Hypertension, Chest Pains, and Toprol

Hello, thanks for taking my question....I have been experiencing alot of chest or sternum area pains and was just recently evaluated at a training hosp. in their cardiology dept. as part of a work-up for clearance for esophageal surgery coming up next week....We wanted answers to what exactly was causing the chest pains. Was it coronary or esophageal in nature?....Im not sure I still have an answer....After an exam I was started on Toprol immediately, to take daily in addition to two other medications I already take for HBP..My bottom number was pretty high at this exam...Later in the day I had a dobutamine echo and the results were normal..Considering that, am I to assume that the chest pains can now be safely attributed to esophageal spasms? I was given a script for one Yr. for the toprol and told not to ever go off of that medication....However, that was before the normal echo....Is Toprol only for angina pains or will it also help the HBP and is that probably why Im to continue it even though I've been given coronary clearance?..I have been on it about 6 days and am resting better and have not been awaken once this week with heart palpitations that had become a part of almost every nites sleep for recent months and the chest pains are improving....Im just a little confused as to how the toprol can seem to be helping so much if the pains are in fact esophageal related? Could the high diastolic number on my BP be responsible for the chest discomfort?. ..If you can offer me some insight into this I would appreciate it very much......

[CCF-M.D.-RCJ]

Tessa0825,

Thanks for the post.

(1) "Considering that, am I to assume that the chest pains can now be safely attributed to esophageal spasms?"

A dobutamine echo is about 85% accurate for accurately detecting significant coronary artery disease.  Although this is pretty good, it still means that 15/100 cases are missed in the entire population.  However, in a low risk person, the chance of having coronary disease after a negative is test is much less than 15% (this is due to a statistical oddity predicted by Bayes Theorem).

(2) "Is Toprol only for angina pains or will it also help the HBP and is that probably why Im to continue it even though I've been given coronary clearance?"

No, toprol is used to treat many things: hypertension, palpitations, afib, angina, and infrequently, esophageal spasms.

(3) "Im just a little confused as to how the toprol can seem to be helping so much if the pains are in fact esophageal related?"

Beta-blockers do help relieve some people of their esophageal spasms.  Alternatively, you could be feeling better due to placebo affect, or (less likely) treatment of angina.

(4) "Could the high diastolic number on my BP be responsible for the chest discomfort?"

Yes, it is possible, although unlikely.  Hypertension certainly precipitates chest pain in some patients with coronary artery disease.

Good luck.