Chest pain

[Memaw]

My 43 year old son-in-law has chest pain in the area of his heart on a regular basis. This pain is aleviated by drinking cold liquids. Past exams have not shown any heart problems. Could this be a reflux problem or some undetected heart trouble? Thank you for your help.

[CCF-M.D.-CRC]

Dear memaw,

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.

[Goodgal]

just thought id post this bit of info as well

Microvascular angina:

a recently-discovered type of angina
patients with this condition experience chest pain but have no apparent coronary artery blockages
physicians have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs
can be treated with some of the same medications used for angina pectoris

Variant angina pectoris
(or Prinzmetal's angina):

is rare
occurs almost exclusively when a person is at rest
often does not follow a period of physical exertion or emotional stress
attacks can be very painful and usually occur between midnight and 8 a.m.

[Addie]

Thanks for posting this. I have Angina but convincing the docs is another thing.  It took an act of congress to get a Stress Dubertermine/Echocardiogram testlast year. I told them I needed/wanted this before surgery on my knee. I finally had it. I had 3 cardiolgists in the room doing this. (teaching hospital) They place a dye while you are laying down and stress the heart like one is on a thredmill. After 1 1/2 hours they could find nothing in the large arteries. No ishemia, they said.  I had no pain during this test. The lead cardio doc said the pain must be coming from one of the itsy bitsy tiny arteries leading to the heart but not a main one and could not be seen via the testing. I still have occasion anginal pain but one nitro takes care of it within minutes. I had to beg for the Nitro 2 years ago and asked for 12 refills.  My father died at 39 of MI.  My sister had a heart attack 2 years ago and has a stent.  They found a previous heart attack.  She knows when she had it.  She had seen the doctor for this pain but it was ignored by her doc. I truly believe I have Microvascular Angina.
I wish there was a test for this.  Again, thanks for sharing this information.