Chest pain constant and increasing on breathing

[NurseKagome]

Hello,

I started having left upper quadrant pain yesterday that was off and on again until 1100pm last night when it started paining excessivly in my left chest(in my ribcage mostly around and below my lf breast), left side of chest continuing around to the left side of my back and upper back, my left shoulder, neck and left arm to my elbow on the back side of my arm. If I take in a breath, exhale, cough or laugh it hurts A LOT! It feels like a huge stitch in my heart on breathing. When lying down I feel some relief and when standing it hurts much more and with leaning forward,its hard to stand the pain, it's so bad when I lean forward! I still have it today. I went to the hospital last night, dr listening to my lungs, did an xray and she said it was ok that it was probably only muscular. This is a stabbing pain that is very intense. I did not work out or lift anything heavy or any of the sort recently at all period. Should I be worried? It hurts up my neck(carotid left side) and it's like a stinging, stabbing, lingering pain. I have never experienced it before now. Should I just accept it as muscular pain? It doesn't hurt with pushing on my ribcage. I worry it may be related to the birth control pill since young women sometimes get blood clots with it, would an xray reveal a clot? How long does a muscular injury take to heal if that is the case? Could I have developed some pericarditis or other infection? I have been on anti infectives,antibiotics for the past two weeks for a tooth absess (abscess), is this related? And one of the meds I am on is Penicillin VK (potassium), my K+ is normal, could taking this drug increase my K+ beyond it's normal level? How much K+ goes into this medication? I am taking 600mg X 4 daily and flagyl 500mg X 2 daily. Out of 1-10 I'd rate this pain at 7-9.5 when I lean forward. What is your take on this? Thank you for your time and expert advice.

Nurse Kagome

[Forum-M.D.-bkj]

Nurse,

It's hard when someone with chronic symptoms has a change in the symptoms. As physicians, we always ask ourselves is this a variation of same symptoms or something new.

Chest pain is a very concerning symptom. I can't advise what is causing your symptom, but if there is a marked change you should seek medical attention.

good luck

[NurseKagome]

also, I forgot to mention that when leaning forward (the pain gets intense) and it hurts the most on every heart beat. I know that may sound weird, but it's like my heart hurts with every beat when leaning forward only. Please comment on this since it is soooo totally strange! Thanks :)

[tickertock]

I hope you feel better soon. If the pain is that severe maybe you should call your Doctor or go to the ER especially if you're on medication for an infection.

[NurseKagome]

I did go to the ER, but they did an xray and sent me home, said it was probably muscular. Its hard to believe considering the pain I'm in. She said to take an Advil...I'm just wondering why did you mention because I'm on Antibiotics?

[Fionajnz]

I had what they thought to be a PE along with a cardiomyopathy after the birth of our daughter Nov 5th.  Day 4 post C sect I developed pain under my heart when I breathed in, it was very particular to one spot, it was fairly intense (think 5-8 on my pain scale) along with a breathless feeling almost like asthma but my peak flow was okay. The way to clarify if its a PE or not, is to have a contrast CAT scan of your chest and also to check your blood for the D dimer level (if its a PE its very likely to be elevated).  My CAT was reported clear intitally, though the second opinion Dr (pulmonologist) at National Jewish wrote in his report to my PCP, after he looked at the same scans, he suspected PE due to symptoms, level of breathing probs, recent surgery and the fact I had an already dx clotting disorder and they had suddenly dropped my heparin dosing post C sect, plus I guess the post partum cardiomyopathy predisposed me to clots.  Apparently 2% are unseen for PE's.  Interestingly I also had a tooth that had abscessed during my second trimester and it took about 3 doses of antibiotics to clear it and finally they had to drain it.

Get yourself re evaluated pronto, if its muscular - like costachondritis (?sp), you should be able to press on a particular spot and reproduce the pain, I had that too, after my posture changed with a concurrent back and severe breathingss probs during the whole debacle with my health.  It lasted for mths, even now a year later I can still press on the spot and it will hurt, but not constantly now, like it did before.

I hope you find an answer for your issue soon.  Its worrying when you doubt an explanation.

Fiona

[Flycaster305]

Have you been checked by an Arthritis doctor?  I had/have Anklyosing Spondelitis as a younger man, and the pain was very similiar to what you are reporting, it's abated as I got old.    AS usually hits people about 30 years of age, give or take five years.  It sent me to the emergency room a couple of times, I was so convinced it was a heart attack.  As you have been advised, if it hurts to touch it or movement hurts, it probably isn't a heart attack.  I've had both AS/arthritis pain and three heart attacks.  There is a big difference.  If the heart issue is ruled out, I'd sure go to an arthritis doc.  Best wishes

[Fran71]

Hi Nurse,
at the ER did they perform an ECG and checked your enzymes? If all was negative I think it was reasonable to rule out angina or heart problems. If they feel there may be even the slightest risk they would keep you there under observation. Blood markers are very sensitive for ischemia, and an ECG would indicate serious heart rhythm problems.
Also, cardiac pain generally should not vary with change in position, and is not of the "stabbing" nature you describe.
Anyway, if the pain is so strong you should go to the doctor again, since it hurts so much.

Good luck

Fran

[NurseKagome]

Thanks for the info, though there are some cardiac problems that do have a change in pain on positioning. I think that percarditis (also something that needs immediate treatment) can have worsening pain on lying down, and ease off on standing. So, for me though, it's pain bending, and everytime my heart beats i get a surge of pain, it's like a ripping, stabbing pain. It's awful, and it hurts A LOT! I get light headed and feel awful for 10 mins after leaning forward or especailly a full bending...ouch

[NurseKagome]

And, I have an appointment with my family doctor today. Though the pain overall seems to have decreased...I still have the exact same level of pain on bending...arg. I'll let you know what he says.

[EchoTech]

Sounds like pleurisy (sp?) witht eh pain increasing while you're bending over.  generally heart pain from ischemia is dull and pressure like, not stabbing.  An echo could rule out the pericarditis if you push hard enough for it.  

Good night and good luck.