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Chest discomfort for sereral months

I am a 47 year old male who started having some minor chest discomfort about 11 months ago. To be safe, I went to the ER and had it checked out. They told me after about an hour that it did not appear to be anything about my heart, but had me stay overnight to runs some tests. I had a complete cardiac work up including blood tests, xrays and a Thallium stress test, all of which came back normal.

I was released with instructions to follow up with my doctor. The symptoms came and went for about 9 months so I went back to the doctor and he did a couple of EKGs over i month that were normal and unchanged from my previous work ups. Two weeks ago he diagnosed me with GERD and put me on a PPI (Aciphex) which has cleared up most of the problems with the exception of some lingering mild chest discomfort. I also followed up with my cardiologist last week and she reviewed my EKG and the information from my doctor and said it was not likely related to my heart as well.

My question is, how can I tell if I am having cardiac chest pains as opposed to GERD related sypmtoms? I don't want to run to the ER everytime I experience a little pain but I can't seem to stop worrying about it. Would it be normal for chest pain from the heart to go on this long?

About me, total colesterol is 199, HDL 46, LDL 88 & TRI's 280. Blood pressure is controlled and stable at 115-55. There is no history of early onset heart disease in my family as well. I do not smoke and are approx 60 ounds overweight but have recently lost 20 pounds with diet and exercise (no symptoms during exercise).

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Avatar universal
A related discussion, chest pain after stent was started.
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A related discussion, Mild Intermittent Chest Discomfort at Rest was started.
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i`ve been having chest pain for a few months mainly when im resting,i`m only 31 but it is so worrying as i have been getting a stabing pain in my left calf as well had a ecg and was told it was normal ,told before at the doctors that it is costoitris if i spelled it right, that is inflation of the cartlige in the ribs, but when i go to bed i can`t sleep as i worry if i`m going to die of an heart attack
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Avatar universal
As many have said, This is my first time to write a comment.

I have had chest discomfort (pressure, tightening across my chest with some sharp pain) for at least a month.  I have had a stress test with nuclear medicine pictures and Tues. 8/29 had a heart catherization.  The stress test was positive---showed inadequate blood flow to the heart.  Thus, the catherization.  The catherization showed a "good heart, with clear arteries."

I am still having the same chest discomfort.  It is steadier-more constant.  My breathing is difficult if I lay on my left side.

I have no idea where my GP or my cardiologist will go from here.  I was discharged from the hospital with no instructions except to follow up with each doctor in 2 to 4 weeks.

With a positive stress test, showing inadequate blood flow to my heart, is it possible the heart catherization missed something?  Show I ask the doctors to look closer?  If so, how do they look closer?  It seems a heart catherization is the end of determing any cardiac problems.  

If anyone has a similar problem, I would love to know how you are proceeding.

Thanks for any advice.
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Avatar universal
I am really glad to be able to listen to others who are experiencing problems related to mine, because it seems like no one has been listening around me. Everyone tells me it's anxiety, or stress, or depression, and I am so sick of it.

First of all, I am only eighteen years old, which is why It doesnt make sense to me why I am suffering and going through this at such a young age.

Last December, I got brochitis, and during that time I had episodes at night where I felt as if it was hard to breathe and there was pressure on my chest. I had seen a naturopath, and he was giving me things for another problem, as I did not tell him about this because it soon went away so I figured it was nothing. Over the next few months, I had a VERY stressful year at school, my last year of highschool. I experienced this episode where there was dull pain my chest a couple of times, so I got an ultrasound of my heart done at the hospital. It showed that I had mitral valve prolapse, though you could not hear it when listening to my heart through a stethescope. My other doctors and my naturopath did not believe that I actually had it. I did not know what to think.

I rarely felt this pain, and I was healthy for the next few months, right up until beginning of June, during my exam time. I did not feel stressed at this time, I felt surprisingly calm, except when I was writing one of my exams. I got a flu virus duing this time, where my whole body became weak and my arms and legs were sore and sensitive to touch. I had a cough, and runny nose, and all that stuff, soar throat as well. I had experienced no chest tightness or anything, until one nap I had, I woke up with it. I ignored it, thinking it was my lungs, and that it was part of the virus. After this virus went away, I had the cough for awhile, but that soon went away too, and I was left with tonsil pain, in which my naturopath actually fixed, with a remedy that was given to people who felt sad and depressed. After I finished taking that for a couple of weeks, I became very sad, and started crying for no reason. I couldn't understand what brought this on.

