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Heart Disease (Expert Forum)
Re: chest pain
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Re: chest pain
by Cleveland Clinic, MD, Jan 01, 1995 12:00AM
, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD - CRC on August 26, 1998 at 16:02:27:
In Reply to: chest pain posted by rick bivens on August 26, 1998 at 05:24:13:
Hi Doctor,
I am a 40 year old male who had no health problems until 1997.
In May 1997 I had chest pain and was admitted to the hospital for observation. My EKG was normal and no problems were found to cause the pain. The pain subsided with the use of Torodol.
In July 1997 I had a scope down my throat and the doctor found I had a hereditary hiatal hernia. The Doctors believed this was the cause of the pain. I changed my diet and increased my regular exercise. Note I ran a karate school for 10 years and kept in good shape.
In October 1997 after weeks of chest pain and fevers101 to 103 I was again admitted to the hospital this time with pneumonia. I spent 11 days in the hospital with 3 days in intensive care. I was diagnosed with peracarditis, plural effusion, anemia, two pulmanary embolisms upper left lung, situational depression, Temps from 101 to over 104. They could find no cause for all of these things happening and decide I had a viral infection that went wild.
I was on cumadin (coumadin) therapy for 6 months I have no risk factors for blood clots. I continued to have chest pain that waxed and waned. several ER visits where they found a low grade fever 101 and an increase in my sed rate.
My symptoms continued and I have been checked for heart problems stress test and ultra sound, lung scans, x-rays chest and neck, colon cancer, lupus, fungus infection and a battery of blood tests. All with negative results.
I continued to work and take a 100 mg of naproxen daily. The pain became constant with ranging from mild to severe. On April 28, 1998, I had a low grade fever 101 and severe chest pain I went to the ER and they found an elevated sed rate to 92, anemia, slightly elevated blood pressure. They prescribed percocet and I was released. I have not worked since 4 -28-98
I continue to have constant chest pain that sometimes radiates to my left shoulder and also my left arm is numb. My heart rate is 92. When the pain is bad it is worse with deep breaths and is sharp.
My doctors have found no answers, I was taken off the naproxen for two weeks and my symptoms got worse chest and shoulder pain was severe for 9 days, I went back on naproxen and used percocet to dull the pain. Since then the pain has ranged from slight to moderate but always present.
Any help you can offer will be greatly appreciated.
Rick B
------------------------------------------------------------------------------------------------------------------------
Dear Rick,
Thank you for your question. It sounds as if you have been going through some difficult times. Chronic chest pain can be a difficult problem to diagnosis and treat and I doubt I can make a diagnosis over the internet. I would recommend you show the following article to your doctors. If they feel this treatment is appropriate it may really help you. Hope this helps. Good luck.
N Engl J Med 1994 May 19;330(20):1411-1417
Imipramine in patients with chest pain despite normal coronary angiograms.
Cannon RO 3rd, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Uhde TW, Waclawiw MA, et al
Cardiology Branch, National Heart, Lung, and Blood Institute; National Institutes of Health, Bethesda, Md 20892.
BACKGROUND. Ten to 30 percent of patients undergoing cardiac catheterization because of chest pain are found to have normal coronary angiograms. Because these patients may have a visceral pain syndrome unrelated to myocardial ischemia, we investigated whether drugs that are useful in chronic pain syndromes might also be beneficial in such patients. METHODS. Sixty consecutive patients underwent cardiac, esophageal, psychiatric, and pain-sensitivity testing and then participated in a randomized, double-blind, placebo-controlled three-week trial of clonidine at a dose of 0.1 mg twice daily (20 patients), imipramine at a dose of 50 mg nightly with a morning placebo (20 patients), or placebo twice daily (20 patients); this treatment phase was compared with an identical period of twice-daily placebo for all patients (placebo phase). RESULTS. Thirteen (22 percent) of the 60 patients had ischemic-appearing electrocardiographic responses to exercise, 22 of the 54 tested (41 percent) had abnormal esophageal motility, 38 of 60 (63 percent) had one or more psychiatric disorders, and 52 of 60 (87 percent) had their characteristic chest pain provoked by right ventricular electrical stimulation or intracoronary infusion of adenosine. During the treatment phase, the imipramine group had a mean (+/- SD) reduction of 52 +/- 25 percent in episodes of chest pain, the clonidine group had a reduction of 39 +/- 51 percent, and the placebo group a reduction of 1 +/- 86 percent, all as compared with the placebo phase of the trial. Only the improvement with imipramine was statistically significant (P = 0.03). Repeat assessment of sensitivity to cardiac pain while the patients were receiving treatment showed significant improvement only in the imipramine group (P = 0.01). The response to imipramine did not depend on the results of cardiac, esophageal, or psychiatric testing at base line, or on the change in the psychiatric profile during the course of the study, which generally improved in all three study groups. CONCLUSIONS. Imipramine improved the symptoms of patients with chest pain and normal coronary angiograms, possibly through a visceral analgesic effect.
