Chest pain after exercise, not during

[Damsdams]

Hi,

In the last few months, I have suffered from moderate, localised chest pain after long exercise. The pain seems to be inside in the middle of the body, around 1 inch to the right of my left nipple. I also get shortness of breath at the same time.

I get these symptoms only if I run/exercise with a HR @ 165bps for 1 hour (my max HR being 197). The symptoms start approx 1 hour after the end of the exercise, and last for a few hours. A short exercise, even hard, will not trigger those pains (for example 10 minutes at 175bpm will not)

I've had a stress ECG on a treadmill. Apparently, above 160bpm, I have a marked latero ST depression. A stress eco shows nothing special. Blood test, eco and chest x-ray all normal. However, I am still concerned as none of the test, even the stress tests, have triggered the pain so that doctors may be missing the problem.

Do you think I should have other tests?
Have you ever heard of such symptons occuring after exercise and not during?

Thanks

Dams

[CCF-M.D.-MJM]

Hi Dams,

It sounds like you are pretty fit.  I have heard of pains similar to yours that start after exercise, but not usually several hours after exercise.  This is very unlikely to be ischemic or heart related chest pain.  That being said, my approach would depend on your age, cardiac risk factors (age, smoking, cholesterol, diabetes, high blood pressure, family history, obesity) as well has the history and physical exam.

If you are concerned you can always see a local specialist, but be careful, if you look hard enough it is not difficult to find someone that will be willing to do an angiogram.

I would order a high sensitivity CRP and cholesterol panel to help further risk stratify you.

I hope this helps and good luck.

[Damsdams]

just to had some details:
I am a 28 year old male, I run 3 times a week, non smoker, normal blod pressure during and after exercise

[arthur]

The chest pain you are describing sounds a lot like it could be coming from the muscles and tendons running over and between your rib cage (intracostal).  It could also be related to a "costochondritis" - like condition, ie, an inflammation of the cartilage within the ribs.  Like any inflammation, the condition can take some time to heal (weeks to months); some folks complain of it for years.  It's origin could have been an over exertion or a physical hit to the spot your are describing.

I am not an expert in these matters, however, as someone who plays soccer, I can state that this sort of injury can feel like it's cardio-related.  If you carefully examine the general region with your fingers you may find a small sore spot on the ribs (probably inconspicuous).  This spot could easily radiate pain across the chest after exercising simply because it was strained.

-Arthur

[Mantels]

I also run 20 something miles a week as well as lift and cycle (when dry enough). I have similar symptoms and tightness that happen after exercise also. The difference is that I had an MI and stents 15 months ago. Mine tends to be more to the right side. I am thinking that it has to do with a lack of activity and the muscle groups not being used. My question to you is did you lose or gain alot of weight recently?

If the shortness of breath happens during the run or if you suddenly find that you seem tired during your run but shouldn't be. Get it checked out!

[rbfhold]

A related discussion, chest pain, usually after running was started.