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Dr. Andrew Rynne

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40 years old. Why am I having chest pain while climbing stairs?

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Dr. Anil Grover

Cardiologist

Practicing since :1981

Answered : 922 Questions

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Posted on Wed, 12 Dec 2012 in Hypertension and Heart Disease
Question: Hi I m male of 40 year i have pain in the center of chest while climibing stairs and running
doctor
Answered by Dr. Anil Grover 1 hour later
Hello XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence.
THough you have not given much details. But whatever you have written means that on exercise when your heart needs more blood for itself for the action of pumping, there is shortage of supply. That mismatch causes pain which is also called ANGINA. As you have rate dependent left bundle branch block, therefore, a test like Treadmill Test can not be used to confirm this. You ought to see a medical specialist preferably cardiologist (you will find a department in the Medical College of Nagpur), who would thoroughly examine you, and you will be suggested to undergo a radionuclide study or coronary angiography. This is a necessary to establish that you do not have coronary artery disease. At this stage it is easy to treat. That is the best suggestion I can give you.
If there is further query which you might have I will be most happy to answer. Good Luck.
RegardsWith Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 10 minutes later
my coronary angiography has been performed and that is normal i dont have any coronary artery disease. my echo is also normal i dont have any abnormality in my heart earlier they had given me beta blocker but due to those my blood pressure was getting low then i m shifted on Ivabradine 5 mg bd. that medicine helped me but still after climibing 30 steps i get pain in the center of my chest which subsides after one minutes. this condition exagerate when i have stomach problem and acidity. I am confused what is the actual problem please help me whether there are chances of sudden death please tell me
doctor
Answered by Dr. Anil Grover 39 minutes later
Thanks for writing back.
Then the diagnosis is clear what you have is Gastoesophageal Reflux Disease (GERD), in this condition, acidic contents of stomach spill over to your food pipe leading to cental chest pain. It is aggravated by exercise. NO YOU DO NOT HAVE SUDDEN CARDIAC DEATH MORE THAN ANY PERFECTLY HEALTHY PERSON OF YOUR AGE.
1. Please follow up and take prescription medicines as advised by your doctor(preferably a gastroenterologist with qualification of DM in gastroenterology) . If you have not been prescribed get Metochlorpropamide(Perinorm tablet) prescribed to you. Antacids are available over the counter take 2 table spoon fulls one and three hours after meals.
2. Take one course of tinidazole (500 mg twice a day) for three days for Giardiasis that is at times mimic the symptoms. Your doctor will happily prescribe this.
3. Please do not lie down for at least an hour. That is the time food takes to go down from stomach to intestine.
4. No spicy foods, no alcohol and I hope you are taking proper cardiac drugs (check with your doctor who treats your elevated blood pressure- in fact I am not sure from your details whether you have any raised blood pressure elevation- for certain drug will not suit you) because those relax the sphincter separating esophagus (food pipe) and stomach.
5.With, experience you will come to know what food suits you and what medicines helps you most. Stick to that. Usually, then it becomes self limiting illness with a slight change in life style.

Relax, when the most serious illness has been excluded that is you do not have coronary artery disease and the pain is not because of heart. You did not quite sound happy when you wrote those lines!
If there is further query which you might have I will be most happy to answer. Good Luck
Regards
With Best Wishes
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 14 minutes later
thank you very much sir for your kind words. My endoscopy has also been performed and it is absolutely normal there is no GERD. they say it is due to heart only i m taking antacid regularly Pantocid 40 daily in the morning and i have also completed the course of tinidazole I do not have high blood pressure they have also performed holter monitoring there they say that it is rate dependent LBB. I do have acidity problem since long if I miss my acidity tab then my aciditiy rises very fast so i have to take it daily. they also ruled out the EP study as they say it is arising out of sinus and it sinus tachycardia with aberrant conduction. I am Assistant Professor in Veterinary College, I am really confused if it is due to heart what actually is the problem if you wish I can send you my treadmill ECG and holter report.
Please help me
doctor
Answered by Dr. Anil Grover 1 hour later
Dear XXXXXXX,
As you are disclosing things one by one, obviously, it is not helping. I am open to reconsider everything, I had said.
Why not retell the whole story and send all the investigations and doctor's reports about the various diagnosis, opinions and treatments you have undertaken in a chronological order. I will take some time but definitely come up with enough explanation to answer your primary question or a name of doctor whom you ought to consult so that you can be reviewed by physical examination and any other investigation require. I know, the situation apart from rate dependent intraventricular conduction block which also causes concern not panic- is not as bad as you perceive. Yes, you will have to give me time after giving me all the details. May be you let me know your phone number and tomorrow that is friday evening to give you a call if by tonight you send me throught internet all the details. Regards. (You will have send through WWW.WWWW.WW they have a way to send reports)

