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Chest Wall Pain / Anxiety ?
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SFL234 posted:
Are there tests that can identify chest wall pain caused by inflammation, etc.?


I started having left-side chest pains about a month ago. I went to the clinic the morning after experiencing them the previous night. I had no chest pains at the time or during the course of the day. After describing my symptoms, they hooked me up to an IV, administered a nitro pill, which dropped my blood pressure to 70/35 (scary - I don't think they expected that). Then they loaded me into an ambulance for a trip to the hospital (I think that was CYA, which is fine).

At the hospital, ~9:30am, they hooked me up to an EKG, drew blood for Troponin tests 90 minutes apart, and scheduled a supine exercise-bike stress echo test afterward (with EKG, BP, ultrasound, and I think some kind of dye was injected in the IV). All tests came back negative and they discharged me around 5:30pm.

I went back to the urgent care clinic two days later because the chest pains persisted. A quick EKG, BP, oxygen, and temp test came back normal. The urgent care doc thought it might be chest wall pain and advised an increase in ibuprofen.

The chest pains subsided after a week, but haven't gone away. My primary care physician believes it's anxiety and prescribed Zoloft. The Zoloft (.25mg) has made me more anxious in the first couple of weeks, but a Xanax "crutch" for when I need it seems to offset those feelings. My chest pains aren't as prominent, but they still occur. I know anxiety can cause them, but I have a hard time buying into that when the chest pains occur at 2am while sleeping or out of nowhere when I'm not really worrying about anything.

I think the tests they performed at the hospital, plus wearing a prior 24-hr Holter monitor, are a pretty strong indication that it's not heart-related. However, I'm more inclined to buy into chest wall pain or something else compounded by anxiety than believing anxiety is causing the chest pain. Some doctors have stated that a coronary angiogram is the gold standard for ruling out heart conditions, but based on my previous test results, along with my information below, nobody thinks that's necessary, and I don't really want to do it, either. But, it would be nice to know if there are non-invasive tests that can tell me what it is instead of just knowing what it's not.



Age: 42
Sex: Male
History: no family heart issues
Height: 6'1"
Weight: 170
Active runner (2-4 miles/day). Exercise doesn't worsen the pain.
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cardiostarusa1 responded:
Hi:

"Are there tests that can..."


As reported, if it's say, benign chest wall pain/transitory benign chest wall pain/BCWP/TBCWP (pain may/can be brief or fleeting and often described as being sharp) or costochondritis, it is diagnosed/confirmed via patient history and physical examination, as opposed to specific lab or diagnostic imaging tests.

As applicable, costochondritis (chest wall pain, costosternal syndrome and costosternal chondrodynia) is an inflammation of the cartilage where the ribs attach to the breast bone.

Initially, the symptoms are like those of a heart attack (myocardial infarction, MI) with pain moving from side to side of the chest and to the arms and neck. In fact many sufferers rush to the ER fearing an attack.

Non-invasive diagnostics such as CXR, ultrasound, CT, nuclear or MRI are sometimes used to confirm or rule out other conditions that can exhibit similar symptoms but are dangerous, such as cancerous lesions or heart disease.

In general, chest (right, left, upper, lower, center, side) pain, stationary or radiating elsewhere, with or without accompanying symptoms, has various causes, cardiac and non-cardiac, which includes, but is not limited to, pulmonary, gastrointestinal, musculoskeletal, and psychological/psychogenic.

Also, of the various kinds of heart conditions, some which can occur at any age, symptoms may/can be acute (occurring suddenly), be chronic (occurring over a long period of time), come and go (be transient, fleeting or episodic) or even be silent.

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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Be well-informed


MedlinePlus

Chest pain

http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm

Mayo Clinic

Chest pain

http://www.mayoclinic.com/health/chest-pain/DS00016

eMedicine Health

Chest pain

http://www.emedicinehealth.com/chest_pain/article_em.htm

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Non-cardiac chest pain

Musculoskeletal-related

The chest contains many muscles, bones, tendons, and cartilage and strains or sprains to any of these may/can can cause chest pain. Chest pain associated with musculoskeletal injury is typically sharp and confined to a specific area of the chest.

The pain may/can be brought on by movement of the chest and/or arms into certain positions, and often is relieved by changing position.

The pain may/can be triggered off by pushing on part of the chest and often become worse when taking a deep breath. Though the pain typically last only seconds, it may/can also persist for days or longer.

If/when chest pain increases when you press your finger on the painful site, or if you can pinpoint the spot that hurts, it is most likely chest wall-related pain, which may/can be caused by strained muscles or ligaments or even by a fractured rib.

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WebMD

Heart Disease TYPES

Men/Women


http://www.webmd.com/heart-disease/heart-disease-men

SYMPTOMS

http://www.webmd.com/heart-disease/guide/heart-disease-symptoms

Mayo Clinic

Heart Disease

Symptoms. Complications. Tests and diagnosis...

