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Mystery! Noncardiac Exercise Chestpain

I’m a 38 year old male and have been experiencing exercise induced chest pain for the last four years. The pain generally begins with sudden exertion (running for a bus) or mild exertion that’s gradually increased (moving from the easy part of an elliptical trainer routine to the really hard part). I’ve noticed that the pain usually hits at about 145-150 heart beats per minute. The pain manifests in the upper left quadrant of my chest. If I don’t stop when the pain begins, the pain will spread from my chest to my neck and down my left arm. Slowing down or stopping makes the pain subside. Classic stable angina, right? Wait there’s more. There is no shortness of breath, palpitations, crushing chest feeling, cold sweats, dizziness, or other general signs of heart attack.

I’ve been to several cardiologists for multiple tests. EKG, stress test, nuclear stress test, Holter EKG are all normal. CT angiogram shows no blockages. Calcium score is zero. Blood pressure is fine. Cholesterol is slightly elevated but the “ratio” is fine. Echocardiogram revealed a slight pulmonary valve insufficiency. I am not overweight. I don’t suffer from chronic heartburn (occasional at best). I do have a polyp in my gallbladder, hemorrhoids, and asthma (though this is very mild at this point and I take no medication for it).

My cardiologist believes the pain is heart related. My question is what could it be then? It hurts a great deal and quite frankly makes me not want to exercise. I’ve been a very active soccer player my whole life and can no longer enjoy the game because as soon as I sprint I will have pain.

Could it be spinal? Lung? Muscle? Skeletal? Arterial? Nerve?

Where’s Dr. House when you need him?
2 Responses
Avatar universal
What did the nuclear stress test show? Did any of the stress EKG tracings show ischaemic changes? Did you have symptoms on the treadmill? Since you say your symptoms happen at about 140-150 bpm, an adequate stress study for your age should have taken you at least into that heart rate range (.85 X (220 - 38) = 155).

If no demonstrable ischaemia on stress EKG, despite symptoms, then I don't understand why your doctor thinks you have heart disease. But if your tracings showed exercise-induced ischaemia, and angiography showed no blockages in the major coronary arteries, you could still have microvascular disease, sometimes called Cardiac Syndrome X.

Hope this helps. Again I am not a doctor, just an educated patient.
Avatar universal
Update on my condition. So, my cardiologist thought we should do an angiogram just to cover all our bases but he didn't think he'd find anything. After all, it had only happened to him once before in his entire career that someone would show completely normal with every test only to have a problem revealed by an angiogram.

So I'm lying there on the table getting the angiogram when he goes, "Well, you've got a blockage." Make that two times in his career. I had an 80% blockage in my left anterior descending artery right at the first bifurcation. The choice was stent of bypass surgery. Went with a medicated stent.

Physically, I feel pretty great. I had a stress test the other day and hit 90% peak without any angina pain. Mentally, I'm a bit wobbily but I'm working on it.

The moral of the story is this: no matter what your doctors say, keep pushing them. Though I love my cardiologist he immediately discounted any chance of a blockage in my heart because I have none of the risk factors (no smoking, no drinking, no drugs, not overweight, plenty of exercise, no history of CAD in family, normal cholesterol). You have to take control of your treatment. Luckily it worked out for me. Imagine if I hadn't kept pressing and had a massive heart attack in 2 years.
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