Chest Pain Input Please

I want on a backpacking trip over Labor Day weekend. We left Thur. and arrived in the San Juan Mtns. of Colorado on Friday. We setup our basecamp and on Saturday we did a strenous day hike of 10 miles going to an elevation of 10,600 feet which was an elevation gain of about 3000 feet. Saturday night I awoke with chest pain that increased when taking a deep breath. However, after rolling onto my side for a few minutes the pain eventually went away. I've experienced this pain each night for the past 5 nights and a couple of times during the day. BTW, I left CO on Monday around noon. I went to my GP today and he doesn't know...he says he doesn't think is heart related since the pain went away when I moved to my side. But he still wants me to do a stress test. Anyone have any thoughts on what could be causing this?

Did you fly there (or take a long car trip there in which you were sitting still for a long time)? Are you on birth control? Have you had any leg cramping?

Regardless of the answer to the above, please please ask your doctor to order a D-dimer blood test - simple blood test. That's an indicator of clotting. You could possibly have developer a pumonary embolism. The odds are not high that you have, but could be deadly if you did.

ETA - the fact that it subsides depending on position could mean it is pleurisy, which is often secondary to PE. Please get that test.

Agree with maillotpois on the tip to investigate pulmonary embolism. Also, even though 10K is not that high, high altitude pulmonary edema should also be ruled out.

I had some lovely odd symptoms once, and the doc ordered a d-dimer test. It was up around 500, which I guess was kind of exciting... :rolleyes:

Anyway, please ask for the test. It only takes a blood draw, and it gives some important info!
(which could save your life, and I'm not kidding)

I would 4th getting the d-dimer test. The chance that you have a blood clot is low but the consequences of missing it are BIG.

Having said that it sounds like a blockage of normal rib motion that could have been cuased by your back pack. Once you've ruled out the nasty stuff, go see a DO or PT that is trained in manual therapy, they should be able to help. Right now, you could try placing a tennis ball at the wall and leaning against it with your back but at the same level where the chest pain is or slightly higher. Roll the ball around the area with your back and see if it bings on your symptoms or hits some trigger points. If it does, it's even more unlikely that you have a clot and you might be able to ease you symptoms some with this type of self massage.

I did have a long bus trip to CO and I am on BC. I'm not having difficulty breathing so wouldn't that rule out the PE? 10K is high for someone who lives at 600 ft above sea level. ;) I don't have an appt to see the doc again. Am waiting for them to call me with an appt for a stress test. Didn't have the pain last night but got it this morning. Rolling on my side didn't help this time.

I would go to the doctor for a followup sooner rather than later!

On a side note,... how was the hike? Where'd ya go and what trails did you hike?;)

Long bus trip plus BC are both risk factors for PE. Lack of trouble breathing - who knows what that means. While I did have trouble breathing, it was ONLY at the very high end output levels - fast climbing on a bike, for example. In everyday life, hiking, walking, climbing stairs, carrying groceries, riding my bike on flat or rolling terrain, I had NO trouble breathing at all. I also had a 100% oxygen sat level. And I had multiple, relatively large, PEs in both lungs.

Knowing what I know now, I wouldn't take the risk.

Well, I called my HMO and spoke to my dr.'s nurse. Asked about the d-dimer test. She said they can't give it - that I'd have to go to the ER for those types of blood tests. I've had the chest pain for 4 hours but now it seems to be subsiding. They didn't seem to think that PE was likely but said if I was concerned I should go to the ER. I just don't want to be the one to "cry wolf." Doesn't seem to be an emergency. If my dr isn't concerned...I guess I shouldn't be. They are working on scheduling my stress test.

Maillotpois didn't cry wolf either and I don't think her docs were worried -- thought it was asthma. While you may have to go to the ER to have the test done, your doc can sure order it. That's baloney.

In this case, don't listen to my signature line: it's not supposed to hurt.

When I finally called my doctors office on the Monday having had chest pain over the weekend they freaked out that I hadn't done anything about the chest pain. I guess I got lucky with my doctor. :rolleyes:

I sure hope your doctor is right.

Go to the emergency room!!!!!

