn
I have had a pain that concerns me occur twice, and not sure if I should go to the DR, or wait and see if it happens again.  The second time was this afternoon on my way home from work and almost couldn't drive.  I get an excruciating pain on my left side below my arm pit, about 2 fingers below my breast.  The pain travels up my side, my shoulder, down my arm to my hand, I can move my arm, but can't use it.  I almost went straight to the hospital today, but decided to wait it out, the last one only lasted about 10-15 minutes, and so did this one.  It does,however leave a strange feeling in my chest and throat, kind of a quivery feeling.  I am trying to decide if I should call the Dr., I might look silly if he can't find anything because I will probably feel fine tomorrow, or wait and see if it occurs again.  Any thoughts?
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Avatar_n_tn
Screw feeling silly, what are doctors there for? Whens the last time you were in an ER, I bet 90% of the people in there if anybody is there at all, are there for minor aches and pains maybe a broken bone or in need of a few stitches. Doctors on vacation refer there patients to ER's for coverage while there gone if no doctor is available. SO don't think about being foolish or displacing someone who may be in dire need of care
most of the patients are there because there doctor couldn't fit them in....  or they have no regular doctor. When I went to the ER thinking I was having a heart attack, there were 4 or 5 people in there waiting to be seen, I went to the desk to sign in they asked me what was wrong I told them about my pain and weakness and they walked me right in....
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Avatar_n_tn
Greg ~

So what did the doctor diagose you as having, or rather, attribute your chest pain to?  Also, do you ever get symptoms when you become overly tired?  How long does your chest pain last and what types of chest pains do you experience?

Emerald ~
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Avatar_n_tn
Sorry about all your problems.  I have a lot of the same symptoms as you.  My doctor is now doing some tests to check out the adrenal system.  Should have all the results in another week to 10 days.  Will keep you posted on what comes up.
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Avatar_n_tn
Emerald,

2 doctors said the same thing because I didn't believe the first one I went to a second one, that I had Anxiety/Stress related Chest pains. When Im overly tired doesn't seem to make a difference, But I get them several times a week and there usually sharp and last up to 10-15 mins sometimes only a few seconds. They have woken me up from sleep before. I also get palps first and they seem to trigger the chest pains.. this has been going on for a year no ever since I got super dehydrated from eating or drinking something that made me very sick....thats what they diagnosed me with in the ER was Dehydration and then after I felt better with 2 IV's in me they asked if I was under alot of stress...etc My doctor did tons of blood tests and an EKG and couldn't find anything so they defaulted the symptoms to Stress induced Anxiety..
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Avatar_n_tn
I'm curious to see what they come up with re your adrenal glands.  I, too, went to see and endocrinologist who ordered two 24-hour collections to check my adrenal glands.  The results came back normal, but he said it sounds like I'm spurting out adrenaline throughout the day and am ultra-sensitive to it for some reason now.  Sometimes, when I'm real symptomatic, I also get these surges of adrenaline that run through my arms and chest. Just like when someone scares you when you're not expecting it - ya know that surge ya get that zaps through your body?  Then it seems to land it my heart where I get a flip-flop.  This can happen when I'm just sitting watching television.  So bizarrrrrr ~~~~  If you'd like you can e-mail me privately at ***@****.  I'm interested in knowing how your stuff started and what your specific symptoms are also.  Thanks.  Also, thanks to you Greg, for your reply!!!!
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Avatar_n_tn
Greg, thanks for acknowledging my posting.  I did call my Dr. office today, they were rather annoyed that I didn't go straight to the hospital.  They want me to come in next week, but in the interim if it should happen again I am to go straight to the ER.  With the HMO's and such, I never know what to do.  Good luck Emerald and Greg, perhaps I will have answers soon, or perhaps never get the pains again, that would be nice.
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Avatar_n_tn
Hollow feeling?  does that sound like "dematerializing" across the chest for a 1/2 minute or so ? sort of a weakness once in a while.If so, what I had was fixed by a chiropractor and involved c6.  The sharp pains  sound like the time i broke a rib.  It did not get better until I slept sitting up in a chair. Seemed like after that it knitted.