Sincerely,

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 10 hours later
Sir,
My problem started in 2008 I was in Mumbai I started feeling chest pain while walking fast and climbing stair case I went to KEM hospital Mumbai after an ECG they say it is Myocardial infarction and throbolysed me I remained in the hospital for two three days they recommended angiography. My angiography was done in Nagpur in 2008 at Cresent Nursing home (Dr. Aziz Khan) and all other allied test were performed which all were normal. The doctor said it might be due to spasm and prescribed betablocker for six month and then stop. my thyroid cholestrol and all other test are normal. In january 2011 I again started feeling the pain frequently. then i went to the cardiologist he performed treadmill test there they discovered rate dependent LBB my heart rate went upto 150 bpm with pain in the chest again I was hopitalized for two days. and given cordron and betablocker though my heart rate was normal after ten minutes. then holter monitor was given and the report was discussed with electrophysiologist he said that it is sinus tachycardia with aberrant conduction and EP study is not indicated he prescribed beta blocker and recommended Cardiac MRI which I have not done. later on Dr. Khalilullah from Delhi was in Nagpur I consulted him he said that twleve lead holter should be done and prescribed me Ivabradine 5 mg bd it helped me for one year then again I started the little pain and when I miss tablet it is always there. I consulted the same electrophysiologist Dr. XXXXXXX Nabar from Mumbai he also said to continue the Ivabradine 5mg bd and said there is nothing serious you go for cardiac MRI to see any abnormality in the walls of the heart due to excess pumping. He asked me to do it at Mumbai. I could not go to Mumbai and it is pending. Strange thing is that some time I get the pain even after taking medicine and some time it is normal no pain. Other wise my resting ECG is absolutely normal many times still it is normal. therefore it is a confusion actually what is causing the pain Dr. Nabar told me that this condition is prevalent in many but there is no pain in others. then why the pain is there i dont under stand whether it is due to heart or respiratory condition since the GERD is ruled out. when I run after some time I started feeling the Pain in the center of the chest when i climb the stairs and after 30 stairs I feel the pain except pain in the center of the chest there is no other complaint. earlier the medicine helped me but now ever after getting medicine some time I feel the pain. my file is quite big it is difficult to send it through inter net one of my colleage suggested the name of Dr. XXXXXXX Jagtap at wochart hospital nagpur
i m in confusion kindly help me
doctor
Answered by Dr. Anil Grover 4 hours later
Sir,

I had requested you to send the scanned copy of all the investigations. So that I can help you. It is possible through WWW.WWWW.WW Ask a direct question and enclose all the investigation to reach me at email address YYYY@YYYY if not directly. Give me few hours after that I will answer your series of questions till your are satisfied. Your quoting names and passing judgement like GERD was ruled out does not help me or you to achive a satisfied client.

Regards

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 3 hours later
Sir,

I have send the reports through mail here it is problem uploading the reports since the size is more than 2 mb

regards

XXXXXXX
doctor
Answered by Dr. Anil Grover 7 hours later
Dear XXXXXXX,

Please write your phone number and email address to my email address YYYY@YYYY You can copy doctors notes on word page. Paste some reports which are pictures on word page and make them smaller this way all the reports can be sent (may be it takes more than one email). I want to give a reply that should satisfy you. Waiting for a day or more will not affect you adversly but an satisfying reply would help you a lot. Therefore, please do not rush. You have seen a dozen doctors who had not been able to diagnose your problem to your problem. Now you have come to me so let me try my best to satisfy you. After getting a written reply I will also suggest a time slot when you can call me to answer your questions if any. Please bear with me. Regards.

Sincerely

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 7 hours later
Sir,

I have already send you the reports by mail on YYYY@YYYY my number is 0000

XXXXXXX
doctor
Answered by Dr. Anil Grover 5 hours later
Dear XXXXXXX,

Thanks for sending me all the details and investigations which I have received and partly reviewed. There is good news and not so good. Good news is that in my considered opinion you do not have risk of SCD (Sudden Cardiac Arrest leading to death or revival in hospital setting) more than a person of your age without any of the findings you have. And not so good is I can not discuss your case with you today on phone or write the detailed summary because I have two emergencies lined up for management over next few hours to late in evening may be night. Tomorrow, I will call you at 2 PM sharp if that time is not convenient please suggest any other time after that or you can call me at 0000 (SMS me the time before so that I keep myself free). As life saving emergencies take priority in a cardiologist's life I have to apologise for today. Regards.

Sincerely,


(ANIL GROVER)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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