muscular skeletal chest pains

[jill42079]

i have been having these terrible sharp pains only on my left side, feel like a heart attack figured i was too young because i am going to be 23 went to the er given a ekg and chest xray both came out normal given a dose of 800mg of ibruphen pain went away for a short while. saw family doctor said thats probably what it is musclarskeltal chest pains went for a echocardiogram with doppler waiting for results to come back my question is, if i have these chest pains is it normal for the left side of my chest to become when i get these sharp pains and i only get them like around my heart thats what makes me nervous the pain can last from a 1min to 20 mins i have to take shallow breaths and walk around for it to go away, i get tired from walking up the stairs and even when i dont have pains my left side of the chest aches alot also i like to work out but with these pains it has been very tiring to do what i would normally do any suggestions -Jill

[cartervw3]

A related discussion, Chest pains was started.

[ograc]

has anyone experienced what is described here? I have a "tightening" feeling in my head, primarily forehead several times a day that will last 10 min or 1-2 hours , it comes and goes. sometimes it feels like 10000 tiny needles. this is accompanied with a tight discomfort in the center of chest and a radius of about 3 in from the center. also a weak feeling in my legs. it seems to come on after a pac or pvc. docs are stumped and don't know what it is. it started about 1 year ago, but has gradually increased where it is now a daily activity. i would appreciate any feedback. many thanks

[isabele]

I'm 18, or will be turning 18 on July 23.  I'm 5'8 and a female.  I've had no problems with menstrual abstractions in the past and they're just fine.  I have given blood two times before, I weigh 135 lbs. and am still in high school.  I'm having problems throughout my body and for a moment, I thought it was leukemia because this all started happening around my heart and maybe I gave too much blood.  I have these sharp pains that start around my heart area in my chest and continue to back of my back, still occuring inside my body and I can feel it from the outside.  I've had dizzy spells sometimes on top of this and believe that it may have been the same case.  Sometimes I get these pains when I'm breathing in and out of my body.  I really can't say I know completely when they occur, all I know is I think I've had this for about a year maybe and it never really started getting bad like this before.  I don't know what is going on.  Please help me to find out.

[isabele]

I'm 18, or will be turning 18 on July 23.  I'm 5'8 and a female.  I've had no problems with menstrual abstractions in the past and they're just fine.  I have given blood two times before, I weigh 135 lbs. and am still in high school.  I'm having problems throughout my body and for a moment, I thought it was leukemia because this all started happening around my heart and maybe I gave too much blood.  I have these sharp pains that start around my heart area in my chest and continue to back of my back, still occuring inside my body and I can feel it from the outside.  I've had dizzy spells sometimes on top of this and believe that it may have been the same case.  Sometimes I get these pains when I'm breathing in and out of my body.  I really can't say I know completely when they occur, all I know is I think I've had this for about a year maybe and it never really started getting bad like this before.  I don't know what is going on.  Please help me to find out.

[squeala7]

Be glad your a man John! The majority of the time a woman says she has chest pains, its ANXIETY. Take a pill. Relax! LOL! THey have done studies that prove that men are given the full range of tests with chest pain and women are not. PRetty scary for women! But your right - chest pain can manifest in so many ways and how do you know, this is it? this is a heart attack? Or if your a woman like me, you wait so long because you don't want your Dr telling you its 'in your head' and you need to chill out! haha - Good luck!

[delta74e]

Hi
i just want to say that many young females are gettign chest pains these days and doctors all too often say its nothing to worry about b/c young women are in a low risk category. i'm sorry, but when most of my female friends (including me) have had episodes of chest pains centred on the left side of the chest and very painful, how is this so?

I quit smoking last yr (social smoker) and recently stopped the pill, and am still getting pains every few mths or so. they range from chest tightening to sharp stabbing pains that last for 5mins, 30mins, sometimes an hr overall.

I don't know what to say to the doctor - do i request a full medical examination or do i say exactly what i've said here? sometimes i think they just dont listen and i dont want to be seen as a hypochondriac!! PS> i have low blood pressure (even when i smoked and was on the pill) and am normal weight & height and mid-20s.

[japanpaul]

One of the frustrating things is that one cannot often ask a question or get a followup, so in the interim, I found Dr. Rich over at about.com

He gave similar advice, and I have just had the tests... A summary is posted here, because I have also heard some people suggest I have intercoastal muscle problems.

Not sure if my notes will help anyone.  I hope they can.
But I am frankly scared/pissed off by the way my case has been handled.  With nothing to compare it to, and the fact that different medical cultures may be at work (or the Japanese doctor is limited by these things that are not within his control), I don't like to jump to conclusions, but hope someone reading this will
see themselves in it and offer theiradvice.


Sent this just now to about.com's Dr. Rich.
--->Have gotten results
after waiting so long, and am as confused as ever.