I don't want to minimize the possibilities -- the bad stuff that's been mentioned is NOT to be ignored, but:

You say there was a long bus trip. I had an assortment of not-so-long airplane rides this last week, and ended each day of flying in some wicked pain too. Home since Tuesday night, things are finally starting to feel much more normal. Yup, over a week...

DH has decided he prefers window seats on airplanes. He seems to have decided that I really like center seats.

I'm not small enough to be comfortable sitting between two people who are larger than me. It's hard to spend a couple of hours at a time sitting with one's arms crunched tightly at one's sides as though FIRMLY duck-taped to the rib cage with no expansion space allowed for breathing. Oh, and in that curled position that those evil airplane seats force me into -- also aids in the reduction of breathing space...

It was seriously painful to lay in the strange bed at night, for the whole trip, and yes, the first couple of nights at home too -- so I have to ask:

Did you also enjoy the pleasures of not enough personal space during your trip???

Karen in Boise

Your HMO is full of BS.

And I had minimal transient chest pains and NO difficulty breathing, so GET YOUR BUTT TO THE ER RIGHT NOW, DAMMIT and get the d-dimer test.

Do not pass go, do not collect $200, do not complain about it, just DO IT.

Once a clot issue is cleared, then you can have fun taking your time exploring other options. A clot problem can KILL YOU. It can turn YOUR BRAIN TO LIFELESS MUSH if a clot decides to spend quality time in a cerebral blood vessel. (that's what's known as a stroke)

Go to the ER, get the test your darn doc can't be bothered with, and let us all stop worrying.

It's all about us, you know!

BTW: a stress test could blow chunks into your heart/lungs/brain. I think your doc is being horribly negligent not clearing you for clotting issues before running a stress test. Sue his buns off. Or tell your next of kin to do it.

Mom has had multiple pulmonary embolisms. Always very exciting :P because she looks and feels perfectly normal until she's in *really* dire shape. Get the test. You can't tell by looking, unless you've got a CAT scan machine at home.

Torrilin - you're mom's got to be a coumadin lifer, right? Bummer. That's my fear. If this happens again, I am a lifer. Fortunately, I think we nailed and eliminated my risk factor. And I'll be shooting up (w/lovenonx) before any long flights, just in case. :cool:

I agree a stress test shouldn't be the place to start. It's funny they'd rather run a complicated and lengthy procedure instead of a $50 blood test. Whatever. :rolleyes:

Just remember: It's your body, not your doctor's. I am sure your doctor has good intentions, but PE is the leading sudden death killer for a reason - it is often mis-diagnosed or just plain missed.

ETA: In case there's still some perception of wolf crying here - I had an interesting discussion with an old friend of my in laws who is a pulmonology researcher at Scripps in SD. He developed some drug or something that allows premature infants to breathe. Which is cool. Anyway, he was asking questions about my episode and was just amazed that I was okay. He says that the PEs can not only simply cause you not to have enough air, but they can actually cause some sort of neurological reaction that shuts your heart down. :eek:

As said, we all hope you don't have a PE and you probably don't. However, the 5 - 10% chance that you do isn't worth messing around with and waiting for a doctor to figure something out.

Wow, I certainly appreciate all the concern. I didn't go to the ER and I've not had any pains over the weekend. I probably should have gone just to make sure. If it happens again I'll go...but right now I'm feeling fine. Rode yesterday and today with no problems. I'll feel really stupid if it's just "gas" or something like that. :o I will keep an eye one it. Thanks everyone.

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Originally Posted by maillotpois

Torrilin - you're mom's got to be a coumadin lifer, right? Bummer. That's my fear. If this happens again, I am a lifer. Fortunately, I think we nailed and eliminated my risk factor. And I'll be shooting up (w/lovenonx) before any long flights, just in case. :cool:

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IIRC she's not a lifer. The first one they nailed down some of her risk factors, and eventually weaned her off coumadin. The second one happened while she was in the hospital for shoulder replacement #2. Sorta hard to keep her mobile enough with major surgery involved.

li0up, don't feel stupid about getting tests and coming back negative. There are a lot of cheap and simple tests that make life much easier for doctors (and patients!). Much better to use them if it's called for.

