Constant chest pain for 2 months after taking Adderall(adderrall)

[JoeJack101]

I'm 21 years old and male.  On April 21st of this year, I was prescribed Adderall (adderrall) to help me deal with ADHD.  When I took it that day, I immediately noticed that I would not be able to continue this medication since it was causing my heart to beat faster than usual (I could feel discomfort).  Here's what's important:  Ever since that day I have had constant chest pain in my left side, kind of a crushing tightness and I can literally feel it in the outline of my heart inside of me.  It is not present on the right side.  I'm certain that this issue began when I took that medication, and due to whatever damage or condition it caused, the pain continues.  I got in to see a cardiologist on June 2nd, and before any tests were even run he had already made up his mind that the pain was simply due to the fact that I had Mitral Valve Prolapse (which I already knew I had).  This would have made sense to me if the pain came in episodes, but there is NOBODY with constant chest pain from MVP, only episodes.  Not only that, but again I can tell you this started immediately when I tried Adderall (adderrall), which I discontinued immediately.  He ended up ordering an echo and a treadmill stress test. The results are posted in other posts below.  He prescribed Toprol XL to take at 25 mgs daily, however the pain has not gotten any better since over two weeks ago when I started taking it, actually worse.  What could chest pain be coming from?  What would you do if you were me?  What are some worst case and best case scenarios?  Perhaps the Echo missed something significant...

[Michael J. McWilliams, M.D.]

Joe,

I can only give general advise here.  Reading all those numbers doesn't make a lot of sense without seeing the study.

Your doctor essentially said that you have a normal stress and good functional capacity.
Your echo is normal other than thickened mitral valve.

They essential told you that they don't believe the chest pain is dangerous.  You cannot have ischemic chest pain that long with damaging your heart muscle  --- that would have shown up on the EKG, stress test and echo.

There are many people that I see in clinic with chest pain that do not have a clear reason for the chest pain.  I view my role as a cardiologist to determine if I think it is dangerous and if it is cardiac.  Not all chest pain is cardiac.  There is no way to prove that chest pain is from MVP but it just so happens that many people with MVP have chest pain.  

I honestly cannot tell you why you have chest pain after taking a new medication.  Unless a clear cause shows up in the work up, chest pain like you describe often goes without a clear diagnosis or cause.  We can put names to like "MVP" or "anxiety" but the reality is that we cannot prove anything in these situations.  We can say that if the cardiac tests are negative and it is not consistent with a blood clot or aneurysm, that it is not dangerous.  I think your doctor was trying to reassure that it was not dangerous.  

Without seeing the studies, I cannot speculate if the echo missed something.  If you go to an ER they would probably do a CT angiogram to rule out PE, rule aortic dissection and they can suggest whether there is coronary disease or not.  The problem is when that study is negative (as it likely would be), you are back to square one.

Worst case scenerios are heart attack, aortic dissection, pulmonary embolism and death. I wouldn't normally state it this way but if you ask a direct question, I have to give a direct answer. It is very likely that your doctor wouldn't miss those and I certainly cannot diagnose them on the internet.  If you are truly concerned that something was missed and that this is serious, you need to see another doctor and an ER is the only route on the weekend.

I hope this helps.

[JoeJack101]

Here's the test results (according to that particular cardiologist):

Echocardiogram:
M-Mode
Right Ventricle:  2.63 cm
Septal Wall: 0.64 cm
Left Ventricle (d) 5.00 cm
Left Ventricle (s): 3.18 cm
Posterior Wall: 0.73 cm
Aortic Root: 3.09 cm
Left Atrium: 2.39 cm

Mitral Valve
Peak E: 0.84 m/s
Peak A: 0.51 m/s
E/A: 1.64

Tricuspid Valve: TR Vmax: 1.93 m/s
RVSP 24.9 mmHg

Left Ventricle: LV shape and wall thickness are normal. Spectral Doppler shows normal pattern of LV diastolic filling.
Left Atrium:  The left atrium is normal.  The left atrial A/P dimension is 2.39 cm.  The atrial septum is intact.
Right Atrium:  The right atrium is normal.
Right Ventricle:  The right ventricular size is normal.  RV wall thickness is normal.
Aortic Valve:  The aortic valve is normal.  No indication of aortic valve regurgitation.
Mitral Valve:  The mitral valve appears myxomatous.  There is mild calcification and thickening of the mitral valve.  Mitral leaflet mobility is normal.  No evidence of mitral valve regurgitation.
Tricuspid Valve:  The tricuspid valve is normal in structure.  No tricuspid regurgitation is present.
Pulmonic Valve:  The pulmonic valve is normal>  No indication of pulmonary valve regurgitation.
Pericardium:  No pericardial effusion is seen.  No pleural effusion noted.
Aorta:  The aortic root appears normal.
Pulmonary Artery:  The tricuspid regurgitant velocity is 1.93 m/s, and with an assumed right atrial pressure of 10 mmHg, the estimated right ventricular systolic pressure is normal at 24.9 mmHg.

Physician Impression:
Ejection Fraction:  estimated to be 55 to 60%
1. Moderate mitral valve prolapse.
2.  Myxomatous mitral valve.
3.  The images were of adequate diagnostic quality.
4.  There is mild calcification and thickening of the mitral valve.

Cardiology Consultation:
Heart:  The PMI is in the 4th intercostal space.  He has got a normal S1 and S2, no S3 or S4.  He does have a systolic click, though.  It worsens when we squat him to standing.

EKG:  EKG is sinus rhythm and complete right bundle branch block, essentially normal for his age.

Exercise Tolerance Test:
Findings: Resting EKG is sinus rhythm, within normal limits.  Patient walked for 13 minutes 28 seconds, achieving 16 METs.  Maximum heart rate achieved was 181, 90% of predicted maximum.  It is clinically and electrocardiographically negative.

Assessment:  This is a normal, regular exercise tolerance test, negative for stress-induced ischemia.

[JoeJack101]

Some of these are outside normal ranges it appears.

Right Ventricle:  Normal would be 0.7 to 2.3.  Mine is 2.63cm.
Septal Wall:  Normal would be 0.8 to 1.1, but mine is 0.64.
Also, I wonder if Left Ventricle (s) at 3.18 cm is abnormal.  It doesn't say.

[judy1386]

A related discussion, Adderall (adderrall)  and mitral valve prolaps was started.