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Went to ER with Chest Pain - no diagnosis, but still paranoid
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Went to ER with Chest Pain - no diagnosis, but still paranoid

A week ago I went to the ER with chest pain.  Background - 33Y old male, 5'10, 205 lbs.  Cholest - 230, 140ldl, 65 hdl. Non smoker.  Grandfather died in early 50's of MI.  Previous to my trip I was having shooting pains in my arms and jaw and back, outside of my chest, cramps in my legs etc for 2 weeks. Came home late one night with major pain in the center of my chest (8 on a 10 scale). Took over an hour to go away, should have gone to the ER then.  Next morning still had some center chest pain so called my doc - said go to the ER.

Upon arrival at the ER.  BP 210/110, pain was only about a 3.  Chest ECG- normal, blood work - normal, chest x-ray normal.  Yet they still ordered a nuclear stress test with exercise. BP came down on it's own.  All tests were normal (why did they order the nuclear if my chest x-ray, ECG, and blood work were normal?)

They released me with no diagnosis, said to follow up with primary in 2 days. I still am getting these shooting chest pains to the outside of my chest, in my arms and jaw. I can breath fine, exercise doesn't bother me. Primary ordered more blood work - CRP-.8  ESR-2.  BP was normal at visit, but I check it a lot and many times its 145/90ish.

I'm still getting these shooting arm/jaw pains, random chest pains (both more at rest than exercise). I'm still worried it's cardiac, though all those tests said otherwise.

I burp a TON so I started prilosec OTC for possible GERD. I've never had a hard time breathing, nor sweats with this center chest pain.  Should I see a cardiologist? I'm constantly worried about this now. Thanks.
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Hi Eddie,

I hope you are feeling better now.  Going to the ER was the right thing to do.

1. why did they order the nuclear if my chest x-ray, ECG, and blood work were normal?

while it is rare, it is possible to have significant CAD at your age.  Ekgs and blood work are important to rule out acute problems.  


2. Should I see a cardiologist?

I think you should see a cardiologist for two reasons.  One, you need reassurance that you are ok and it is better to have a specialist do this since they are more likely to be in tune with rarer causes of heart disease.  The other reason is that you are young and you have hypertension.  People with a new diagnosis of hypertension at your age should be worked up for secondary causes of hypertension -- things like coaractation of the aorta, renal artery stenosis and the ever popular pheochromocytoma (very rare).  In you in particular, it is important to rule out a coarcation.  Coarctations are associated with bicuspid aortic valves and other aortic pathology.

I hope this helps answer your questions.  Thanks for posting.
20 Comments
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Avatar_n_tn
That since my trip to the ER I have had two episodes of this dead center chest pain.  Both times it went away after 30 minutes or so, and neither were more than a 4-5 on a 10 scale pain wise.  No problems breathing either time.
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Avatar_n_tn
I have the same symptoms for several weeks (shooting pains or spasms on jaws, chest, arms, legs).  When I visited my PCP, my BP was 149/100 and doctor noticed my heart pumping really hard. I was on beta-blocker since then.  I continued having pains for a few weeks so I referred to a cardiologist who ordered me to have 24-hr holter monitor, blood work, nuclear stress test and echocardiogram. All came back normal except for the BP and fast heartbeat so I'm still on with my medicine.

The nuclear stress test will show any ischema or blockages that could be causing the pains. It's good to have that test because it helps ease your mind. In my case, I didn't have any blockages. The pains that I'm getting are from HBP and fast heartbeat. Beta-blocker alleviated that problem.

Work with your doctor. Good Luck!
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Avatar_n_tn
How do you know when to go to the ER???  

I mean chest pains can be from so much.  I went to the ER 2-3 yrs ago with L. upper back, neck, and arm pain, it was a 10.  I had a coincidental abnormal EKG (they have my normal on file).  My cardio's colleague admitted me.  Everytime I stood up I felt better.  Turns out it was c-spine related.

Last evening I had chest pains, about a 6 or 7 when they came.  They seemed almost to pulse and I had pressure in the middle of my chest.  I, also, had the back pain.  This time when I sat down they would go away.  When I stood up they came back.  

I only have mild problems: mild MVP, MR, and TR, mildly elev. pulmonary pressure, IST and NCS.  Family history isn't great, but...

I think if I ever have a heart attack that I will die from it, because I will sit at home until things get bad.  I won't run to the ER with pain that isn't severe or specific.  Fortunately, I guess, I am on 81 mg of aspirin for a blood clotting disorder.