I finally got scared enough about the chest pains that wouldn't go away and went to the ER yesterday afternoon. I told them I had been told to ask about this test and the dr. asked if I knew some doctors or something...just told him I had some knowledgeable friends (thanks everyone). Anyhow after talking with me he seemed to be concerned about the possibility of PE and ordered the d-Dimer. It came back "high" and so then I had a chest x-ray and then a CT scan of my chest. I'm happy to report that those came back negative. I'm happy that a serious medical condition like PE has been ruled out but I'm still wondering why I continue to have these chest pains. He still wants me to have the stress test on Tue. He's starting to think that it may be gastric and gave me an Rx. I'll try that and see how it goes.

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Originally Posted by li10up

the dr. asked if I knew some doctors or something...

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:D :p ;)

Wow - well good for you for following up. I am glad the CT was okay. Fun experience, isn't it? :rolleyes: (They used the iodine contrast that makes you feel like you peed your pants, right?)

I am far from an expert but my dad had pains like he was having a heart attack before having his gallbaldder removed. The pain was terrible when he breathed and woke him up at night, since he has elevated blood pressure he was convinced it was a heart problems. What kind of gastric problems was he thinking?

Did they make you drink the fabulous juice for the CT? My husband had 4 CTs last fall and he always mentions how much he hated the drink.

If they were checking for PEs, they wouldn't have had her ingest anything for the CT, but would have run an iodine dye contrast. Which is even more fun... :rolleyes:

Quote:

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Originally Posted by maillotpois

If they were checking for PEs, they wouldn't have had her ingest anything for the CT, but would have run an iodine dye contrast. Which is even more fun... :rolleyes:

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Oh yeah, my husband had one of those too. When they did the CT Guided Aspiration. Being a Crohn's patient, he gets to have all the fun medical procedures. :rolleyes:

Quote:

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Originally Posted by maillotpois

Wow - well good for you for following up. I am glad the CT was okay. Fun experience, isn't it? :rolleyes: (They used the iodine contrast that makes you feel like you peed your pants, right?)

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Wow, that's EXACTLY what it felt like...for a moment while I was laying there I wasn't sure what had happened...it was pretty weird.

I got an Rx for Prevacid and took my first dose this morning. About 45 minutes later I had pretty bad chest pain. Thought maybe I was having a reaction to it. But after an hour or two the pain subsided and I've felt pretty good all day...just minor discomfort. Maybe GERD is all it is. All of this sure has made me appreciate the good health I have always pretty much taken for granted.

Thanks to those of you who encouraged me to go get more tests...I hated to go to the ER but at least now I'm not worried like before.

Not trying to be a party-pooper here, but...

Your D-Dimer test came back "high"

so, where's the clot?

Is it in your heart?

(and yeah, I loved the iodine with the CT scan. My rad was nice and warned me I'd feel it. Weird sensation all right!)

You know......

Knott has a very good point.

Any possibility of a clot elsewhere?

Apparently the d-Dimer is very sensitive. He told me that if I had scraped my knee it would show up on the test. Weird thing is is that I don't have any bumps, bruises or scratches ANYWHERE on my body...so can't acct. for the "high" result. He said that perhaps my body was doing some repair work from the recent hike or recent bike ride and the test picked it up. Sounds kind of iffy to me but that's what he said. I'm just glad to rule out the pulmonary edema...which, as was pointed out to me, is a killer. So I'm just looking forward to the stress test which I'm hoping will show that my arteries are clear with no blockages whatsoever. Then I'll feel okay about riding hard even if I'm having chest pains. As it is now I'm a little nervous when I'm riding.

It's actually pulmonary embolism which you wanted to rule out. I believe that pulmonary edema generally goes away when you return to lower elevation. And pulmonary embolism is the one that kills you instantly.

Every once in awhile, I get a pain in the center of my chest.....it's when my back is trying to go out. It is directly behind my breastbone, which seems to pull on my ribs or something. I can't take a deep breath when it hurts. My back doesn't have to actually go out for it to hurt. But when it does go out, it hurts even more. I describe the pain as feeling like someone stabbed me in the chest. Once my back goes in (or gets put back in) the pain is gone immediately.

