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Chronic chest pain between center of chest and right nipple,spasm in heart stress test,muscles tight,atenolol

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Internal Medicine Specialist
Practicing since : 1998
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Feel pain in chest half way between center of chest and right nipple about two fingers higher than nipple pain has been chronic i am 55 and take 25 mg of atenolol for about 15 years . Seems like a spasm. Wiegh 210 . 6'1". I had a heart stress test once and had a spasm at the end of the test and it hurt right where i have the pain. Feels like it is under the ribs but muscles are tight there.

Sun, 20 May 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Jasvinder Singh 1 hour later
Hello Randie,

Thanks for posting your query. I can understand your concern for these symptoms and given your history of taking atenolol for the past 15 years, I have 3 possibilities in mind which need to be ruled out. These are:

1)As a thumb rule in medicine, any chest pain in medicine is a cardiac pain unless proved otherwise. You had a spasm at the end of the stress test. So in order to confirm the diagnosis and completely rule out any coronary artery disease, I suggest you to consult a cardiologist and get a coronary angiography done.

2)The second possibility is of costochondritis which is an inflammation of the joints in your chest. The diagnosis can only be reached after excluding more serious causes of chest pain that are related to the heart and lungs and there is no specific test for this. But people have reported improvement after applying warm compresses and taking esophageal spasm which causes non cardiac chest pain. Manometry studies and an upper GI endoscopy can confirm the diagnosis.

It will also help me in understanding your condition better if you could let me know if you have any additional history and symptoms of cigarette smoking, nausea, heart burns or difficulty in swallowing.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.

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