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What Causes Chest Pain And High Heart Rate?
Question: i have been facing chest pain from last few years but whenever doctor carries out thread-mil, ecg , echo all r coming negative. Last one year 3 times i had gone through thread mil and results is its nagaitve at heights load. But my resting heart rate is high around 85-90 for which calaptin 20 mg tablets is advised three times a day. Most of the doctor says its panic anxiety disorder my BP is always between 120-134 / 80-90 my fasting sugar is around 98 and pp is around 90 . Echo shows very minute prolapse in mater valve rest are okay. My cholestol is arrount 150 triglyseride is arround 125 and ldl arround 85 and hdl around 45 please
Brief Answer:
Relax and seek internal medicine opinion.
Detailed Answer:
Dear Sir
A pain chest can have many causes. Classical angina pain occurs behind the breastbone, it comes with exercise/ exertion/ emotional stress and goes away with rest. Repeated negative TMT at high workload are strongly against any possibility of angina. If a subject can do TMT at high workload appropriate for his age and do not experience symptoms of chest pain during TMT, then his pain chest is not considered to be angina in nature.
The Range of heart rate, blood pressure, blood sugar and cholesterol levels are within normal limit.
Too much worrying, panic and anxiety may lead to such symptoms. Try to reduce your stress levels. Do not think on lines of angina pain. Stress itself is a major risk factor for heart attack, hence you must avoid thinking of it. The blood tests, ECHO and TMT are reassuring. There is no test available as yet with medical sciences which can predict a heart attack in a given individual. Hence, you must not try to ascertain it by worrying excessively.
I would advise you to seek help of a good internal medicine specialist, so that he can evaluate your pain and see if there is any tangible /real / organic cause.
Sincerely
Sukhvinder
Relax and seek internal medicine opinion.
Detailed Answer:
Dear Sir
A pain chest can have many causes. Classical angina pain occurs behind the breastbone, it comes with exercise/ exertion/ emotional stress and goes away with rest. Repeated negative TMT at high workload are strongly against any possibility of angina. If a subject can do TMT at high workload appropriate for his age and do not experience symptoms of chest pain during TMT, then his pain chest is not considered to be angina in nature.
The Range of heart rate, blood pressure, blood sugar and cholesterol levels are within normal limit.
Too much worrying, panic and anxiety may lead to such symptoms. Try to reduce your stress levels. Do not think on lines of angina pain. Stress itself is a major risk factor for heart attack, hence you must avoid thinking of it. The blood tests, ECHO and TMT are reassuring. There is no test available as yet with medical sciences which can predict a heart attack in a given individual. Hence, you must not try to ascertain it by worrying excessively.
I would advise you to seek help of a good internal medicine specialist, so that he can evaluate your pain and see if there is any tangible /real / organic cause.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Sir,
In that case how often i need to go through treadmill test and echo .As far as i remember during the first week of JULY 2016 i had gone through thread mill test , echo and blood test please advice.
Everyday i usually go for 30 to 40 minutes of walk and 20-30 minutes breathing excesize. Since my Heart rate is around 90 i am afraid to go for jogging or running as i feel it further increases my heart rate . I would like to ask you can i go for jogging ?
Some times after food i feel my palpitation increases bit high (around 100) for an hour is it okay
sir please advice on the above questions
Regards
XXXX
In that case how often i need to go through treadmill test and echo .As far as i remember during the first week of JULY 2016 i had gone through thread mill test , echo and blood test please advice.
Everyday i usually go for 30 to 40 minutes of walk and 20-30 minutes breathing excesize. Since my Heart rate is around 90 i am afraid to go for jogging or running as i feel it further increases my heart rate . I would like to ask you can i go for jogging ?
Some times after food i feel my palpitation increases bit high (around 100) for an hour is it okay
sir please advice on the above questions
Regards
XXXX
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
1. As per standard literature, there is no recommendation that a healthy male must undergo periodic ECHO or TMT. The person should be subjected to tests only when there are symptoms and the physician thinks that tests will help in arriving a diagnosis. Hence, there can not be recommendation for periodic or regular ECHO or TMT in such individuals. Such kind of periodic testing has not been found to be beneficial. Only a few blood parameters should be monitored regularly; there include blood sugar, blood cholesterol and HbA1c. Their periodicity depends upon their actual level. However, in case of normal values, they should not be repeated before one year.
2. Any person who can do treadmill testing at high workloads without symptoms and his test being negative, can also do jogging. A basal heart rate of 90 bpm is no contraindication. Normal heart rate varies from 60 to 100 beats per minute in different individuals. Everyone has his or her unique range of normal heart rate. Hence if someone is comfortable at 90, its normal for him. It is normal for heart rate to increase during exercise and for a male of age 45 years, a heart rate of 175 beats per minute at peak exercise is very much acceptable, provided he has no symptoms.