*Sigh*
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Avatar_n_tn
Oh, another thing...I get palps from different lil arrhythmias (noted on event monitor and Reveal monitor).  They usually don't bother me at all, but the other day I got what felt were just 2 PACs, but I had NEAR SYNCOPE!  What's up with that?!
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Avatar_n_tn
HI al

I'm a 27 year old female nearly 28 and have had severe chest pain sometimes radiating down my left shoulder for over 16months have been in er 11 times and have had a few overnight stays in hosptial for monitoring. First episode came on within 10minutes it was the worst pain I have ever experienced it felt like a crushing, stabbing elphant sitting on my chest, I was hysterical and a work friend drove me to er and I was convinced so where they at first that I was having a heart attack, which was scary as at the time I was a long distance runner, non smoker non drinker extremly fit but had the scare that my dad had a massive heart attack at 45 and was also a runner non smoker etc lucky he is ok but we have a family history of heart disease. Anyway the only diagnosis I have ever really been given to explain my constant chest pain is that at the start of this problem on a cat scan I had done it showed up possible pericarditis which is an infection of the pericardium or sack around the heart, I was given all the treatment for that but I'm still in chronic pain everyday of my life directly under the left breast and central chest, it gets worse with exercise and with any emotional upset or stress or caffine as well. Currently is is 2am in the morning and I'm up typing as the pain is way to bad to even consider trying to lye down flat and sleep it is better if I sit upright and try to fall asleep that way. I have had all the heart tests, blood tests bone scans, lung scans only sus thing was the initial small amount of fluid around the heart, my heart appeared rather large apparently for someone of my size I'm only very petite, and on the ecgs I have it always shows up pericarditis but apparently if 5 percent of the population had a ecg it would show up pericarditis so I'm confused about what my problem is but I thought I would let others know about this as percarditis is a lot more common in  young males and this could be your problem sometimes you can have dry pericarditis which is what I think I now have and that is where the layers of the heart rub together due to having an infection which leads to sticking like a blister rubbing. I"m starting the pain clinic next week so I hope it will help to turn my life around it has been hell for nearly two years I have lost a lot of weight look very pale and generally feel very tired all the time. I can only work on a casual basis and I no longer can exercise as it is not worth the pain it causes a few hours later. If anyone has any other suggestions as to what could be wrong with me please let me know I'm desperate, I hope I have offered others something interesting to consider.
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Avatar_n_tn
I have had dry pericarditis and you might be right. Some of the symptoms fit. Unfortunatly the treatment is antibiotics and in severe cases a pericardectomy. This is where they cut a hole in the pericardium, releasing the tension around the heart. Another condition that some of your symptoms fit is common in young women but is treated only with anti-inflammatory drugs and steroids (don't quote me on this, I might be wrong). This condition is costochondritis, and it is basically pain around the breastbone and ribs. This pain is not substernal(meaning the pain does not originate from below the sternum or ribs) so if you feel the pain coming from under your sternum or ribs, you might be able to rule costochondritis out. Still, check with your doc. Try and cut out caffiene for awhile, as it can lead to chest pain and palpitations(if you drink it in large quantites. I too am having chest pain that no one can seem to find a cause for, so I empathize with you. I wish you the best.
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Avatar_n_tn
My husband went to the ER on Aug13 with severe chest and arm pain, at 44 years old with no (at the time) known risk factors other than smoking, and no family history.  Tests were abnormal but not conclusive. Even though pain was unremitting with morphine and dilaudid, from 2:30 pm to about 11:00pm, they didn't do much. At 11:30 pm,sent him upstairs on a monitored floor until Monday.  The blood taken at midnight showed a spike and that a MI had occurred.  At 5 am, the pain started up again, and the EKG showed another MI in progress.  They finally took him into the cath lab, and found a 100% blockage in the LAD and 40% in the main.  A stent opened the LAD, but the damage was done.  He is currently in rehab, but we don't know how much of his function is going to return.  His EF was about 35% when he got out of the hospital, and on the last echo was about 43%.

Hindsight is 20/20, but if I had it to do over again, I would have forced the cath on Saturday.  If you really suspect heart or CAD, get the cath, and insist.

I also have chest pain, which I have been blowing off for years, since the cardiolist I saw in the late 90's said "women don't get heart disease".  After my hubby's MI, I was also referred to his cardiologist (great cath man), who did a cath within a week.  The good news is I "passed" the cath, no significant CAD.  The bad news is, we still don't know what is causing the chest pain. Weird thing is nitro helps it, but it's not true angina.  I've had the endoscopy, and do not have GERD.  Go back to the cardiologist next week, and we'll see where we go from there.