When I had my boyfriend to talk to about this, I got better, and I slowly started to go back to my normal self. This is vvery confusing im sure, but I do not want to leave anything out. Suddenly I started to feel headaches, nausea, fatigue, and my sleeping patterns started to screw up. I would wake up at least ten times in the night, so my eyes became very purple underneath. My throat has been soar for the last few weeks, but that is not what Im worried about. One night I started to get the feeling as if i could not breathe again. It slowly got worse everyday, turning into the absolute worst feeling I had ever felt. I would have moments during the day where the center of my chest tightened up completely and felt very weird and ..at times very painful, but mostly just an uncomfortable feeing. I pretty much couldnt do anything...this pain stopped me from having a normal summer, which has affected my attitude as well, as I am constantly worrying now. I know that that is the worst thing to do, worry, but I cant help it. Doctors wont look into my heart because they say im young. I went to see a naturopath who is into eastern medicine, he was recommended to me by a friend.

Now when I went to see him, it was very strange. He looked into my eyes, and checked my pulse, and was able to tell me that I had mitral valve prolapse and polycystic ovarian syndrome, and he had never met me before. He was also able to look at my mother and tell her that she had a thyroid problem, which she already knows about. It was the strangest and creepiest thing. He told me that the pain I was having in the chest, was angina pain. He said that my arteries were starting to get a hard layer on them, and it was difficult for hte blood to flow  through, and that that was what was causing the pain and difficulty with breathing. I told this to my other naturopath, and he said that it was muscle spasms, while the doctors said it was a virus in the chest.

I went to a respiratory specialist, and they had done a holter monitor test, which I have not got results back. Unfortunately, the eastern medicine doctor, gave me heartdrops, that were meant for heart problems, and my problem was slowly getting better everyday. I have become a hyprochondriac because of all this, and I know that is contributing to this and making it worse, but I cant help but worry.

Im scared of dying young, and I feel so scared and alone ebcause nobody believes me. Everone says its stress. But Im the only one feeling this pain, and I know it cant be just stress. The chest problems have goten better and I started to get so happy, and then today, they came back out of nowhere. It was a little different this time though. I got sharp shooting pains on the left side, for about ten seconds and then it went away. Soon after I felt pain sort of shooting up into my throat. This happened twice today, and the rest of the time I noticed irrgular heartbeats and palpitationos and what not, which I had been feeling a week ago with the pain before. I am so worried, what do I do? Could it be a heart problem? Im 18, Im underweight, I eat healthy, like REALLY healthy its not even funny, its rediculous, and I exercise. I also have no history of heart problems in the family, AT ALL. Please give your opinions.
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Avatar universal
I was 41 (Nov 2004) when all my problems started.  Woke up with severe chest pain and back pain.  Called 911, and was taken to the ER and admitted. Ran numerous blood work, EKG, stress test and others.  Everything was normal.  Was given nitro when admitted and wore nitro patches during  my stay there.  Released that afternoon.  Returned next day with same pain, but with the oncall PCP.  Repeat EKG, normal.  No meds for pain.  Repeat blood work, possible Hepatitis. Repeat blood work in a couple of days, no sign of hepatitis.   Called my PCP next day and  was referred to a gastro specialist.  Performed many tests.  Barium Burger Swallow, knocked me out to check out my esophagus, and inserted tube in nose and wore for 24 hours.  Diagnosed with GERD and esophageal spasm.  Treated with Nexium?  (One of the purple pills.) 2 tabs daily.  Couldn't afford and didn't want to take the rest of my life.  Elected to have the "Nissen Fundlipation surgery" for GERD(Feb 2005).  Developed 3 hernias.  Bad decision to have the surgery!!!!  Pain continued!  Surgeon did Upper GI and CAT scan.  Nissen still intact!!  No gallbladder or pancreas problems. Went back to Gastro specialist, where he performed more tests.  Still says that it might be the esophageal spasm.  My PCP gave me a prescription for Norvasc, but Gastro doctor didn't seem to  care to much for that form of treatment.  But yet, didn't give me anything for the pain.  Was told to come back when I'm actually having the pain, to better diagnose symtoms. That was in Oct of 2005, well Feb 28, had the severe pain again, unable to talk to doctor, and unable to get into office untill next afternoon.  Ended up back at the ER.  Heart fine!  Gave me valium.  Didn't really help.  March 16th, 12:30AM, it started again.  Aroung 4:30AM faded a little, and at 7:00AM, it flared up again.  For some reason, the doctor doesn' want to treat the problem.  I have an appointment, late tomorrow afternoon with PA.  If no luck, have 2nd. opinion set up for April 7th.  This excruciating pain lasts for several hours.  If anyone has any suggetions, I would greatly appreciate hearing from you. Thanks!
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Avatar universal
If you work at a major medcial center or hospital go talk with a cardiologist and requests you have some tests done, even agree to pay out of pocket if insurance is an issue. Also working in the medical field you have easy access to health professional who can help ease your mind and talk to you about your medical condition.

