Unexplained Chest Pain

[whthouse]

I have been exercising 3-5 times a wk for 3 yrs (treadmill walk/jog w/free weights).  I am 29 yrs, 5'7", 128 lbs & I don't smoke.

During the first year I was exercising, I could jog for 1 mile (never any more).  Then, my endurance started decreasing.  I could jog for 5-7 minutes, walk, jog again.  Then, my jog endurance came down to 3-5 minutes at a time.  Currently, I can jog for no more than 3 minutes before I have to slow down (feel like I'm hyperventilating).

About a year ago, I started getting a pain in the right side of my chest (feels like a side stitch in my chest) that radiated up to my shoulder and neck when I pushed myself extra hard (example: walk 5 min., jog 5 min, walk 3 min, jog 3 min -- in the next jog session, usually after about 8 minutes of total jog time, the pain would start).  When I stop jogging, the pain stops.  I was checking my heart rate manually, and I bought a heart rate monitor, and my heart rate increases to 150-160 bpm with walking alone, and increases into the 185-200 range when at a slow jog.  

This morning, I had the chest pain again (after the usual 8-10 total min of jog time, run 2, walk 2, run 2...etc...), took my bpm and it was over 200.  My strength and endurance are coninuing to decrease.  After I excercise, I feel like I can't take a breath without coughing.  I start to cough sometimes if I take too deep a breath.

I recently had an exercise stress test, EKG, chest x-ray, spirometry, and echo done, and the results all came back normal.  I feel like I can't get an answer as to what is wrong with me.  HELP, PLEASE!

[CCF-M.D.-RCJ]

whthouse,

Thanks for the post.  Sorry to hear of your ordeal.

The good news is that with a normal treadmill test, normal ecg, and normal echo, the likelihood of any disease of the heart is exceedingly low.

The bad news is that it can be difficult to diagnose the cause of chest pain and decreasing endurance.

My first thought when I read your story was exercise-induced asthma, especially with the history of cough.  This diagnosis can be difficult to diagnose, and spirometry will often miss the diagnosis unless provocation is done with methacholine challenge.  Alternatively, the spirometry can be done pre- and post-exercise.

I would seek a second opinion from a reputable internist at a major medical center.  One way to further exclude the heart as the source of your problem would be to have a stress echo -- this is a treadmill test followed immediately by an echo to assess for exercise-induced changes.

Hope that helps.

[hbp702]

Your doctor didn't do a Holter study?!?

[CCURN]

You are not alone in that frustration!!  A year ago I could do everything I wanted, step aerobics for example, and not be short of breath.  Then everything changed suddenly after I had a virus. Fatigue, chest pains with exertion and terrible shortness of breath.  Like you, EKG, echo, stress test...normal.  I had rapid heart rates in the 150's with just minimal exertion.  After having a tilt table test, I was diagnosed with neurocardiogenic syncope.  They have been having some trouble controlling my symptoms, but hang in there, if God wants the Drs to find out what is wrong, they will.  I was just in the hospital with severe chest pain, and they ruled out a lot of things, but never actually pinpointed what it was.  At least you can rest your mind when they rule out the very serious stuff... Good luck to you.
CCURN

[happy gilmore]

Hi, when I was in high school I exercised a lot because I was on two varsity sports, Water Polo and Swim Team.  Around my junior year when I was about 17 I started getting severe chest pains when I would swim a lot.  I never had the problem before the age of about 17.  My doctor told me that it sounded like exercised induced asthma and gave me an inhaler without doing any tests or anything.  The inhaler never really helped when I would get the chest pains, but I just ignored the problem and dealt with the pain.
I am 20 now and I just recently started working out again and I get the same chest pain after I run a couple of miles.  Sometimes this chest pain will go away while I’m still running and other times it goes away immediately after I stop running.  My heart rate is usually around 180 when I get these chest pains.
I was just wondering your opinions on whether you think it is just exercised induced asthma or if it might be something more severe.  If it is just asthma I don’t want to go to the doctor because I plan to join the military after college and they will not let me join if I have asthma.

Thank You

[Ianna]

Hi,
-
Look for costochondritis or Tietze Syndrome with Google.
It has got to do with the ribs.
Could be that.
Nothing serious, but it could be painful and takes a (long) while to 'heal'. The pain can return regular. Often feels like 'heartproblems', but is not.
-
Be well - *Ianna*

[whthouse]

I asked the doctor to prescribe me an inhaler for Exercise Induced Asthma.  I used it before exercising for several months and I noticed little to no change.  I think at this point that my doctor is tired of trying to help me.  She suggested trying to continue running to see if the pain would go away.  I  tried that, and when my heart rate gets up to 190-200 (after less than 1/4 mile of jogging), I just CAN'T continue running.  She prescribed me some anti-depressants (Lexapro) for 'chronic fatigue', which were supposed to show results within 2 weeks.  I took them for two weeks and was even more exhausted the entire time.  Now, for exercise, I only WALK on the treadmill for 30-45 minutes.  I've given up even trying to run.  However, I had the chest pain the other day walking at 3.7 mph for 40 minutes, and checked my heart rate, and it was 190.  I guess I need to find myself another doctor for a second opinion.  This is getting pretty frustrating.