Bottom line is, if you are having pain, GET IT CHECKED OUT.  My husband almost died because he thought it was "nothing", and really, so did the ER docs.
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DEMAND AN ANGIOGRAM !!!  I had less pain than you, and just had a triple bypass.  Two 99% blocked arteries, one multi-site 80% blocked.  All other tests were negative.  Once they say the blockages, they operated the next morning.
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I'm 28, male, 6'0, 240lbs., cholest: 200, hdl: 140, ldl:40, BP 140/80 since I was very little, never smoked, sedentary life, 10+ hours a day in front of a computer, a lot of stress, taking 1x0.5mg Xanax every few days. Put a lot of weight in the last 5 years, having back pain now and then. Small family history with regards to heart-related diseases.

5 weeks ago after 19 hours in an airplane, next day I started having shortness of breath mostly in the 2nd half of the day, regardless of doing exercise of not. After a few days I started feeling mild chest pain (3/10), sometimes behind the breastbone, sometimes a little to the left, wasn't going away in 15-30 min., it stayed sometimes for hours, most of the time accompanied with shortness of breath. I couldn't correlate them with exercise or meals.

Went to a cardiologyst, still and effort EKG looked OK, BP OK, still and effort echo OK (or at least this is what he told me, maybe someone could please confirm if these numbers look OK : RV 0.8-3.0, AO 2.0-4.0, LA 2.5-4.0, LVid d:3.7-5.7, LVid s:2.6-3.5, FS%:25-53%, lVS d:0.6-1.2, lVS s:0.8-2.0), didn't feel any pain/shortness of breath while running on the treadmill. No aorta/tri-valves checked as far as I can figure. He said it's probably GERD, although I have GERD once in a while and it doesn't feel like this, no shortness of breath for sure, gave me few pills for GERD, took those for 2 weeks, started also taking 81ms aspirin on my own.

Since then I can't sleep layed on my back, feel like suffocating sometimes, feel like a weakness in my left arm even w/o chest pain, chestpain is still usually difuse and lasts for hours, I have palpitations for 1-2 seconds every few hours sometimes, cold sweats, it feels like a heat wave going thru my body.

Went again to the cardiologist few days ago, did only EKG, looked OK, BP OK as well. He thinks it's just anxiety (although Xanax doesn't help) or maybe a pinched spine nerve.

I had few panic attacks before so I'm used with palpitations, they go away with Xanax but these last weeks even Xanax once a day doesn't seem to help. I also read that angina usually doesn't last for hours. The pain is still usually continuous, doesn't get more than mild, same for shortness of breath.

Is it heart-related, lungs-related, spine-related or something else ?
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Avatar_n_tn
one more thing, did also blood tests including coagulation and chest X-ray, all looked OK
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Avatar_n_tn
Hi, my name is James (not Lemonade, apparently, James was already taken) and I have a few recent concerns regarding my health.

1. I am 23 years old, 6
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Avatar_n_tn
Hi I have just turned 20yrs and suffered chest pain for 2mths before deciding to go to doc. Went to doc and she was very thorough, and stopped me playing my sports. All tests came back normal so I'm allowed back doing everything I want but they still can tell me whats causing the pain, which is still occuring but not as often or as severe. The problem is I can't go back to normal as I really want to know the cause any ideas?
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I have been having chest pains for 4 months and my doctor has given me and ECG that come back normal she told me i dont need anymore tests and my symptoms sound more digestive, although im on tablets for this.

I get a sharp squeezing pain under my left rib and under my breast this comes in waves, sometimes the pain is above my breast this is more a sharp pain. I also get pains in my shoulder blade ( front and back) and i have also got some pain in my left arm, this feels like someone is scratching on a nerve, I have lost alot of feeling in my left hand, everything is really 'fuzzy'

Im being referred for tests on my stomach but still worried if its that or my heart.