I hope to get some help to put it in perspective,
if possible referring to my numbered points.

Part of the problem is cultural--this being a country where many Drs are not used to nagging patients. Plus, I am a certified htpochondriac.

I have given some of this before, but afraid it may
be overlooked, so....I am repeating everything by number.
If possible, please make reference to the numbers.



Most of the questions I have for you are in the latter half.

I apologize for being so verbose.  But I am scared and afraid

I am at the wrong hospital. or I will die before they find out.

(1) Background--I am almost 50, always in good health,
obese as a kid, lost most weight, slightly overweight
now, but do aerobic exercise and light strength training
2-4 times a week for the last 4 years, and less often
over the previous 10-15.  I have moderate asthma, under
control with theophylline, house mite desensitization,
intal, sigulair and furotide. Diet is largely
legumes and very little animal meat, except some fish.
However, like chocolate and similar things....
Weight 77 kilos, height 167 cm. As a kid of 13 my weight
was about 190 pounds.  I also take proscar and paxil. Multivitamins,400 IU of E, calcicum/magnesium, co-enzyme Q10, and SOD.

(2) Father had several heart attacks, starting in his 40s,
was a welder, overweignt, heavy meat diet. He died
at 74 of heart failure after chemotherapyt and radiation
for prostate cancer.  Mother died at 74 also from emphesemia
as a 2-pack a day moker (They both smoked Marlboro or Kent!)

(3) I never smoked.  I drink once or twice a month.

(4) Symptoms started nearly a month ago, seemingly
related to chest or other exercises.  Sharp pain, like
Charlie horse in rib area, possibly also in back.

(5) At emergency room they did several EKGS and blood gas
tests.  They scheduled me for follow up tests I had ONE
WEEK AGO. They gave me these drugs, spelled phonetically
since I am in Japan:

-Itorol (regulate beat?)--20 mg AM and PM
-Bufferin 81 mg
-Nitropen (Just 5 stinking tablets in case I had
angina feeling)

(6) In the interim I was advised by both medhelp Dr.
and you  not to exercise UNTIL the results
are known as this could be life threatening.

(7) I was told that the certainty of the results was
only 90 percent by the Dr doing the stress test.
You commened this was
was strange.  It may have been my interprertation
of the Japanese Dr due to langauge or nuance.

(8) Tests were:

(a) bicycle--20 minutes--on (except PVCS)
(b) echo--PVCs
(c) gamma ray camera (they remarked about PVCS during test)
(d) repeat of gamma ray camera2.5 hours later

(9) Today I got the results by the doctor I saw 3 weeks ago.
He said that the expert who evaluated the EKG noted NO
ischemia---I THINK this means good blood flow.

(10) He asked if I had still had chest pain.  I said it had come and
gone.  I avoided exercise but on the few occasions where I
indulged (before I was told by the US doctors NOT to and
AFTER the stress test, when I experienced no pain) I DID
have pain AFTER the exercise--up to several hours to one dasy after, especially with upper arm exercise.

  Results of taking nitropen--inconclusive.
Seems to EITHER have worked, or NOT to have worked.  In
other words, some episodes were SO short, that it could have
gone away on its own.  But at least once it
came back a few minutes later. Even after taking more nitropen or
a normal aspirin.   My impression is that it is muscular
or nerve in origin, but it is ONLY my impression.

(11) Here is where I am confused.  Japanese
doctors are notorious for being ziplipped. Most
Japanese patients trust the doctor to take care of
them but most Americans ask questions.  As a hypochondriac,
I porobably ask too many.

(12) He suggested I continue to take medicine to see.
The medicine is all the ones metioned above in # 5 PLUS
a new one...called Achist--this is
my reading of the word phontically.

(1/2 of a 20 mg tablet in the morning.  I think it
is called a beta blocker. It may have side effects such as
dizziness.  I just got it  and am deciphering the Japanese
instructions! )  

(13) That's it.  No other words of sympathy, or explanation.
I said that an American Dr was shocked that I had to wait
two weeks for a test.  That in the US it would be done within
a day or two.  He said, "There are various opinions".

(14) That got me more angry, though I tried to stay under control..
This is a university teaching hospital with a so-so reputation
in general. For asthma, it is great due to my Dr in that department
being a prince and a good Dr.  I do not know
about heart. It is Showa Medical University
in Tokyo.

[Note..my wife went to a very famous one--Tokyo
Women's Medical University--10 years ago with some
chest pain and had to wait a month after being
told it MAY be Marfan's syndrome--which I researched
and was scared to find is fatal. After a month, was
told that it was NOTHING--just an inflamed nerve
likely, and that the Dr. who made the original
hypothesis was a specialist of Marfan's and says
that to everybody!!!!!!  I went through the rood
then too!!!!!]