Although I am not a doctor the fact that Nitro helped your pain may indicate a problem with your coronary or carotid arteries. But at your age this would be rare. You may also want to look into vascualr spasms, where the vessels go into spasms and close up for no known reason.

Just be aware that a whole battery of tests. EKG, Stress test, ECHO/Stress ECHO/ Angiogram, etc. will run you a couple thousand dollars or more. But I do know there is no price you can put on your health or to put yourself at ease.
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Avatar universal
I am new to this site and was releaved to find out that I am not the only one having these problems,but also concerned that I am not the only one having these symptoms and issues.
Alittle over a year ago I was driving home from work when while pumping gas in my car I started to feel this pinch in the middle of my chest,followed by pain in my shoulder blade on the left side, numbness and pain in my arm to my fingers and severe acute onset of heartburn in my lower abdomen. I thought holy Sh_t this hurts and continued what I was doing in hopes that it was just anxiety. However this continued for the next 15 minutes and although I felt dizzy and like I wanted to faint I somehow made it home. I could not get into my house fast enough and rip off anything constricting which was only my bra and my turtleneck under my scrubs but the pain was not relieved and I was sure that something serious was wrong. I decided to call 911 dispatch and talk to them,And of course they sent an ambulance to my house. It took oxygen and nitro to relieve the pain along with aspirin and nitro two more times before arriving at the hospital. I stayed the night in the hospital and they did all the tests but nothing showed up so they sent me home the next afternoon. I have been admitted one more time since then for the same thing and always say that it has to be heart burn,Gerd or of course the famous anxiety and stress. Well,since then I have had at least 6 different episodes during the night where I wake up in the middle of the night in a cold sweat with shortness of breath and severe pain in the left side of my neck and dizziness with pressure on my whole chest and my head, my hands turn purple with discoloration and my eyes dialate. I have to take aspirin before this will relieve itself and blood pressure pills,which I am taking three times a day for migraines as well. My concern is that I have a blocked arter on my left side, this is something that you just know about yourself and I am scared to death because although
I work in the medical field myself I feel like my doctors do not take it seriously.
Iam only going to be 32 in june so they always say I am too young but the truth is,today no age is too young for a heart attack. I know I am at risk because my aunt on my moms side had three anurisms and a stroke and my mom was recently diagnosed with conjestive heart failure so it runs in the family.
I am just trying to get input as to whether any of you have done something magic to force your doctor to do an angiogram or am I just doomed to deal with this?
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Avatar universal
Christine,
Let me know what answers you get.  Your symptoms sound most similar to mine.  Last April I began having slight chest discomfort, with slight arm pain and a little back pain between my left scapula and spine.  I am a 27 yr old male with a very healthy history.  Once this began I stopped working out.  Since then my symptoms have gotten worse and include left calf tightness, left shoulder tightness, etc...  Additionally, every now and then, such as today, I get real tired and pale (skin around my eyes get real dark) and people ask, "are you under the weather?"...  if they only knew...  so, i started going to a chiropracter who thinks i tweaked something a while ago and that combined with working at the computer has screwed my thoracic muscles, which in turn affected everything else....  of course, i don't know how that explains how sometimes I have shortness of breath while just talking to someone or how i get real tired....  hmm...  anyway, I had a full cardiac workup (ekg, ultrasound, stress test) and everything came back fine...  I guess I'm not completely ruling out cardiac related because of what everyone else has said, but i  don't know what to make of it....