I wake up early everym morning with the pains and they really scare me.  Im 22 and got no heart problems in my family I alsohave quit smoking a few  month ago ( just before my pains actually)

Im going on hen weekend next weekend and im sure if its okay for me to drink any alcohol or not :-(


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I am 49 years old. last tues i was talkied into having a endeavor stent put in my left artery. I was told it would be more effective than my other ones. i was NOT told that people al over the country are ending up back in the hospital with heart attack syptoms (symptoms) and they dont know why. my docotr told me this after the fact. now i am trying to find others that have had this problem with drug eluting stent. I have had worse chest pains than before and last sat was rushed to the er with such seviour chest pain,shortness of breath. dizziness. it took two nitro and 3 squirts of the nitro spray and morphine before my pain was relived. That was the scarest thing for me to undergo and my family. Just to be told that people all oever are having this problem. I want the damn thing taken out but dont know what to do or who to turn to. I'm scared to go back to work, I'm scared to be left alone. my doctor was honest with me but the one that released me would say one bad thing about this stent. the one i got is not fda approved yet.
anyone else have this problem? please email me at ***@****
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It is so amazing to read how many of you endure the same or similar symptoms. I am 53 and for the past 3 years have experienced on and off chest pain/discomfort. Thank goodness I have had a great GP who thought nothing of sending me to a gastro. and cardiologist for testing. I was put through every test you could imagine. I was diaginosed with a hiatal hernia, but my gastro. does not believe it is causing the chest pain/discomfort. The cardiologist, #1 in the Tampa Bay area saw me after I was rushed to the ER when at work I thought I was having a heart attack. He scheduled me for an angiogram. It came back great. My heart and arteries are in perfect health. So although this past year I continued to still have chest pain/discomfort, I tried not to worry about it. Now after hearing on the news that the angiogram for women unfortunately does not give them the same clear results that it does for men, I now feel that I have been living with a false sense of security. My cardiologist is having me come back in for further testing. I'm not sure what that is, and by all accounts, I'm not sure they have actually come up with a test for women yet to replace the angiogram, but, I've got to find an answer. I will also see my gastro. I've been reading too much on hiatal hernias, I believe there might also be a connection between that and my pain. For those of you that don't have a doctor who is willing to give you the tests you need, find a doctor who will. They are out there.
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Better paranoid than sorry.
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I AM A 53 YEAR OLD WOMEN I HAVE BEEN HAVING PAINS IN MY CHEST THAT STARTED 6 WEEKS AGO I FINALLY WENT TO THE DR AND THEY TOOK AN EKG IT WAS NORMAL HE DIAGNOSED ME WITH STRESS AND GAVE ME SLEEPING PILLS TO SLEEP AT NIGHT AND SLOW DOWN THE RACING OF MY HEART? I AM NOT SATISFIED WITH THIS. I AM UNDER A LOT OF STESS BROUGHT ON BY MY JOB BUT I NEED TO KNOW THERE IS NOTHING STIRRING UP. I TOLD MY DR THAT ON THURSDAY I WAS JUST SITTING DOWN WATCHING TV AND MY HEART WAS RACING AT 110 BPM. IT HAPPENS SOMETIMES WHEN I AM SLEEPING AND WAKES ME UP. LAST WEEK I WAS DRIVING TO MY MOMS WITH MY GRANDCHILDREN AND ALL OF A SUDDEN AT A RED LIGHT EVERYTHING BEGAN TO SPIN. I AM WORRIED. SHOULD I SEE A CARDIOLOGIST?
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Avatar_n_tn
You need to do whatever you can. First is to find the right doctor, one who is willing to order the right tests. Of course if you have been listening to the news lately, even an angiogram isn't 100% sure when evaluating CAD for women. In your case, you should put your mind at ease and continue to seek out an answer to what is bothering you. It is unfortunate that doctors want to put a label such as stress when a woman comes to them complaining of chest pains. You are your own best advocate. Read and be willing to investigate online if you have the tools to do so. Right down everytime you have a pain, or you experience anything out of the ordinary. It is not pleasant experiencing such things, and it is frightening. I hope you find an answer.
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Avatar_n_tn
Hi Lucyod:

As I understand it, many doctors feel that cardiac conditions are sometimes misdiagnosed as stress, especially in women. Stress has many of the same signs/symptoms of a potentially serious cardiac condition. (Many women have smaller coronary arteries than men and present signs and symptoms of illness sooner than men.) I would definately consult a cardiologist at a major heart facility and have tests to determine the exact cause of the symptoms.

In the meantime before your cardiologist visit, consider a heart-smart diet, cut MSG/extra sugar/salt/caffeine from your diet. Also, try to start walking everyday, which helps you feel better.  Yoga is a cool exercise to try as well.

I have tried the same approach and feel it will give you a good start to feeling better..

Hope this helps!
Tom/7deuceman
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