Healing tendons requires a lot of cooling down , no movement, ice, motrin and takes much longer than muscle ( 1 year for a bicepts tendon and I had to tie it to my waist and literally not let it raise up)
Now at 58 I am getting a rapid ( 88) pulse with irregular beating
it feels like a mild pounding.  EKG says extra PVCs  and when heart does not fill all the way it pounds, so they say.  Echogram says normal. Caffeine can bring it on.  Feels llike I took Metobolite356.  Green tea makes it worse   like ephedra
Toptol  takes it away.  Exercise takes it away.  I get it when I rest.  Wouldn't you think the experts would know what this is by now.  Taking Toprol is not an answer.  Curretnly I am eliminating vitamins and adding them back in to see how it effects it.  I thought Glutamine might have done this.. anybody out there found L Glutamine to cause this?

I am determined to unravel this mystery hopefully before it kills me in my sleep.  Appreciate any clues. ***@****
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Avatar_n_tn
I have been suffering with on and off chestpain for two years.  After many trips to the hospital and many doctors, it is now attributed to fibromalsia - there are days when it is absolutely unbearable.  Many times I feel very depressed because of my inability to function as a wife and mother.  This disease appears to only effect my chest, upper back and arms.  Ther is no cure and I have been perscribed medication but due to a GERD problem, it is often hard to take the medicine.  If anyone has any suggestion as to possible treatments I would sure like to hear.
     I have become a regular at the hospital ER because what if - just what if the one time I do not go, the chest pain turns out to really be my heart.
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Avatar_n_tn
I am a 21yr/f and have been in good health all my life. About a month ago I starting getting pain in my chest. One night I felt an aweful squeezing in my chest and I thought I was having a heart attack.  I went to the ER and they did an EKG and chest x-ray and it was normal. The doc said I might have pleurisy and sent me home.  I week later I was still having pain and a "hollow" like, pressure in my chest.  Sometimes the pain was very extreme. It feels like it starts in the center of my chest and runs diagonally up my left breast to my collar bone/shoulder. I have had pain down my left arm and hand and sometimes it goes into my back.  I went to a medcheck about a week later and that doc said what I described sounded like costrocondritis(inflamation (inflammation) of the tissue and lining around the heart and chest). He told me the pain could mimic cardiac pain. He put me on prednesone but I was allergic to it and stopped taking it. I went back to taking vioxx which I had been prescribed by the ER doc.  Two days ago I woke up and felt like my heart was racing. I took my pulse and it was at 120bpm.  I went to work, but my heart kept racing and I went to see the nurse there. She also said my heart rate was at 120bpm and that my pupils looked very dialated.  She recomended I go to the ER to be checked.  I did and they did an EKG, chest x-ray, and blood work(i think they called it a CBC). The doc said everything was normal. I am on several meds for various problems. I take oral contraceptives, claritin, levbid, vioxx, and I had just starting taking zoloft which I had discontinued that morning because I was breaking out in a rash.  The doc said it was probably the levbid causing the rapid heart beat and I alsi had a fever of about 100.  He also said it could be anxiety and stress and not to worry. He told me to discontinue the levbid and vioxx.  I asked him how long the rapid heart beat would last, because it was still up at about 115bpm when I left. He said it could be a week.  I am very concerned but I don't want to keep going back to the ER everytime I feel something because they have now twice told me it's not my heart.  I need a second opion I guess.  For the past 2 days my heart rate is at about 108-120bpm in the morning until about 2:00 in the afternoon.  It seems to go down to about 78-86bpm in the evening. When I wake up in the morning it is back up to approx 108-120bpm. I am currently taking my oral contraceptive and claratin everymorning.  I have taken tylenol on and off for headaches, approx 2 in a day.  I am wondering if it is just my nerves that is causing this, or maybe it was the medication (levbid) I was on.  I still have a pressure in my chest alot of times. Please let me know if I should be concerned about this and if I should take this more seriously than the docs have advised me to at this point. thanks
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Avatar_n_tn
Hallow Feeling????  That sums it up. Add some sharp chest pains every once in a while, the fear of moving because....this feels like the "big one". I take it as a warning, there may be nothing major wrong, the hollow feeling is a constant, like a perpetual warning. Eat well, take care of yourself, exercise, and if not for yourself, then for your kids, Quit Smoking! Preaches mom. But when you don't listen, much like myself, sooner or later your Body begins to preach. This is a warning, take heed, wake up or soon the Preacher will Preach.
