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Old 03-19-2007, 03:47 PM   #1
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mortgagejax HB User
Chest Pains ongoing after stents/cath please help

36 Year-old, white male. Overwieght (working on it). Switched to low fat low salt heart healthy diet. Slightly high blood pressure. Started having chest pains and/or discomfort in chest and left arm approx 4 years ago. Severity of pains slowly grew worse over time however for the first 3 or so years the occurrence of the pains would wax and wane greatly. Went to ER twice (first time 4 years ago, second time 2 years ago). Each time had normal EKG, blood work and second time normal non-nuclear stress test. The last year issues became progressively worse. Went to ER a third time in 09/05/2006, had a mild heart attack. Nuclear stress test, which revealed a large blockage. Had heart cath and three stents placed in artery with over 99% blockage. After leaving the hospital I still had a constant sense of pressure on my chest so cardiologist scheduled another heart cath for 10/06/2006. This revealed another 75% blockage in a different artery and a fourth stent was placed. This relieved the feeling of constant pressure.

I have still had all of the issues/pain described below since the second heart cath. I have been to the cardiologist multiple times and had an additional stress test with normal result. The cardiologist believes that the majority of the additional pain is not cardiac in nature. Primary thought maybe coronary spasm but cardiologist said no. My primary Dr. does not believe that it related to my gall bladder although no additional test have been performed to confirm this possibility. I also had an upper GI done which turned up nothing..

I have recently started a monitored cardiac rehab exercise program at the hospital.

The issues described below have happened both at rest and with exertion (although, if with exertion will usually occur shortly after the activity is stopped). Pain gets worse as the day progresses. It happens whether I am standing or sitting and even sometimes appears to be brought on by talking. The only thing that seems to help is laying down on my right side and sometimes a long hot shower will help a little. I have also noticed that sometimes sitting back in the couch will make the pressure symptoms described in #2 below worse or bring them on quicker.

Finally, approximately 4 years ago shortly before having any of these issues I took a fall off an outside stair platform. The fall was about 4 to 5 feet. I twisted my ankle and landed pretty hard on my left side. My left side and ankle were very sore for about two weeks. Up until 6 months ago I had not really thought about the fall preceding any of these issues. I have told both the cardiologists and primary Doctors about this. Neither placed much importance on the event.

Symptoms:

Chest pains: Primarily two types of pain.

1.Spasm type of pain: A sharp stabbing/spasm type of pain that feels as if it is one to two inches into the chest area. Usually lasts a few seconds with a dull ache/painful after-feeling. Usually comes in multiple sets of “spasms”. These spasm types of pains are always extremely painful. Closest thing I can compare it to is a hot knife being stabbed into the chest area. The area affected ranges from under the armpit area to almost the middle of the chest and from just below the front of the collarbone to a few inches below the left breast area.

2.Pressure Pain(currently the worst issue):This is a hard type of pain to describe as it has subtle differences (it might actually be more than one type of pain). The description of the feeling would vary to include: numbness, tightness, a pressure/weight feeling and/or a squeezing sensation. While this feeling occurs in the same area as the spasm type of pain it is more often concentrated around the left breast area, particularly just above and/or to either side the breast area. These types of pains range from annoying to very painful.

Other Areas of Pain/Concern:

1.Left arm and neck area: Often I get similar feelings/pain, as described in Pressure Pain above, in my left arm and neck. The numbness/tightness to the arm and neck feels similar to when a tourniquet is applied a little to tight for a little too long. In addition, this is accompanied by an achy feeling in my shoulder and sometimes forearm as though I had been hit or struck in those areas.

2.Back Pain: Sometimes when the Pressure Pain described above occurs it feels as though the pain is going straight thru the chest to the back and causes a sharp pain in the same spot on the back. In addition, I will also have pains in the area where the shoulders and base of the neck meet, however I believe that this is probably just tension pain caused by the stress of the above issues.