Information provided here is for educational purposes only. It is not intended to replace your doctor's advice. Only your doctor can make specific diagnosis and recommend treatment. If you would like to be seen at the Cleveland Clinic please call 1-800-CCF-CARE.
In Reply to: chest pain posted by rick bivens on August 26, 1998 at 05:24:13:
Hi Doctor,
I am a 40 year old male who had no health problems until 1997.
In May 1997 I had chest pain and was admitted to the hospital for observation. My EKG was normal and no problems were found to cause the pain. The pain subsided with the use of Torodol.
In July 1997 I had a scope down my throat and the doctor found I had a hereditary hiatal hernia. The Doctors believed this was the cause of the pain. I changed my diet and increased my regular exercise. Note I ran a karate school for 10 years and kept in good shape.
In October 1997 after weeks of chest pain and fevers101 to 103 I was again admitted to the hospital this time with pneumonia. I spent 11 days in the hospital with 3 days in intensive care. I was diagnosed with peracarditis, plural effusion, anemia, two pulmanary embolisms upper left lung, situational depression, Temps from 101 to over 104. They could find no cause for all of these things happening and decide I had a viral infection that went wild.
I was on cumadin (coumadin) therapy for 6 months I have no risk factors for blood clots. I continued to have chest pain that waxed and waned. several ER visits where they found a low grade fever 101 and an increase in my sed rate.
My symptoms continued and I have been checked for heart problems stress test and ultra sound, lung scans, x-rays chest and neck, colon cancer, lupus, fungus infection and a battery of blood tests. All with negative results.
I continued to work and take a 100 mg of naproxen daily. The pain became constant with ranging from mild to severe. On April 28, 1998, I had a low grade fever 101 and severe chest pain I went to the ER and they found an elevated sed rate to 92, anemia, slightly elevated blood pressure. They prescribed percocet and I was released. I have not worked since 4 -28-98
I continue to have constant chest pain that sometimes radiates to my left shoulder and also my left arm is numb. My heart rate is 92. When the pain is bad it is worse with deep breaths and is sharp.
My doctors have found no answers, I was taken off the naproxen for two weeks and my symptoms got worse chest and shoulder pain was severe for 9 days, I went back on naproxen and used percocet to dull the pain. Since then the pain has ranged from slight to moderate but always present.
Any help you can offer will be greatly appreciated.
Rick B
------------------------------------------------------------------------------------------------------------------------
Dear Rick,
Thank you for your question. It sounds as if you have been going through some difficult times. Chronic chest pain can be a difficult problem to diagnosis and treat and I doubt I can make a diagnosis over the internet. I would recommend you show the following article to your doctors. If they feel this treatment is appropriate it may really help you. Hope this helps. Good luck.
N Engl J Med 1994 May 19;330(20):1411-1417
Imipramine in patients with chest pain despite normal coronary angiograms.
Cannon RO 3rd, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Uhde TW, Waclawiw MA, et al
Cardiology Branch, National Heart, Lung, and Blood Institute; National Institutes of Health, Bethesda, Md 20892.
BACKGROUND. Ten to 30 percent of patients undergoing cardiac catheterization because of chest pain are found to have normal coronary angiograms. Because these patients may have a visceral pain syndrome unrelated to myocardial ischemia, we investigated whether drugs that are useful in chronic pain syndromes might also be beneficial in such patients. METHODS. Sixty consecutive patients underwent cardiac, esophageal, psychiatric, and pain-sensitivity testing and then participated in a randomized, double-blind, placebo-controlled three-week trial of clonidine at a dose of 0.1 mg twice daily (20 patients), imipramine at a dose of 50 mg nightly with a morning placebo (20 patients), or placebo twice daily (20 patients); this treatment phase was compared with an identical period of twice-daily placebo for all patients (placebo phase). RESULTS. Thirteen (22 percent) of the 60 patients had ischemic-appearing electrocardiographic responses to exercise, 22 of the 54 tested (41 percent) had abnormal esophageal motility, 38 of 60 (63 percent) had one or more psychiatric disorders, and 52 of 60 (87 percent) had their characteristic chest pain provoked by right ventricular electrical stimulation or intracoronary infusion of adenosine. During the treatment phase, the imipramine group had a mean (+/- SD) reduction of 52 +/- 25 percent in episodes of chest pain, the clonidine group had a reduction of 39 +/- 51 percent, and the placebo group a reduction of 1 +/- 86 percent, all as compared with the placebo phase of the trial. Only the improvement with imipramine was statistically significant (P = 0.03). Repeat assessment of sensitivity to cardiac pain while the patients were receiving treatment showed significant improvement only in the imipramine group (P = 0.01). The response to imipramine did not depend on the results of cardiac, esophageal, or psychiatric testing at base line, or on the change in the psychiatric profile during the course of the study, which generally improved in all three study groups. CONCLUSIONS. Imipramine improved the symptoms of patients with chest pain and normal coronary angiograms, possibly through a visceral analgesic effect.
Information provided here is for educational purposes only. It is not intended to replace your doctor's advice. Only your doctor can make specific diagnosis and recommend treatment. If you would like to be seen at the Cleveland Clinic please call 1-800-CCF-CARE.