-dave
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Avatar universal
I have had chest pressure for the last 2 weeks, 27 year old female. Have had a EKG and x-rays. They said I pulled a muscle in my upper chest, but it doesn't hurt just tightness. They say I am healthy but I am scared. Any suggestions???
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Avatar universal
Hi, this is all new to me!!  I have been having chest discomfort for 3 weeks now with lightheadedness and sweating.  No fever. Went to the dentist last week and when the epinephrine hit my heart I started saying my Act of Contrition. Never had it hit me like that.  I am very restless at night, don't sleep well.  No nausea (so far). I don't feel like I have a virus. I am on 3 BP meds as it seems to be creaping up on me.  I am an avid Juice Plus taker and my BP went down after starting on it 3 years ago. I have been very healthy except for a brown recluse spider bite (actually 2) last year. Pretty rough!!  Went to the doctor last week after the dentist visit. EKG was normal. Heart enzymes were off but I can't find where to check normals to see how much they were off. I am scheduled for a dobutamine stress echo next Wednesday. They aren't going to do a regular stress test as I hurt my back last fall and they don't want to stress it too much.  Can anyone tell me where to look for the blood test results so I can see what is happening.
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Avatar universal
try taking Xanax for a few days (0.5mg once or twice a day), if the pain goes away than it is anxiety

same with GERD pills, if it goes away after one week of those, then it's GERD

what could happen (like in my case) is that even with those the pain doesn't go away, but even so it might not be cardiac related

however, in my case also it lasts for hours at least, in most of the cases that means it is not cardiac (if it lasts for hours/days/weeks and nothing really bad happens)
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Avatar universal
Hiya!


All the symptoms christinee described are exactly the same as mine! I have so much pain around my chest area all day and night, sometimes a burning sensation under my breast and under my rib other times a. ache in my upper chest, under arm and down my arm.

I have had this problems for 5 months now and been to the Docs at least once a week but they wont test me for anything,  I have neen told my problem is anxiety and stress and i have nothing to worry about

Because im only 22 they dont think its serious.  This has effected my life, im so scared and cant find an escape from the pain, im now so depressed and scared about whats wrong with me and its horrible becuase nobody cares.

I wish i could get all them tests done at least for my peace of mind, but i know every negative test ( well i hope they are) will make me want another.


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Avatar universal
Larry, the chest pain you said you had before the surgery was lasting for hours or only 15-30 min. or less ? mild or severe ? exactly in the middle of the chest or sometimes also over the heart on the left ? did you do an echo also in dec. 2005 or only EKG ?

Martha, I've been having pain and pinches in my arms and legs from my spine (too much sedendarism in front of the computer) for few years now (and I'm 28), only recently some mild chest pain but long lasting (hours, 1/2 day) almost every day. When you say you think you get chest pain from the nerves/spine, the pain is also mild or more severe ? short or long lasting ? any shortness of breath ? still having leg/arm pain while having chest pain at the same time ? you did any tests to conclude it's the spine or you just think it is ?

thank you both and take care
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Avatar universal
In re: of your esophagus spasms - I would describe mine as feeling you swallowed a bowling ball.  It comes in a "wave" and as it will start to pain it will radiate under your chin.  The pain is excruciating.  It took 30 years before it was diagnosed for me, so I had tried many, many different ways to get relief.  Pain pills did not help, but I found that 1/2 tablet of 0.5 mg of Xanax will help - just enough to relax the tightness and tone down the pain.  This also helps me with PVC - to lessen the severity.  Hope this helps.
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Avatar universal
hi christinee,

ihad similar symtpoms and i went to ER and they said everyhting is fine , BP very normal, healthy weight and no history of Heart disease in the family. I am just 28 F. I am looking at lyme now a days. May be you want to consider... I get muscle aches/ burning sense in the arms and legs and tight spinal cord and which is making my chest tight and painful.

If I move sometimes I can feel it soemtimes don't. I am taking it easy and checking with GP every other 2 weeks just to be calm...


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Avatar universal
Sorry to comment here but I'm desperate!  Please feel free to comment on my situation.

I am a 31 year old female, non smoker with no family history of heart disease.  I am in good health, not overweight and have not had any major surgeries.  I am also not on any medications.

I have had reoccurring chest pains just to the left of the centre of my chest.  The pain comes and goes with no known reason.  I usually notice the pain after a big meal or when I'm resting in the evening.  This pain has been reoccurring for about 8 months or more.