                                      God Bless
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Avatar_n_tn
This is my first time to pull up this website because I have recently had some chest pains and am researching.  I am a 38 yr. old female, good health.  Have had chest pains for about three weeks that mainly are in my upper left chest area and sometimes run down my L arm and sometimes I have the heavy feeling and hard of breathing in my middle chest area.  EKG's were fine, so thought was costrocondritis and was put on vioxx.  Due to major family heart problems was given the two part stress test, which came back positive for inferior & anterior ischemia.  Went thru cardiac cath 5 days ago and Heart Dr. said no blocks and could not believe it was the same patient of the stress test report.  He put me on prilosec and I am still having some chest pains and trouble breathing sometimes.  Also, due to my cardiac cath. I have turned black and blue all around the procedure area and I am having trouble walking on my R leg.  So any suggestions on where to go from here?
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Avatar_n_tn
i am a 29 yr old female with 15 months of breathing problem. All started
with the feel of not getting enough air mainly at rest. I won't say
exercising at that time increase the breathlessness, but i do get
palpitations just come out of the blue. I have dyspnea daily (constantly
knowing myself of not able to get enough air in), occ tightness of chest and
stabbing pain on Right sided chest pain from scapular to front. I have RUQ
pain too (around and under costal carilage)
things continue with longer duration and intensity. my stomach get bloated
after a few months with an upper chest discomfort(under sternal notch), a
blockage/congested feeling which makes me cough, streaks of blood seen. This
discomfort is worse when i lie on my back or stretching upper body from side
to side eg driving or doing house job. My throat will get a feeling of the
dry, pressurised feeling just like you have run for a bus -- at rest.
As time goes by, my RUQ pain flares up frequently, it's sharp stabbing in
nature under my ribs like a knife cutting the edge of the ribs. my SOB
worsen with
continuous discomfort on upper chest. RUQ stabbing pain and back pain occurs
when breathe in. i am scared of breathing.  i always run a low grade fever
of
99.4F. One day i suddenly feel that I have bad SOB (heavy chest discomfort,
tightened upper chest, and palpitation) on walking up stairs. Now
progressing to normal walking and interferring with my housework. Taking in
deep breath is a torture because my upper chest is like a stiff board which
i have to put in extra effort to do inspiration and to fight against the
somekind of restriction. i have to deliberately lift up my upper chest and
throat muscle. i feel that my diaphragm when doing inspiration is not
expanding well and stretching the esophagus or structures around it. my
swallowing is not good either, when i swallow saliva or fluid, it seems to
hold up at the back of the throat, and the fluid is sort of fight its way
down the esophagus with air present, so that loud noise heard from the
substernum.
for the past couple of weeks my chest pain is worse. chest pain happen at
rest, happen when sleep (there's a night i cannot sleep at all  because of
the chest pain which last forever), happen when i walk happen when i
exercise for a few minutes.
i am scared that i am dying. i have seen many doctors. my ANA is positive
1:>320 homogenous pattern
2 esophageal manometry showed different result-- one said that i have
esophageal dysmotility (88% incoordination) one said that i have
hypersensitive esophagus.
2 echo showed different results too: one done in april 2001 show normal,
with false tendon in LV. no comment on pulmonary artery pressure, one done
in june 2001 show mild MR, TR. PASP~43mmHg normal LV systolic function
normal chamber sizes. my TRp is 33 and they add 10 (presume RA pressure to
33 making the PASP to 43). i know this is High. but how high? my doctor
didn't comment on this value at all. Note that I have pulmonary function
test a day earlier than the second echo, which i think i have inhaled some
nitric oxide in the PFT, could this affect the value in the echo the second
day? if so does it mean that my PASP will be even higher?
