Re: Chest Pains

Posted By CCF CARDIO MD - CRC on November 30, 1998 at 16:47:48:

In Reply to: Chest Pains posted by Marian on November 30, 1998 at 16:25:29:






My boyfriend has been feeling intermittent chest pains for the last 10 years.  His family has a history of heart problems so he diminishes the pain and doesn't feel it is important to see a doctor.  He has been told that he has a heart murmur.  But that was during a highschool physical.  I've been demanding he goes, but he has great anxiety about this.  He's only 26 years old and he's healthy and pretty athletic.  He's a bit underweight, 5'10'' and about 135-140 lbs. but strong.  The pain is usually on the right side just by the rib cage or right lung.  It may not be his heart, but he isn't too sure.  He says it's a tightness and a pain like someone just punched him.  He doesn't get it during exercise or weightlifting.  It just comes anytime during movement or during rest.  One time he got severe pains when he was 17 and fell to the ground, dizzy and out of breath.  Is this a heart condition or a lung condition?  Maybe it's stress or severe heartburn?  Should we be concerned?  



_____


Dear  Marian,
There are many causes of chest and neck 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), 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. I would recommend that your boyfriend have his symptoms evaluated. A good Internal Medicine doctor should be able to work through the potential causes of his symptoms.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.