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Went to ER with Chest Pain - no diagnosis, but still paranoid
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by Eddie 14, Dec 27, 2005
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.
Answer:
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by CCF-M.D.-MJM, Dec 27, 2005
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.
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Member Comments (20)
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by Eddie 14, Dec 27, 2005
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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by calico1, Dec 27, 2005
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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by jan, Dec 28, 2005
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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by jan, Dec 28, 2005
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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by wazza, Jan 04, 2006
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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by rhuck, Jan 10, 2006
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.