Re: Chest Pressure

Posted By CCF CARDIO MD - CRC on January 25, 1999 at 13:50:50:

In Reply to: Chest Pressure posted by Sarah on January 25, 1999 at 13:35:13:






In the past couple of months I have been having an odd feeling in my upper chest.  It feels like someone is stepping on it.  It doesn't hurt, but is really uncomfortable, and doesn't feel like heartburn.  I went to the doctor last month and she gave me an inhalor, Proventil, and told me to take it when ever I have the feeling.  This feeling lasts from 1 minute to two hours.  When I went to the doctor the episodes were really really short, but now they are lasting for an hour at a time, daily.  It is noticable when I'm sitting or laying down.  The inhalor doesn't seem to stop these episodes.  I'm 19 years old and have low blood pressure.  The doctor says my chest sounds okay.  Do I need to worry, and do I need to see my doctor again?  What could it possibly be?



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Dear  Sarah,
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), 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.
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.