jaw pain

Question #1:If angina presents as jaw pain with no chest pain, what, typically, is the nature of the pain? Diffuse? One-sided? Squeezing? Including the neck too? I have a mild discomfort only in one particular quarter size area of my jaw, just to the left of my chin that comes and goes. It can last a few minutes or a couple hours. Exertion does seem to bring it on, but I also sometimes have it at rest with a heart rate about 75. Also it is no worse with more intense exertion with a heart rate of 140. My dentist couldn't find anything. I've asked two cardiologists about this. One doc thinks its nothing to worry about, the other suggested an angiogram. My history: 39 year old female, healthy weight, Cholesterol total 154, HDL 49, LDL 88, VLDL 17, Triglycerides 83, never smoked, BP 120/70, no family history, not diabetic, pre-menopausal, basically no risk factors at all except that I have panic/anxiety diorder for which I take 60mg Paxil/day. A echo-stress test done 3 months ago was normal. I reached 102% of predicted maximum heart rate during the test. An angiogram seemed too risky to me given the atypical nature of my pain and my history. But the second cardiologist thought that if the pain is related to exertion it was needed. Q2: Can you give me any reasurrance. Does the fact that the discomfort is mild and in just one area mean anything. I feel like most people wouldn't even think twice about it, but here I am considering an angiogram. Q3: How do you determine when an angiogram is needed? Thank you very much for you time and consideration.

[Cleveland Clinic]

andie,

thanks for the post.

1) Angina presents in different people differently. The fact that exertion doent increase your symptoms does however make it less likely to be anginal. Without any significant risk factors, the odds of this being cardiac becomes very small.

2) Im only a person readina snippet of history on the web. Although, as I mentioned above, the chances of a young woman with no caridac risk factors with atypical symptoms having significant caridac atherosclerosis is very small. With a negative stress test, it is near zero.

3) In someone with proceed with an angiogram if there is a significant chance that thier symptoms are cardiac in origin. This is because the wisk of the proceedure is outweight by the risk of not doing the procedure.

Your overall risk of coronary disease is almost zero. You have a negative stress test and symptoms that are not consistant with cardiac pain. I would personally be very reassured by these findings.  

good luck

[andie3330]

Thank you for your kind words. I do have a lot of muscle tension due to anxiety. I wonder if I could be subconsciously causing the pain by anticipating it when I exhert myself. I don't know. But I do know I won't be able to totally write off this pain until I'm confident its not cardiac in nature. So I guess I have more work to do.

[jeff 67]

Does anyone know whether EF is always assessed for a stress-echo? I had a stress-echo but the summary report I have a copy of does not show an EF.

[assured]

I've had the EKGs, blood work, thallium stress test, echo, and heart cath.  I thought everything was fine.  Now you say that small vessel disease doesn't show on those.  Oy!  There's always something to worry about.  When and how do you get evaluated for that?  

Cindy

[upbeat63]

I had a stress-echo last year and they did not calculate the EF. I thought this was standard reporting, but apparently not.

I did call the clinic where it was performed and asked for the EF but I was told it was unnecessary because "normal was normal". However I was told, if I wanted it that badly the echo tech would have to spend more time on it, and that in turn would cost more money! I have a very large deductible, so it was all coming out of my pocket in the first place (stress-echo I seem to remember was $695.+/- , I had other things like lab and holter and doctors visits, so I can't remember the exact number BUT I sure didn't want to spend more money to pursue "normal". Hope you get the answers you are looking for.