(15) Anyway, I said, well why am I getting more medication.
I do not even now understand his answer.  If he gives me
the medicine with the beta blocker and I STILL get the pains,
will that suggest it is NOT heart?  Or that
I have something that NOTHING is effective with???????

(16) I said I heard that Caterization of the heart can help
rule out unclear situations.  He said he was an expert in
this and that in HIS OPINION I DO have ischemia because
he showed me dark pink and light pink pictures.
He said that HIS OPINION was different than the EKG
specialist.  He said he could sign me up for the
procedure in a couple of weeks.  It is quite full
and I may have to wait another few weeks after that.

(17) I asked if it was painful.  They said they
use local (?) anesthesia and I am conscious.
I have to be hospitalized for two days or so.
I decided to wait.

(19) I asked about holter monitors, etc.
He said that if pain persits and the catheter
finds nothing, then he would do the monitor.

(20) He said the test results SO FAR show an
accuracy of 70-80 percent but that the catherization
would show closer to 100 percent.

(21) Now I am stuck...do I go for another opinion?
Do I try a place that will schedule me right away?
As a teacher it is hard to be absent salary wise and
in terms of finding substitutes.  

(22) Do I do the catherization there? What pisses me
off is the attitude towards patients' fears, but I
know nothing of their ability to diagnose or help
a patient manage their disease.  I do not want to
WASTE time if what I am reacting to is
simply attitude toward the patient's right to know
rather than competence.  

(23) If I go to another place (I have to research
where there might be a better place), do I have to REPEAT
all these tests, or can I JUST request catherization?

(24) I am totally confused.  Do all patients who present
my kind of symptoms get this unclear runaround sort of response?

(25) My bp in the hospital was 140 over something.  It is
ALWAYS high there.  It is ALWAYS 120/80 or better when I do
it at any sprots club or the hospital waiting room.

(26) I had all of 12 minutes with the Dr. today.  And
I found they STILL hadn't checked my blood sugar, HDL,
LDL, triglycerides.    

(27) I asked if I had had a heart attack (infarction). They
said no!   But there is likelihood of angina they suggested
based on his interpretaion of the pink/purple color of the
pictures.  And my mentioning I still have pain.

(28) I am pissed because I try to keep in shape
and now I don't know anything.  Why would I have any kind
of heart disease?  Why did I not experience any sort
of breathlessness once in the last month?  Why  
was my performance on the bicycle test fine as
far as the EKG goes (no pain, no fatigue).  Why
am I told to do even more tests and no suggestion is
made to look at other causes in the interim?

While I am taking even more time to look into the heart isn't
my relative lack of inactivity going to CAUSE heart disease?

(29) And can't they see if my artery walls are blocked?  Would't
that have showed up?  Will caterization carry any risk of killing
me if they mess up? Will it be painful?

(30) Last but not least, my wife harps on the fact that I missed
a day or work, which adds to my stress. I can't tell if
she is really being hard hearted (no pun intended) or just
in denial that i could be sick.  Probably the latter.  She was like that when our cat died at the ripe old age of 21.

(31) I do have a grueling schedule of about 50 hours of
work a week at about 5 universities, as do many of my colleagues.
And I complain about overwork all the time, but she poo-poos it.

But my stamina is better than my Japanese wife of 43. I still
intuitively believe it is muscular.  Anyway, I am just confused,
scared, distrustful, angry about the aloofness about doctors
here and have to run into the bathroom at work to cry.

Thanks for your advice.  If you know of any
Japanese Drs/hospitals you think I can trust,
please let me know.   Despite what I have said,
I come across as almost too trusting, which makes
me even angrier when the trust does not get clear answers.

Paul
***@****<----------

Well, that's the super long message I have sent.

Thanks for listening.

Paul in Japan

[johnh]

I, like Jill, suffer from Chest Pains.  I am a man of 53 years and every time I talk about chest Pains they automatically think it's a heart attack.  In the last 5 years I have had 4 stress tests that come back negative.  One doctor finally told me I had Intercostal Muscle Spasms.  However, the last time this occurs I was diagnosed with an ulcer in my esphogus and stomach. (This has been treated) I continue to experience the pains in my chest.  The muscles on my left side hurt like I have sprained or pulled them and the ribs are sensitive to the touch.  What makes it worse is that I also like to sleep on my left side, which doesn't help.  Should I see a sports doctor?  I was doing a daily routine of walking and upper body exercises until my pectoral muscles on my left side started to act up again.

[CCF-M.D.-CRC]

Dear Jill,
There are many causes of chest pain.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  This is much less likely in a young woman and musculoskeletal pain is more likely.  Usually antiinflammatory drugs such as ibuprofen relieve musculoskeletal pain and do not cause many side effects beside stomach upset.  

If you are not getting better then other potential causes of chest pain must be considered.  Gastrointestinal causes of chest pain such as reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm must also be considered.  
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms and help you find relief.