Heart disease is a broad term used to describe a range of diseases that affect your heart and sometimes...

http://www.mayoclinic.com/health/heart-disease/DS01120

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LEARN ABOUT the Heart


WebMD

The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

http://www.webmd.com/heart/picture-of-the-heart


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HeartSite

Heart info, cardiac tests info, actual diagnostic images.

http://www.heartsite.com

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Quote!

"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society

.

It's your future......be there.

WebMD forums does not provide medical advice, diagnosis or treatment.
 
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James Beckerman, MD, FACC responded:
I agree with you that your work-up so far is very reassuring - and if you were my patient I would be less inclined to recommend an invasive coronary angiogram.

Chest wall pain is a difficult thing to test for. I do think it's valuable that you have determined that anxiety can lead to your symptoms, and anti-anxiety medication can make them go away.

Inflammation of the tissues around the heart (pericarditis) is another consideration for you and your doctors to discuss, although it does seem less likely based upon the information you have shared.

These types of symptoms are often very frustrating, but in my experience if they are non-cardiac they usually tend to go away gradually on their own.
 
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SFL234 replied to James Beckerman, MD, FACC's response:
I had another chest x-ray, which ruled out pericarditis after asking about it. I think I've exasperated my doctors in Minnesota and the last one was probably correct in stating that they're not going to find the cause of my chest pain in an urgent care setting. It's frustrating, but good to know it's highly unlikely that it stems from anything serious. I'm moving and have a follow-up appointment with a doctor in California to see if they can find anything.

I've been taking Zoloft for about four weeks upon a doctor's anxiety prognosis, but it hasn't helped the chest pain yet. I will give it more time before ruling out an anxiety-induced situation. Taking Ibuprofen 3-4x/day every 6 hours seems to help more, which leads me to believe that there's an inflammation somewhere because it flares up and the pain gets worse if I stop taking it. Hopefully, this will all subside over time.
 
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bobby75703 responded:
I was in similar situation to you. Mine turned out to be Pericarditis which took three trips to the doctor to figure out.

Each trip they did an EKG, and the pericarditis failed to show up on the EKG. It wasn't till the 3rd time they nailed the diagnoses with certainty.

Like you, mine was triggered while lying down. The horizontal body postion compresses the pericadrium against the chest wall. ( this is the explanation they gave me) triggering symptoms.

Two causes of pericarditis were quoted. Viral or bacterial. But they didn't quote me the 3rd cause which is low thyroid hormone. Thats what mine turned out to be. My TSH lab of 8.0 went ignored, and I was living with hypothyroidism and didn't know it.

While anti inflammitory drugs relieved the symptoms, treatment with thyroid hormone ended the attacks for good.

Wish you the best in finding the answer to your chest pain.

Bobby
 
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bobby75703 replied to bobby75703's response:
Ironically, I was also in Minnesota when I had my unexplained chest pain. Urgent care couldn't figure it out. Only when I went to ER at Methodist Hospital in St. Louis Park did they catch it.
 
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SFL234 replied to bobby75703's response:
Sorry to hear about that, but glad you got it figured out. My full day of heart-related work-up was at Methodist (Troponin, stress echo, EKGs, chest x-ray, etc.). The cardiologist discharged me same day after everything came back negative. I've probably had 5 EKGs in the last two months, and just had a second chest x-ray a couple of days ago, which another doctor said showed nothing serious. He went on at length to tell me how he's been an ER physician and specifically addressed the pericarditis issue saying it wasn't that. My TSH on the CBC (complete blood count with differential) is within the acceptable range. Hopefully, my persistence is paying off by ruling out anything serious by multiple doctors, but it'll be good to get a second look or corroboration from some doctors outside this system when I move.
 
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bobby75703 replied to SFL234's response:
Wish you the best. Hopefully after you move, a new doctor will uncover something.
 
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SFL234 replied to bobby75703's response:
A doctor in CA tends to agree with the anxiety diagnosis, but mentioned costochondritis or Prinzmetal angina as possibilities of the chest pain, too. She extended my Zoloft medication and ordered more lab work before I see her again in a couple of months. I'm going to visit a psychiatrist after my new insurance cards arrive to talk more about anxiety and tapering off the Zoloft (after six weeks, the stuff still kind of "ratchets me up" at various times in the day). I still get minor dizzy spells and infrequent light chest pain. I'm not sure if the Zoloft is helping or if it's the Ibuprofen I take 2-3x day. I think it's the latter, which is why I want to discuss tapering off the Zoloft. And I'd like somebody more qualified in the field of mental health to weight in on the anxiety prognosis.
 
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billh99 replied to SFL234's response:
Talk to the psychiatrist about cognitive behavior therapy and/or relaxation methods to reduce anxiety.

The relaxation methods include things like yoga, meditation, deep breathing exercises, and imagery.

One source of information is The Relaxation Response Herbert Benson.
 
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SFL234 replied to billh99's response:
Thanks. I'll look into those. Some doctors have already recommended yoga and even acupuncture. I'm giving the Zoloft a little more time to stabilize (the side effects aren't quite as bad now). Aside from the physical effects, the worst aspect of it is when recurring thoughts of mortality ("we're all gonna die some day") pop into my head. It annoys the hell out of me, because it makes me feel like I'm 42 going on 85.


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