Can you relate my symptoms of one and a half year ago to the value of PASP?
Is my chest pain caused my ischaemia- complication of pulmonary
hypertension? causing ventricular dilatation and a incompetence tricuspid
valve? Am I getting heart failure and dying soon?
I have been suffering this for a long time, with numerous investigations
which i have lost count of.
I really hope that someone can give me some advise.
waiting list to do this test to see this doc is quite long. Do you think i
should go to get another echo?
I AM REALLY SCARED. SCARED TO DEATH.
God bless everyone.
-Zoe
***@****
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Avatar_n_tn
i am a 29 yr old female with 15 months of breathing problem. All started
with the feel of not getting enough air mainly at rest. I won't say
exercising at that time increase the breathlessness, but i do get
palpitations just come out of the blue. I have dyspnea daily (constantly
knowing myself of not able to get enough air in), occ tightness of chest and
stabbing pain on Right sided chest pain from scapular to front. I have RUQ
pain too (around and under costal carilage)
things continue with longer duration and intensity. my stomach get bloated
after a few months with an upper chest discomfort(under sternal notch), a
blockage/congested feeling which makes me cough, streaks of blood seen. This
discomfort is worse when i lie on my back or stretching upper body from side
to side eg driving or doing house job. My throat will get a feeling of the
dry, pressurised feeling just like you have run for a bus -- at rest.
As time goes by, my RUQ pain flares up frequently, it's sharp stabbing in
nature under my ribs like a knife cutting the edge of the ribs. my SOB
worsen with
continuous discomfort on upper chest. RUQ stabbing pain and back pain occurs
when breathe in. i am scared of breathing.  i always run a low grade fever
of
99.4F. One day i suddenly feel that I have bad SOB (heavy chest discomfort,
tightened upper chest, and palpitation) on walking up stairs. Now
progressing to normal walking and interferring with my housework. Taking in
deep breath is a torture because my upper chest is like a stiff board which
i have to put in extra effort to do inspiration and to fight against the
somekind of restriction. i have to deliberately lift up my upper chest and
throat muscle. i feel that my diaphragm when doing inspiration is not
expanding well and stretching the esophagus or structures around it. my
swallowing is not good either, when i swallow saliva or fluid, it seems to
hold up at the back of the throat, and the fluid is sort of fight its way
down the esophagus with air present, so that loud noise heard from the
substernum.
for the past couple of weeks my chest pain is worse. chest pain happen at
rest, happen when sleep (there's a night i cannot sleep at all  because of
the chest pain which last forever), happen when i walk happen when i
exercise for a few minutes.
i am scared that i am dying. i have seen many doctors. my ANA is positive
1:>320 homogenous pattern
2 esophageal manometry showed different result-- one said that i have
esophageal dysmotility (88% incoordination) one said that i have
hypersensitive esophagus.
2 echo showed different results too: one done in april 2001 show normal,
with false tendon in LV. no comment on pulmonary artery pressure, one done
in june 2001 show mild MR, TR. PASP~43mmHg normal LV systolic function
normal chamber sizes. my TRp is 33 and they add 10 (presume RA pressure to
33 making the PASP to 43). i know this is High. but how high? my doctor
didn't comment on this value at all. Note that I have pulmonary function
test a day earlier than the second echo, which i think i have inhaled some
nitric oxide in the PFT, could this affect the value in the echo the second
day? if so does it mean that my PASP will be even higher?
Can you relate my symptoms of one and a half year ago to the value of PASP?
Is my chest pain caused my ischaemia- complication of pulmonary
hypertension? causing ventricular dilatation and a incompetence tricuspid
valve? Am I getting heart failure and dying soon?
I have been suffering this for a long time, with numerous investigations
which i have lost count of.
I really hope that someone can give me some advise.
waiting list to do this test to see this doc is quite long. Do you think i
should go to get another echo?
I AM REALLY SCARED. SCARED TO DEATH.
God bless everyone.
-Zoe
***@****
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