chest pain, stick-in-the-chest

[Angie7]

I'm 61.I've had off and on pain-pressure in my chest area that feels like a "stick-in-the-chest".This stick pain started 4th day after angiogram(angiogram negative.Angiogram was 27 days ago)This morning,I feel chest pressure,a little stick on normal walking.
33 days ago,I had rowing class that gave me a pounding heart beat early next morning.(Prior to this,any heavy exercise in P.M.would cause chest pressure early morning hours.Is this to be concerned about?)I then went to ER.I had nuclear stress test indicating "old"heart attack.Angiogram ordered.10 days ago, my cardio said stress test was a false-positive.How acurate can he be about this assesment?
On follow-up of ER, 24 days ago, my cardiologist gave me echocardiogram,which was negative.He thought I might have inflamation (inflammation) of sac around heart, or spasms. Dr. prescribed naproxen.Pain gone  but left me extremely weak,  malaise. Stopped it 6th day.Stick pain returned along with  pounding heartbeat when walking normally.Now take lopresser,walk slowly.
I use to walk-bike everyday  pain-free for years.
My cardiologist is now on vacation. Yesterday, his associate,who gave me angiogram said, my complaints have nothing to do with the heart. Can this be true? His  echogram  was negative, no fluid-inflamation he said.Suggested seeing internist.
30 yrs ago I would rarely get stick pain at the end of a LONG  tired work day.It would last about one or two hours when I would sleep it off.
What could  stick pain be?Are my concerns Heart related? or from angiogram complications?Lopressor helpful?Are my death feelings
of concern?

[CCF-M.D.-MJM]

Hi Angie,

I won't be able to give you any definitive answers on most of these  questions.  They are bit more involved than an online forum.  If you have an angiogram with out significant blockages, it is possible to have exertional angina from microvascular disease. This requires flow measurements during a heart cath.  The usual patients with microvascular disease is an overweight type two diabetic with hypertension.

It is true you can have false positive stress tests.  It is also true that coronary arteries can remodel after a heart attack and leave no residual blockage.  It depends on your history to decide which event is most likely.

Naprosyn typically does not cause fatigue.

It is possible the pain is non cardiac.  The reality is that pain like yours is often difficult if  not impossible to explain.  The cardiologist ruled out significant disease that would cause pain and probably feels like there is nothing else they can offer at this time.

Your last paragraph makes you pain sound more anxiety/depression related.  This is VERY common.  From what you have written in your post, my best educated guess is the pain is not cardiac and related to anxiety/depression.  The main reason I say this is:
1. negative cardiac work up
2. similar symptoms when you were much younger and very unlikely to have cardiac disease.  The feelings of death are also associated with anxiety/depression.

I hope this helps answer your question.  You can always get a second opinion to be sure.

[Angie7]

Thankyou Dr. for your answers.
In retrospect, I wish that I never had the angiogram, because I feel worse today, now that I feel this "stick-in my-chest" pain. The angiogram seems to have stirred up an old pain that I rarely had. Prior to my angiogran, I would occasionally feel depressed at the end of the day when I felt tired. Now I feel depression throughout the day when I attempt to walk normally, because walking gives me chest pain.
When my cardiologist says that my nuclear stress test was a false positive, it is hard to believe him, after reading the report myself. The report states.."The study demonstrates a large fixed abnormalityu to the inferoseptal wall of the left ventricle with impaired contractility. This finding is suggestive of  an infarct or an area of tight stenosis." Who am I to believe?...  What the cardiologist says or what the nuclear stress test report  states. I don't understand why the cardiologist thinks the stress test is a false positive.
Has anyone else had these issues?

[Carolina03]

Angie,

Microvascular disease could be a cause, even in light of a normal angiogram. The CCF doc is right -- the only way to confirm the diagnosis is through a highly specialized cath. (Try a Google search on "Womens Ischemia Syndrome Evaluation" study or the NHLB's WISE study on women with chest pain and normal angiograms).

I'm taking an ACE-inhibitor and Inspra, two heart medications which have markedly reduced my symptoms from "endothelial dysfunction" or constriction and stenosis of the arterioles, the small vessels.

Keep exercising. Walk, stretch. Give-up rowing if it hurts too much. Build stamina. Rest when you feel the discomfort. Eat right -- this is a big part of remaining symptom-free. I eat lots of whole grains. I also enjoy food and red wine, in other words, everything in moderation.

An antidepressant may help, too. Think of it this way. You have chronic pain and loss of stamina. An antidepressant will help you cope.

There's no cure to date for microvascular disease. The meds help with the symptoms, that's it. There's no cure for atherosclerosis -- CAD -- either. Cardiovascular disease is dynamic. Stents seem and by-pass seem like a cure, but many people in this forum will tell you about multiple therapeutic caths.

Bottomline, Angie, be assertive in your care and keep looking for an internist or cardiologist who takes your symptoms seriously. You may have to do some homework. It's not an easy quest. Don't lose heart. You know your body. Even the best doctors in the most respected institutions make mistakes in diagnosis. Medicine's an art as well as a science.

Hope this helps some.  

C

[jaydens mom]

sorry to use this as a new thread but i can never get one opened. My dad had a triple bypass 15 years ago. Just recently had a cath. done and it showed that 2 of the three that were bypassed are clogged again and not giving the left side of the heart proper blood flow. Dr said doing another bypass is too risky and that no dr would do it. They want to put a defibrillator in. He is a diabetic. They said the vein that they used for the bypass is in excellent condition and that is a good sign as well as the fact that he exercises, watches his diet and takes care of himself as well as being an avid golfer. Do you have any input or suggestions on this?

[LacyMary]

Question:  Can one suffer from CAD and Microvascular disease and is Microvascular disease also known as small vessel disease and how do you diagnose this?

