Uncomfortableness in chest area

Posted by John on April 27, 1999 at 09:23:50
Hello.
Recently I have been feeling a pressure in my chest that is rather uncomfortable.  It only seems to appear when I sit down and especially when I lie down to go to sleep.  When I am trying to sleep and I start to feel the pressure I get very nervous and extremly aware of my heartbeat.  It seems to be regular but I find that sometimes when I am just drifting off to sleep I will suddenly bolt up and take a deep breath, as if my heart had stopped or skipped a few beats.  I have no pain associated with this, just a pressure like someone is squeezing my upper chest.  As I type this I am feeling very fatigued, but that could just be due to the lack of sleep I have been getting due to this problem.  I am a 22 year old male with no history of heart problems.  I currently suffer from CIDP which is being kept under control with treatments of Immune Golbulin.
Thank you for any help you can offer.
  

Posted by CCF CARDIO MD - CRC on April 27, 1999 at 11:00:10
Dear  John,
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.  Do you have any personal or family history of heart problems?  Are you a smoker?  Do you have high blood pressure?  Do you know your cholesterol?  All of these things are important to know.
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.