Delayed (24 - 48 hrs) Chest Pain after Exercise

[kiaorana]

I am a 68 year old man, quad bypass in 2001. Strong family history of heart disease.  I an generally active - walk  
stairs, mow lawns, etc. 5' 8", 160 lbs., 21% bodyfat, blood pressure typically 110/65, pulse at rest 55 - 60

I do a stress test every year and typically achieve Bruce Protocol level 6 or 7 (16 - 18 minutes on the treadmill).

Since the surgery I have had bouts of delayed chest pain (with pain in the left arm etc) starting about 24 - 48 hours AFTER exercise and persisting for weeks before finally fading away.  The pain comes and goes but is debilitating.  Seems better with light exercise - but it is hard to convince yourself to go for a run when you have chest pain, breathlessness and pain radiating though your neck and left arm.  HOWEVER - NO pallor or cyanosis.

Hospital visits to check this out show NO cardiac anomalies - blood tests are fine, ECGs fine - they pat me on the head and send me home with no diagnosis -- but I feel horribly ill!

If I do nothing for a month or two the symptoms subside.  

Very light exercise - a 20 minute walk - doesn't induce the symtoms - but harder exercise does - Latest bout came 36 hours after a 5 mile hike along a fairly challenging hilly terrain walking about 4mph.

Any ideas???  

[kiaorana]

Thanks for the input guys:  Last year - after a similar bout of chest pain, my physician did a Cardiolyte Perfusion along with the stress test -  I did 16 1/2 minutes on the treadmill to my max heart rate of 150 or so -- ECG showed normal sinus rhythm with no anomalies or STCs and the Cardiolyte showed no ischemia, a normal ejection fraction and no abnormalities.

I'm not on any meds except niacin and to keep my cholersterol down and 80mg ASA.

It is stressful because as you said Ed, the symptoms are so stereotypically "incipient MI" that I have thought that death was imminent several times.  I have been hospitalized at least 10 times in the last decade, undergone MRIs, psychiatric assessments, xrays and stress tests with no diagnosis :-(.  I don't think I'm imagining things (neither did the shrink :-) -- but I sure could do without the pain and worry LOL.

My experience has been that the Doctors promptly go into "CYA -- Check the Cardiac Status" mode - and when they don't find anything immediately life threatening -- they do no further follow up - just pump me full of morphine (nitro has no effect in pain reduction) and send me home.   Even when I have taken my complete set of detailed records and explained all previous treatments - they do the same old thing.  I no longer go to the emergency room - can't afford the cost - and no longer see the point -- especially with no diagnosis - and I haven't died yet LOL.

I was hoping that folks on this page might have different experiences and be more lateral thinkers - as you have just demonstrated :-)  Thanks

[ed34]

Just to add, it might be worth looking at any medications you were put on after surgery and have been on since. I had no chest pains or symptoms after my 2 stents in march, but my Doctor started me on an ace inhibitor recently to lower my BP. I started to get chest pains and throat discomfort along with bad shortness of breath. I honestly got depressed because I thought I was in line for another MI incident. After stopping the BP medication (Ramapril), all the symptoms cleared up after 24 hours. I have just read the leaflet that came with the meds, and it says in very rare cases can cause stroke or heart attack.
At the same time, KK gives excellent advice here regarding a perfusion scan.

[kenkeith]

You have the symptoms of coronary vessel occlusions.  You should have a stress perfusion test to rule out any significant occlusions.  If you are experiencing chest pain (angina), that idicates the heart cells are not getting enough oxygenated blood, and when the heart cells do not get sufficient oxygenated blood, the cells can become inactive and reduce the contractility of heart walls causing heart failure...an EKG is not a very good source to diagnose vessel occlusions...blood test can rule out any acute heart failure, but it can't provide much cardiovascular information.  Frankly, I'm surprised based on your information and cardiovascular history the medical staff hasn't progressed testing for a more significant assessment.  

Thanks for sharing and if you have any further questions or comments you are welcome to respond.  Take care,

Ken