Also, ever since I had my first cath, I have suffered with strange type of sticking pains under the left breast.  They went back in with another cath to check it out and they made it worse and nicked an artery.   Too many unecessary cath's are being done in my book. Now, my HS C-reactive protein is highly elevated.  )-:  There is infection and or inflammation somewhere in the heart.

[Angie7]

Thankyou all for your comments. I can't believe I identify with you all.You have been very helpful.I am not crazy.
My sharp little stabs began after my angiogram 6/22/05. I haven't felt them in several days. Was I nicked in the angio?
BEFORE my angiogram, I had chest squeezing bouts when very fatiqued. I felt like I too would fall over (and die) if I didn't immediately lie down. Elevated feet would take the edge off this malaise.Sometimes these events would make me tired for the rest of the day and sometimes after 2 hour rest, I would bounce back. I had to pace myself carefully. I must say that I (before my angiogram) use to walk every  morning event free followed by carefully pacing myself, with naps, etc. all day long in order to avoid hellish events.
Al Dente, I am very interested  in the diabetic-insilin-heart issue you mention.What do those numbers indicate to  you? Anyone with early morning palpitations?Is there a connection between spasms and insilin?
LacyMary..Sorry to hear about your being over cathed. How long ago did you have it?Are you on medication for inflamation (inflammation) , infection?  I identify so closely with a similar stick in the chest.Mine is in the center of my left breast.I have a slow gait now,because of it.I hope it lessens. I can't figure out if lopressor helps rid palpitaions or not.My palpitations started on the second day I stopped naproxen 500mg, which I took for a total of six days.
Thanks all for helping me understand this "battle to prove our heart issues, to wish for expert treatment to prolong our lives"! Yes, "we know our bodies"!!

[Angie7]

When they gave you the second cath, you say they nicked an artery? How do you know that? Are you taking medication for the infection/inflamation? I was told that I have perioditis (inflamation (inflammation))and was given Naproxen, which made me extremely sick so I had to stop it. Now, I take Lopresser which is not anti-inflamatory, which I don't understand.

[LacyMary]

How did I know I was nicked?  Well, About 8 hours after the Angio/stenting I felt like a weight on my chest.  I complained to the nurses but was ignored. I felt awful. I was also a bit lightheaded.  No heart enzymes were taken before or after the Cath.  2 days later, I told hubby to take me to the ER room. (same hospital) The ER doctor took heart enzymes and they were elevated. He called the doctor on call with the Cardio group I was seeing and this doc on call told the ER doc that I probably was nicked during the angiogram/cath/stent (necrosis) and that is why the enzymes are spilling over and to send me home.  The ER doctor wanted to admit me but doc on call, said no. This was a Sunday afternoon and we figured the doc on call did not want to mess with admitting a patient. (think there was a good football game on that day)  Two days later, my regular doctor mentioned the same thing that most likley one of the heart arteries was nicked and that is why the troponin level was elevated.  This cardio said he would of admitted me.  No one gave me anything for this. I did run a very low grade fever and did not feel well and then the stick light pain continued in the left breast area.

[spencer123]

i'm a 15 year old male and i'm very scared of my heart. reason being was because a few months back i got to be so worried about my heart, that it began to beat very quickly at around 128 bpm at rest. i went to the ER and they did an EKG and checked my blood for thyroid problems. both came back normal. i followed up with my pcp and he said that he strongly doubted that i had any kind of heart problems but i have a very hard time believing him. he noticed that when i stand my HR can increase to 130 bpm. at rest my heart rate when i'm not worrying about it is about 75-80 bpm. this is killing me!! I cannot stop thinking about it and it scares me so bad and i have times where i will just break down and cry. I have done numerous hours of research and i fear that i'm in the early stages of cardiomyopathy. when i excersize, my heart begans to beat very fast very quickly and my heart rate recovery is poor even hours after excersize it still beats fast. i dont know if this could be from just worrying about it or if i have some kind of problem. i also get feelings of wetness in my left chest i dont know if this is cardiac related but my mind tells me it is..i'm so sorry that i use this post for it but i can never get a question post open. Anybody have any kind of clues or the same symptoms?

[Billie Gene]

To Spencer 123,

I was in the hospital for 4 days with knowing something was wrong.  I got dizzy hart racing hard time brathing and paoin around the heart.  I went to three doctors they all said stress.
I didn't agree you can tell something is wrong you know. I went to the ER and the put me in the hospital.  I was seen by a heart doctor everyone told me I was young I should not have problems.
He did a stress test of the heart.  I did the first part of the stress test, but the second part they couldn't even start me on the second part of the stress test.  I had the same problem as you.  When I was sitting or laying down my heart rate was normal when I was standing my heart rate went to 165 the doctor was worried but they did find out what it was. It was not my heart it was my blood presure was very very low it's rare to have a low blood presure, but it made my heart work harder than it should of.  The pain in the chest that I had was my heart was working over time that I had a brused heart cavity.  Other doctors told me for 4 months it was stress and it wasn't.  You know your body and if you feel something is wrong go to many doctors and if they tell you your to young like they told me and you feel something is still not right go to another doctor, but be firm and let them know you know something is wrong!  I hope I helped.  Get a stress test done that is how I found out.

[DIGreener]

I Have been diagnosed with Cardiac Syndrome X / Microvasular disease.  It has been found that my return blood flow is sluggish on it's return. Angiogram is clear and I have had two of them. They have me on Plavix, Advicor, verapimal, .6 Nitro patch with a sublingual and L-Arginine.  However, the pains and episodes have increased.

Q1: Can this be life threatening or do I need to worry about it.
Q2: Laymens terms, please tell what I am dealing with and is there any solution to this problem.