Re: Chest Wall Pain

Posted By CCF CARDIO MD - MTR on December 20, 1998 at 14:47:39:

In Reply to: Chest Wall Pain posted by mommydee on December 17, 1998 at 23:06:52:






Thank you for your recent conversations with me via this forum regarding my 14 yr old daughter and her recurrent sometimes severe chest wall pain (possible lupus patient, and 6 yr Graves' Disease patient).  You suggested that despite having normal tests last April (EKG, Echo, Exercise Stress with PFT, Chest XRay, and 30 day loop event monitor) and a normal EKG and chest XRay in the emergency room while having the chest pain and shortness of breath...that I should not wait till summer for her next appointment, but just let her cardiologist know that she was having worsened pain.  I did that, expecting them to say that since all the tests were normal, and she was being evaluated by other doctors for the chest pain (pediatrician, gastroenterologist currently, will see neurologist in January), it would be fine to just wait for her next appointment.  I was very surprised when they said they needed to see her next week at the latest, and gave me an appointment for Tuesday...they want me to get an HMO authorization for repeat EKG, repeat Echo, Stress test, chest Xray, Holter monitor, and 30 day loop monitor...they told me to go ahead and get authorizations for all this although they may or may not do all these tests.  
The only abnormal cardiac test she has ever had was ONCE she had an abnormal EKG...the instant report said enlarged right atrium, the EKG was repeated at cardiologist and showed the short spike that follows the large spike was largely elevated in height...it was almost as tall as the first spike.  However, with normal echo, and no symptoms at the time (2 yrs ago), this abnormality was of unknown significance and I was told to just watch her, call them if she passed out or anything.  Since that time she developed the symptom of the chest pain and shortness of breath, but all followup EKGs have been normal, and the second echo last summer was normal. With the addition of the last EKG at the hospital ER last month while in the midst of a severe attack of pain being normal, how likely is it that there could still be something cardiac related.  I wasn't worried at all about the heart being involved until I saw how concerned they were...it normally is not that easy to get an appointment, you have to call weeks or months ahead, yet they are working her in almost immediately.  This has worried me.  I was hoping you could give me a better perspective of what they are doing and how much concern I should give this.  Thank you for ALL your help!  
Dee



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Dear Dee, thank you for your question.  I think it would be extremely unlikely that your daughter has cardiac disease unless she is truly diagnosed with a connective tissue disorder like lupus.  With the multiple normal tests that you mention, I would be hard pressed to determine a cardiac cause for your daughter's chest pain.  However, if you want the issue truly solved, you could speak to her physicians about a cardiac catheterization.  This procedure is an invasive approach which relies on catheters inserted into the bloodstream to directly image the coronary arteries to look for blockages.  However, I have never heard of a 14 year old needing such a procedure unless a congenital cardiac disorder is present ( which does not appear to be the case with your daughter).  Often, in young people, anxiety plays a big role in chest pain syndromes so you may want to investigate this.  However, since I do not know your daughter, I'm only able to make general recommendations in this forum.
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.  Good luck!
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.