3.Vision: Sometimes, usually accompanied by the above described pressure feeling I will notice a pulsing sensation in my vision/eyes. I have taken my blood pressure several times when this has occurred any there has not been any substantial increase or decrease.

4.Tenderness in the chest area: There’s a general tenderness in my left chest area. The severity of this tenderness comes and goes more or less in conjunction with the Pressure Pain described previously.

Medications:
Asprin 325 mg
Plavix 75 mg
Toprol 50 mg extended release
Lisinopril 2.5 mg
Aciphex 40 mg (20 mg in AM, 20 mg in PM)
Crestor 10mg (recently changed from 40 mg Lipitor)
Tricor 165 mg

Any advice would be appreciated...these issues especially #2 have basically riuned my life.

Last edited by mortgagejax; 03-19-2007 at 04:09 PM.

 
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Old 03-20-2007, 05:00 AM   #2
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Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: Chest Pains ongoing after stents/cath please help

jax,

You hace painted a pretty thorough picture of your misery. I will think on it.

But seat of the pants:
1. Have you had your thoracic area thouroughly X-rayed or better yet MRI'd. It sounds like you might have injured or broken something in that fall. Often though, tendon and ligament injuries can hurt like bejesus but be invisible on any test.

2. What happens to your symptoms after a fast(ISH) 10 minute run? Does your chest hurt/squeeze more? Is it a typical exercise angina pattern?
Is the #2 type pain sensitive to changes in body position or to the depth of your breathing?

3. I really think you need another NUCLEAR stress test to confirm that all areas of your heart are being nourished.

Where was that 4th stent placed? It seem THAT was the one they SHOULD have done first. Was it the RCA (right coronary artery.)

Do I read between the lines right and the pain of #2 is not so much debilitating as frightening...fear of another heart attack?

Do you really think you have GERD...is the Acephex very helpful?

p.s. I'm another, like you, who had a plain vanilla stress test and passed with better than flying colors even with an almost complete blockage of my RCA. After 10 years of classic anginal chest pain it took an angiogram to confirm the blockage, In this day and age, that plain stress test test has LONG outlived its usefulness, IMHO <humble, MOI? >. Probably many people got an AOK on it only to stroll home with a smile and soon die of a heart attack.

Last edited by Lenin; 03-20-2007 at 05:12 AM.

 
Old 03-20-2007, 08:26 AM   #3
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Join Date: Jun 2006
Location: North Carolina
Posts: 98
vooda HB User
Re: Chest Pains ongoing after stents/cath please help

Quote:
Originally Posted by mortgagejax View Post
36 Year-old, white male. Overwieght (working on it). Switched to low fat low salt heart healthy diet. Slightly high blood pressure. Started having chest pains and/or discomfort in chest and left arm approx 4 years ago. Severity of pains slowly grew worse over time however for the first 3 or so years the occurrence of the pains would wax and wane greatly. Went to ER twice (first time 4 years ago, second time 2 years ago). Each time had normal EKG, blood work and second time normal non-nuclear stress test. The last year issues became progressively worse. Went to ER a third time in 09/05/2006, had a mild heart attack. Nuclear stress test, which revealed a large blockage. Had heart cath and three stents placed in artery with over 99&#37; blockage. After leaving the hospital I still had a constant sense of pressure on my chest so cardiologist scheduled another heart cath for 10/06/2006. This revealed another 75% blockage in a different artery and a fourth stent was placed. This relieved the feeling of constant pressure.

I have still had all of the issues/pain described below since the second heart cath. I have been to the cardiologist multiple times and had an additional stress test with normal result. The cardiologist believes that the majority of the additional pain is not cardiac in nature. Primary thought maybe coronary spasm but cardiologist said no. My primary Dr. does not believe that it related to my gall bladder although no additional test have been performed to confirm this possibility. I also had an upper GI done which turned up nothing..

I have recently started a monitored cardiac rehab exercise program at the hospital.

