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Dr. Andrew Rynne

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Had lumpectomy. Feeling pain in ribs and shoulder. Took aspirin. Symptoms of heart attack?

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Dr. Stephen Christensen

General & Family Physician

Practicing since :1986

Answered : 212 Questions

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Posted on Wed, 12 Dec 2012 in Heart Attack
Question: Just had a lumpectomy on my left breast 4 weeks ago...walked 2 miles for the first time ...came in had some vegetables and ice cold water...had extreme pain underneath my ribs radiating on my left side to shoulder...thought I was having a heart attack...almost went to the emergency room...took aspirins. That was last night...the pain underneath the ribs has subsided...now just aching on left side and shoulder
doctor
Answered by Dr. Stephen Christensen 2 hours later
Hello
Thanks for writing to us
I'm sorry you're uncomfortable. Obviously, without an examination and a few more details about your recent surgery and medical history, it won't be possible to identify the cause of your symptoms. However, there are several thoughts that come to mind here:

Your breasts are supported by ligaments -- Cooper's ligaments -- that get stressed when the breast is jostled. If your lumpectomy was near a Cooper's ligament, exercising may have stirred up some residual inflammation that is now irritating the ligament and triggering your pain.

If you've been relatively sedentary since your surgery, you may have developed a blood clot in one of your legs. Walking may have broken a fragment from the clot, which could have entered your circulation, travelled back to your heart, and thence to your lung. This condition, called pulmonary embolism, is XXXXXXX

I presume your lumpectomy was performed to evaluate a breast mass that may have been cancerous. If the lump was malignant, there's a small chance your pain is due to cancer involving your chest wall.

Your pain began shortly after eating some vegetables and drinking cold water. An esophageal spasm could trigger the type of discomfort you described, and the pain might even persist for several hours after the initial spasm calms down, particularly if you have a bit of acid reflux in the bargain.

Finally, I see from your historical data that you're at an age where heart disease becomes an issue. Thus, it's possible your chest pain is due to ongoing angina (heart pain). Usually (but not always) angina gets worse with exertion and resolves or gets better with rest. In contrast, if certain movements -- stretching, reaching, or twisting -- aggravate your pain, or if pressing on your chest increases your pain, it's more likely due to something in your chest wall than it is your heart.
The bottom line here is this: since it isn't clear what's causing your pain, and since it's possible there's something serious going on, it would be prudent to see your doctor as soon as possible.
I'll be available to answer any additional questions you may have.
I hope that helps, and I hope you feel better soon.

Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Stephen Christensen 45 hours later
I went to the emergency room and the did a heart monitor, echo, lung X-ray and found all results clear. The sent me home to follow up with my local doctor for a stress test if needed.
The internist thought it might be esophageal and prescribed pantoprazolesod dr before meals. I just got up and have pain now in my chest bone and underneath my left breast. I'm using a heating pad and taking it easy.
My question is if it had been a blood clot...it would have been picked up by the lung X-ray right? And I plan to see a gastrologist for the esophageal spasm as well as refrain from exercise for a while right?
doctor
Answered by Dr. Stephen Christensen 1 hour later
A chest x-ray usually doesn't detect a pulmonary embolism, but the ER doctor probably ordered a blood test called a D-dimer that would have helped him/her decide if further investigation was needed. A chest CT and/or an ultrasound of your leg would have been done if the doc thought you had a blood clot.

I'd definitely recommend taking it easy until you feel better. And you're right: a gastroenterologist is the specialist you'd need to see to work up an esophageal problem. In the meantime, try alternating ice packs (15-20 minutes) with the heating pad (20-30 minutes).

Hope this helps. I will be available for further assistance if needed.

Good luck!

Above answer was peer-reviewed by : Dr. Prasad
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