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Have chest pain intermittently. What sort of treatment will solve this problem permanently?

Have had chest pain intermittently throughout the past 10 years; diagnosed as anything from coronary spasm to right ventricular apical ischemia. Five years ago, however, had a negative angiogram. (There was mention on the report following the procedure regarding the fact that they had to administer nitro during the procedure because of spasms; my guess is that this is not particularly unusual or concerning.) Whatever the case, 99% of the time, nitro spray takes care of the problem quickly. Usually, withing 15 - 30 seconds I feel it release and the pain - which is like having someone with a cowboy boot stand on my breastbone with the heel of their boot - will diminish and disappear altogether. Occasionally, more than one spray is required.
In the past month there has been a new development, which is that when I go on walks (which I do year-round), I become breathless quickly. In fact, I usually walk when talking on my cell phone, but in the past month I have to gasp for breath while I do this.
This past Friday, I called my doctor while having one of these episodes to suggest that we schedule a stress test; however, by the time the nurse came on the line I was vomiting from the breathlessness - which progressed to pain AND breathlessness. I "hit" the nitro spray and it began to release, but they had me call 911 for (another) aggravating trip to the E/R. After being held overnight and having a negative stress test (confirming the lack of an apparent blockage), I was really frustrated, because I KNOW this is somehow heart-related, and don't have a firm diagnosis. The good news, however, is the cardiologist on call spoke with me and suggested that it could possibly be diastolic dysfunction. After looking that up on the internet, the pieces seemed to be falling into place for the first time. Past ultrasound (10 years ago) showed that the aortic valve is tricuspid, and I have always had a heart murmur (diagnosed as aortic). My question is this: if this IS eventually diagnosed as diastolic dysfunction, does that account for the chest pain as well as the breathlessness? And, what does the rapid onset (one month) of breathlessness mean? Does the fact that the aorta is a tri-leaflet make a difference? (My father had exactly the same aortic structure and I learned that it can cause the aorta to become less flexible more rapidly than a bi-cuspid valve, if I understood the cardiologist correctly). Is this diagnosis less concerning that having an actual heart attack? Should I skip the ride to the E/R next time?
Asked On : Thu, 11 Apr 2013
Answers:  1 Views:  23
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General & Family Physician 's  Response
Thank for choosing HCM, your over all symptoms are suggestive of Obsessive- compulsive disorders (OCD), but still I would say that the under laying cardiac pathology can not be neglected, you have symptoms are there sine last 10 years & nothing happened to you since then otherwise the prognosis would be grave, you have described that you are on Nitro- Glyceryle spray, I agree that this agents give relief from chest pain rapidly, but Angina is not always stand for cardiac pain, Nitro-Glyceryl is vasodilating agent, and it dilates the vessels if it is constricted with any under laying reasons, so the effects you get from this could be placebo effect, you have a normal life ( Almost), looking to your over all complains I would suggest you to go for certain investigations, like Ambulatory EKG, CT Angiography, MRI of thorax this investigation would clear the picture, you need not worry about the aortic valve,, your symptoms are not co- related with aortic valve anomalies, so I would not talk about it, you need not to compare the reports of your father with your own this will make you more apprehensive, Enjoy your life & have good day
Answered: Wed, 3 Jul 2013
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