The issues described below have happened both at rest and with exertion (although, if with exertion will usually occur shortly after the activity is stopped). Pain gets worse as the day progresses. It happens whether I am standing or sitting and even sometimes appears to be brought on by talking. The only thing that seems to help is laying down on my right side and sometimes a long hot shower will help a little. I have also noticed that sometimes sitting back in the couch will make the pressure symptoms described in #2 below worse or bring them on quicker.

Finally, approximately 4 years ago shortly before having any of these issues I took a fall off an outside stair platform. The fall was about 4 to 5 feet. I twisted my ankle and landed pretty hard on my left side. My left side and ankle were very sore for about two weeks. Up until 6 months ago I had not really thought about the fall preceding any of these issues. I have told both the cardiologists and primary Doctors about this. Neither placed much importance on the event.

Symptoms:

Chest pains: Primarily two types of pain.

1.Spasm type of pain: A sharp stabbing/spasm type of pain that feels as if it is one to two inches into the chest area. Usually lasts a few seconds with a dull ache/painful after-feeling. Usually comes in multiple sets of “spasms”. These spasm types of pains are always extremely painful. Closest thing I can compare it to is a hot knife being stabbed into the chest area. The area affected ranges from under the armpit area to almost the middle of the chest and from just below the front of the collarbone to a few inches below the left breast area.

2.Pressure Pain(currently the worst issue):This is a hard type of pain to describe as it has subtle differences (it might actually be more than one type of pain). The description of the feeling would vary to include: numbness, tightness, a pressure/weight feeling and/or a squeezing sensation. While this feeling occurs in the same area as the spasm type of pain it is more often concentrated around the left breast area, particularly just above and/or to either side the breast area. These types of pains range from annoying to very painful.

Other Areas of Pain/Concern:

1.Left arm and neck area: Often I get similar feelings/pain, as described in Pressure Pain above, in my left arm and neck. The numbness/tightness to the arm and neck feels similar to when a tourniquet is applied a little to tight for a little too long. In addition, this is accompanied by an achy feeling in my shoulder and sometimes forearm as though I had been hit or struck in those areas.

2.Back Pain: Sometimes when the Pressure Pain described above occurs it feels as though the pain is going straight thru the chest to the back and causes a sharp pain in the same spot on the back. In addition, I will also have pains in the area where the shoulders and base of the neck meet, however I believe that this is probably just tension pain caused by the stress of the above issues.

3.Vision: Sometimes, usually accompanied by the above described pressure feeling I will notice a pulsing sensation in my vision/eyes. I have taken my blood pressure several times when this has occurred any there has not been any substantial increase or decrease.

4.Tenderness in the chest area: There’s a general tenderness in my left chest area. The severity of this tenderness comes and goes more or less in conjunction with the Pressure Pain described previously.

Medications:
Asprin 325 mg
Plavix 75 mg
Toprol 50 mg extended release
Lisinopril 2.5 mg
Aciphex 40 mg (20 mg in AM, 20 mg in PM)
Crestor 10mg (recently changed from 40 mg Lipitor)
Tricor 165 mg

Any advice would be appreciated...these issues especially #2 have basically riuned my life.
I after a MI 6 years ago and a stent inplanted still have simular pains and all Dr's say it's not my heart but the muscle pulling from my chest bone, there's a name for it? If I do anything strenious 1-2 days later I get them, it comes and goes, I sometimes have to lie down on my side with my chest muscles closed up. Will last a week or two until I do something that uses those chest muscles.

If you massage the area could you duplicate the pain or does it help ?

Sometimes I'll be doing nothing at all a wammo, it scares the hell out of me. It actually at times feels like someone is taking their thumb and pressing really hard.

Last edited by vooda; 03-20-2007 at 08:27 AM.

 
Old 03-24-2007, 10:34 AM   #4
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Join Date: Mar 2007
Location: jacksonville, fl, us
Posts: 4
mortgagejax HB User
Re: Chest Pains ongoing after stents/cath please help

Quote:
Originally Posted by Lenin View Post
jax,

You hace painted a pretty thorough picture of your misery. I will think on it.