The pain feels very deep and I cannot feel it when I press my chest.  The pain is like a dull throbbing.  It may last for 30 seconds or a few minutes.  I also occasionally feel pain under my arm or at the bottom of my left rib.  Sometimes my throat feels tight when the pain occurs and sometimes I feel numbness in my arm.  I don't notice any pattern to it and don't necessarily notice it while I'm exerting energy.  I do sometimes notice it when I'm walking or if I move a certain way.  If I try to repeat the way I move, I cannot make the pain come again.  I also noticed the pain today when I was walking outside and breathing in cold air.

My family GP did an ECG and I'm assuming it was normal because I never heard back from her.  She felt the pain was muscular because I could localize the pain as it wasn't spread all across my chest.

I did go to the ER about 3 months ago because I was very worried about the pain and getting anxiety from it.  I had a couple more ECGs, blood tests, Xray and was told everything was normal.

I still worry about this pain because I feel it's getting worse.  I now feel a dull ache in-between my shoulder blades, stiff shoulder, sore left calf, sore left hip joint and sore left arm.  My arm muscles do feel sore and when I press on them I do feel muscle pain.

I went to my Chiropractor and she did a thermal scan which scanned my nerves and joints.  She says that the pain is most likely muscle but if it makes me feel better I should check with my GP again.

I've been reading up on angina and read that some form of angina only occurs with rest.  I am not sure if my symptoms are similar to this.  I know that I am young and that this is probaby not a factor however I am still very anxious about this.

I am wondering where I should go from here- I'd like to see my GP and order some tests.  I am wondering what tests to order i.e.. stress test and heart monitor?  And will I be able to get good peace of mind if the results come back normal.  I am not confident with just an ECG test.

I am also wondering how this could be muscular pain?  The pain is very deep, right near my heart and doesn't seem to come and go with stretching, lifting etc.

Can heart pain result in muscle pain of these other areas? Or is the fact that my arm muscle, calf and shoulder sore a good sign that the chest pain is muscular too?

This pain occurs almost nightly now and I'm just concerned that if it's heart related then it's getting worse.  Lately, I've been feeling that my heart beat sometimes beats fast.  I am hoping that this is just stress or anxiety and that once I get checked out I'll be proven wrong.

I should also mention that I am a Stay at Home Mom who looks after a 24lb toddler.  If it is muscle pain I'm assuming it's from lifting him.  However, I am right handed and the pain is only ever on my left side.  My Chiroparactor also feels that my posture at the computer could be aggrivating this.  I am trying to avoid sitting at the computer to see if it gets better.

Thank You for your time,
Christine
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Avatar universal
Hi everyone. Glad I found this place. I'm 34 yrs old. Since last Thursday I've been experiencing wierd sensations in my chest, kind of under my left rib cage. It kind of moves around to my stomach. It might go to my upper left breast near my shoulder. I know my chest muscle is strained from alot of pushups. Even my left bicep is strained from the way I lean on my couch sometimes. I kind of feel tired and groggy. I guess this is worrying me. I'm trying to put all the symptoms I can remember. I might feel a quick sharp pain in my stomach that migh even go to the middle of my chest. And if I let out gas(either way) It'll feel better a little. Feeling is wierd, almost as if its my lungs tired. I'm hoping this is a passing, some kind of virus. Worst part is I've had great insurance coverage for the last 10 years never needed it, until I got laid off last August. Found a contract job in October with isurance way too high, that I passed. I recently picked up some Child Health plus for my kid, he always gets colds. So now I dont have isurance, and bamm. Do things happen as a coincidence or what. So before I stop this post. I'll tell you what I feel before I go to bed. My whole chest feels kinda of sore and the main discomfort is in my upper abdomin right under my center rib cage. I mean it kind of feels like those stomach viruses but more spreadout without the puking and stuff. Sorry if I was too graphic and thanks for reading. Hope someone out there can give me some feedback.
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Avatar universal
Too many push-ups, not likely cardiac.  Cardiac pain is transient, unless you are having a heart attack, and not in the ribs. Heart is right behind the sternum.

I just had a triple CABG (Cardiac bypass grafts) Jan 13, 2006.  I was in very good shape, with no negatives except a wife with a penchant to argue, a teenage daughter, and genetically, heart attack due in my 50's. I'm 53.  Non-smoker, non-drinker, athletic, 6'0", 160 lbs, sufficient cardio exercise, good diet. Cholesterol in 160's, good ratios.