3. Heart rate is variable throughout the day. It increases with physical and mental stress and decreases with rest. So some increase after the meals is a normal phenomenon.
Hope it helps.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
1. As per standard literature, there is no recommendation that a healthy male must undergo periodic ECHO or TMT. The person should be subjected to tests only when there are symptoms and the physician thinks that tests will help in arriving a diagnosis. Hence, there can not be recommendation for periodic or regular ECHO or TMT in such individuals. Such kind of periodic testing has not been found to be beneficial. Only a few blood parameters should be monitored regularly; there include blood sugar, blood cholesterol and HbA1c. Their periodicity depends upon their actual level. However, in case of normal values, they should not be repeated before one year.
2. Any person who can do treadmill testing at high workloads without symptoms and his test being negative, can also do jogging. A basal heart rate of 90 bpm is no contraindication. Normal heart rate varies from 60 to 100 beats per minute in different individuals. Everyone has his or her unique range of normal heart rate. Hence if someone is comfortable at 90, its normal for him. It is normal for heart rate to increase during exercise and for a male of age 45 years, a heart rate of 175 beats per minute at peak exercise is very much acceptable, provided he has no symptoms.
3. Heart rate is variable throughout the day. It increases with physical and mental stress and decreases with rest. So some increase after the meals is a normal phenomenon.
Hope it helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Sir
This the last query from my side.
I came to know from my friends that TMT test will be positive when more than 75 % of the blockage . Angiography will give the clear picture is it so ?. Do you recommend this in my case
With reference to the above information i forgot to mention that iam on medication from last 4 years for cholestrol and i take TAB ROZVEL F5 everyday (0-0-1) ( Earlier my triglycerides level was around 180 to 210).
According to Last lipid profile blood results results as i said earlier it is normal. Do i need to stop cholestrol tablet or what is the way to stop this medication please suggest?
This the last query from my side.
I came to know from my friends that TMT test will be positive when more than 75 % of the blockage . Angiography will give the clear picture is it so ?. Do you recommend this in my case
With reference to the above information i forgot to mention that iam on medication from last 4 years for cholestrol and i take TAB ROZVEL F5 everyday (0-0-1) ( Earlier my triglycerides level was around 180 to 210).
According to Last lipid profile blood results results as i said earlier it is normal. Do i need to stop cholestrol tablet or what is the way to stop this medication please suggest?
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
1. Yes, your friend is partly right. An obstruction which is not causing decrease in flow with exercise will not be picked up on TMT. Usually we consider that any obstruction less than 70% will not cause flow to be restricted even on exercise. But, it does not mean that TMT has no role. We do not get anything out of the angiogram by detecting obstructions less that 70% because they are not known to cause decrease flow and thus, symptoms. I hope you got my point, that any blockade which is not causing flow to decrease will not cause pain chest and neither it will be picked up on TMT.
2. Coronary Angiogram is not indicated in a person who can perform TMT without repetition of symptoms at high workload and has normal TMT study.
3. The F component in ROZAVEL F i.e. finofibrate is not recommended for triglyceride reduction unless there is risk of triglyceride induced pancreatitis. This risk is tangible mostly when levels are more than 500 mg%. Hence I normally do not use it in my patients below this level of 500mg%. The indication of rozavel or rosuvastatin can only be decided if we can have a baseline lipid profile. Why was this medicine started at all? Do you have any chronic medical illness? Please provide the baseline lipid profile which was there 4 years back.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
1. Yes, your friend is partly right. An obstruction which is not causing decrease in flow with exercise will not be picked up on TMT. Usually we consider that any obstruction less than 70% will not cause flow to be restricted even on exercise. But, it does not mean that TMT has no role. We do not get anything out of the angiogram by detecting obstructions less that 70% because they are not known to cause decrease flow and thus, symptoms. I hope you got my point, that any blockade which is not causing flow to decrease will not cause pain chest and neither it will be picked up on TMT.
2. Coronary Angiogram is not indicated in a person who can perform TMT without repetition of symptoms at high workload and has normal TMT study.
3. The F component in ROZAVEL F i.e. finofibrate is not recommended for triglyceride reduction unless there is risk of triglyceride induced pancreatitis. This risk is tangible mostly when levels are more than 500 mg%. Hence I normally do not use it in my patients below this level of 500mg%. The indication of rozavel or rosuvastatin can only be decided if we can have a baseline lipid profile. Why was this medicine started at all? Do you have any chronic medical illness? Please provide the baseline lipid profile which was there 4 years back.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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