But seat of the pants:
1. Have you had your thoracic area thouroughly X-rayed or better yet MRI'd. It sounds like you might have injured or broken something in that fall. Often though, tendon and ligament injuries can hurt like bejesus but be invisible on any test.

2. What happens to your symptoms after a fast(ISH) 10 minute run? Does your chest hurt/squeeze more? Is it a typical exercise angina pattern?
Is the #2 type pain sensitive to changes in body position or to the depth of your breathing?

3. I really think you need another NUCLEAR stress test to confirm that all areas of your heart are being nourished.

Where was that 4th stent placed? It seem THAT was the one they SHOULD have done first. Was it the RCA (right coronary artery.)

Do I read between the lines right and the pain of #2 is not so much debilitating as frightening...fear of another heart attack?

Do you really think you have GERD...is the Acephex very helpful?

p.s. I'm another, like you, who had a plain vanilla stress test and passed with better than flying colors even with an almost complete blockage of my RCA. After 10 years of classic anginal chest pain it took an angiogram to confirm the blockage, In this day and age, that plain stress test test has LONG outlived its usefulness, IMHO <humble, MOI? >. Probably many people got an AOK on it only to stroll home with a smile and soon die of a heart attack.
Lenin,

Thanks for the reply....

In response to your questions:

1. I have had chest x-rays but these have not showed anything.

2. When I exercise, most of the time there is no difference in pain. The number 2 type pain does sometimes appear to be sesitive to position.

3. I just saw the cardio dr yesterday and went over everything again with him. He did not want to do another stress test or heart cath.

While I occasionally have heartburn I don't think that the Aciphex does much for me. I pretty much started taking it to get the Dr's to rule this out.

The first 3 stents were placed in the RCA (99% blocked) the 4th was placed in the LAD (75% blocked).

Both types of pain are debilitating and frighting in their on right. When they happen they both make me think of another heart attack. I just had another last night (aroung 11PM). There was a pressure pain freeling in the left chest area. It grew worse and then felt like multiple spams several inches below the breatbone. Nitro helped (sometimes it does not). I finally was able to go to sleep. When I woke up this morning a I have an achy residual feeling in the same general area and have had several but much more minor spasm feelings in the same area and feel very week.

Basically the cardio dr's take on my situation is that if the pain is not reporduced with exertion then its not cardiac. My take on it is I don't know how much more of this I can take.

Thanks

 
Old 03-25-2007, 06:50 AM   #5
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Join Date: Nov 2004
Posts: 8,508
Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: Chest Pains ongoing after stents/cath please help

jax,

The number 1 type pain really sounds like it is chostochondritis. I think the odds are extremely good.
Of course #2 type is more worrisome. But since you can't correlate the pain with exercise, it points strongly to non-cardiac origins. A tough point is that your 50 mg. metoprolol may MASK some of the angina on exercise. Do you thinkl the pain would increase without it?

I think you should be more persuasive for another nuclear stress test...the evidence is on your side. Just tell your doctor:
1. You have PROVEN heart disease,
2. You have continuing chest pain that you think may be ischemia.
Ask him WHY in the face of those 2 facts he is resisiting your request for a confirmatory ischemia test? If you REALLY want to get "up his nose", tell him you want his response in writing...he'll order the test, I guarantee it!
You MIGHT also ask him what the Toprol is for?

If only for your peace of mind, you really DO need this test.

<My guess is that the cardiologist doesn't want the evidence of one or more of his stents furring up messing up his "record." It also sounds like his call to ignore the LAD blockage the first time was an error in judgement...he went after the wrong artery.>

BUT, remember though, it can all be costochondritis.

 
Old 03-25-2007, 05:23 PM   #6
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(male)
 
Join Date: Jun 2006
Location: North Carolina
Posts: 98
vooda HB User
Re: Chest Pains ongoing after stents/cath please help

Quote:
Originally Posted by Lenin View Post

BUT, remember though, it can all be costochondritis.
Could costochondritis have been cause by CPR by a very large person (I thank God for her).
Thanks
Frank

 
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