My main symptoms were labored breathing I had not had before under light exercise, with a little chest pain.  Twice diagnosed as minor mitral valve problem, 1 year ago and 3 years ago. Stress tests were negative.

Then end of December 2005, frequent chest pain getting longer and longer with cold sweats. Daytime, nighttime, walking uphill. Walking in the mountains.  EKGs showed a healthy heart, enzyme tests said no heart attack had occurred.  We finally insisted on an angiogram.  Result ? The two primary coronary arteries 99% blocked (stenting not possible), third blocked 80% in multiple locations.  They did my CABG the following morning.  I had a last angina attack at 9:00 PM the night before the surgery. Again EKG was negative.

Without the angiogram, I'm either 6 feet under, or having a late CABG after a major heart attack. So I was lucky.  This hospital said they have complications from angiograms in less than .1% of cases, and follow up with CABG or open heart surgery on about 25%, doing about 1400 angiograms a year.  So they seem to be negative 75% of the time, in terms of needing immediate surgery.

Pay attention to being out of breath when you should not be.  But severe chest pain (not muscular, in a pec, bicep or other muscle), along with that is that sign that is closest to saying its either a heart attack, or a near miss.
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63984 tn?1385437939
I've missed the symptoms twice.  The first time I ignored chest pain I had a heart attack at age 59, 6'3", 240 pounds, smoked pimp sticks, an overweight, overworked man with Diabetes.  I retired and dedicated myself to get into shape, and I did; lost 35 pounds, quit smoking, joined a gym, did weights every other day, aerobic exercises including swimming laps the other days, I'm much stronger and healthier than five years ago.  However, last spring I developed Asthma, and had the discomfort of feeling a tightness in the chest.  With Asthma medications the tightness stopped, until two months ago, when I felt chest tightness again.  I did the inhalation meds as I assumed I had asthma. It didn't really help, but I didn't go to the doctor.  It was my heart, I had another heart attack, more stents... I suggest those of us with symptoms and/or a hincky heart to assume nothing, get things checked.
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Avatar universal
Hi,

Thanks for asking this question because it's been a concern of mine lately. I've had a mechanical aortic valve for seven years and recently experienced my first bouts of chest discomfort. I also can't figure out whether it's GERD or a cardiac problem.  

Everything seems to be fine. I just had a lipid panel done and there's nothing abnormal. Last time I saw the doc he said my heart sounded good and that the mechanical valve is ticking away loudly. BP is great and all meds are in range.  

Yet over the past month I've experienced several episodes of fullness/tightness in the chest. Also a few sharp pains, some of which seemed to radiate into my upper back on the left side. I've never noticed that any of this happens right after I eat.  

I hate to go to the doctor only to find it's indigestion. I also wonder if it couldn't be muscular or maybe related to the sinus/allergy trouble I have.  

And yeah, I'm female, so I guess that makes it tougher.

Any ideas or comments?  Thanks.

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Avatar universal
Thanks for your quick reply, this is a great help. My pains do typically begin within an hour of eating and since I started with Aciphex they are not as severe and do not stay as constant as before, just sort of comes and goes for a few moments at a time before going away all together in an hour or so. I am told it takes s few weeks to get the esophagus healed from the reflux which will most likely take care of the pain all together. Also, my pain is never accompanied by shortness of breath or the other symptoms you mentioned.

Again, thanks for your input!

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Avatar universal
I'm right there with you.

Only made 1 ER trip, but I'm only 34 years old.

But, similar scores on Cholestorol, I eat pretty healthy and exercise.  I'm about 20 lbs overweight.  My BP runs a bit high.

Thalium test was clear.  I understand why they don't cath me, and it's not like I'm begging for a cath.  I just want to know what is wrong, and why it can so similarly feel like a heart attack, or warning signs.  I get chest pain and tightness, shooting pains in both arms, and in my jaw all the time.

It's frustrating.
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Avatar universal
Hi - you are not alone with intermittent chest pain.  I too have gone to ER on several occasions only to be told it is not cardiac related but I always wonder if I will know when and if it is.  I am 54 and as I get older, can't but wonder if i will delay getting help when I really need to because of all the previous episodes.  I am looking forward to this answer.
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