Something else you might check into. I hope the cause of your's is found soon, and that it's something easily fixable.

Edna

Ok, I had the nuclear stress test yesterday. Stayed on the treadmill for 12 minutes and got my HR up to 181. Everything went well and I should hear from my doctor "within a few days." Now I'm expecting the ol' ticker to be just fine so when I get a call saying my stress test results are "normal" should I just say "Okay, thanks." and leave it at that or should I press for more info? Seems like after all of that I should get some info that tells me a little more about the health of my heart. What do ya think? As you can probably tell I haven't always been real pleased with my doc's relaying of information. He isn't usually a wealth of information. Maybe I'm just more inquisitive than some. What questions should I be asking?

Asthma could also be a possibility.

Are you still having chest pain? Did they do an echocardiogram at any point?

They probably ruled out asthma, because she's not having any shortness of breath - just chest pain (right?).

I'm still having chest pain several times throughout the day - not intense pain but I notice it being there. Doesn't seem to be related to when I eat, lay down, etc. Yes, I've had 3 EKGs so far and nothing alarming on any of them. Hoping to get the nuclear stress test results today...but don't know what questions to ask other than if any blockages were seen. No shortness of breath. I could barely ride 12 miles on Tuesday...but that might have been due to not eating all day because of the test. Then I got a quick bite at McDonalds about 2 hrs before the ride....so maybe that had something to do with it. I just can't believe that 12 miles felt like 60. Maybe I was just having an off day. Sure hope I get my results today. I'm wanting to try the 100 mile route of the Waco Wild West on the 29th but as it stands now I'm not sure that's a good idea.

By EKG, you mean the thing where they put the round stickers with wires coming out of them on your chest, right? I meant echocardiogram, which is like an ultrasound of the heart. Did you have one of those?

maillotpois, I misread...no, I have not had an echocardiogram...just EKGs and the nuclear imaging - which I'm waiting for results. All the docs seem to think it is not heart related - which is a good thing!

Well, I rec'd my results from the nuclear stress test - anterior ischemia. So it looks like I've got some sort of heart issue going on. I'm going to be referred to a cardiologist. Hope it's soon as I'm still having these chest pains.

Wow. Sounds pretty serious. I hope the cardiologist is helpful. Glad you're being looked after by the right people and what a relief to finally have the issue nailed down. That's got to be the best part - you finally have a diagnosis (from real doctors ;) ) and now you can just get to work on fixing it.

Wow, keep us posted. VERY glad you took this seriously and got tested. I don't know a thing about AI, but hope it's treatable and that you can still ride. Let us know what you find out and we'll all be pulling for you here!

Emily

From an old CCU nurse, "anterior" refers to the front part of the heart and
"ischemia" refers to lack of oxygen. That means that the front portion of your heart is not receiving sufficient oxygen. You could still have normal restng EKG's because there is no heart damage. Normally, ischemia occurs when a major coronary artery is partially blocked and the portion of the heart which receives blood supply from that artery is not receiving sufficient blood supply. There are 4 major coronary arteries. The stress test allows them to view any EKG changes which may occur when the heart is placed under stress/excercise and, since the heart needs more oxygen when under stress, the area of the heart affected will be demonstrated. Sometimes, smaller arteries can be the source of the problem, but usually it is one of the 4 major arteries. The condition is easily treated, sometimes with an angioplasty and the insertion of a stent which opens the artery and allows it to remain open.

Mind you, I am relaying this information mearly based upon the diagnosis of anterior ischemia. We normally think of coronary artery disease (blockage of the coronary arteries) as an older person's disease. However, some people can be gentetically predisposed to this condition at a younger age. The main thing is to get a diagnosis because heart disease is easily treated. Ultimately, this will not keep you off your bike, as excercise will build collateral circulation in the surrounding blood vessels. Please do ask the cardiologist any questions you may have. Ask to see diagrams of the heart and the vessels.

All the best and I know you will be fine!!