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Is my jaw pain related to heart disease?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I am a 63 years old Indian woman currently living in Sweden . Two years ago I had lot of jaw pain due to tooth problem. After taking out the teeth it went away. At that time I had TMT where I walked for 10 mins. My cholesterol was sometime at borderline sometime below that. HDL was good, so I didn't take medicine.I used to walk everyday briskly for 1 hr. and practice yoga for about 45 mins for the last 35 years. My BMI is 25. I never felt any breathing problem or chest pain. But on the last 3rd July, I got up with a severe jaw pain that wont go. I went to the hospital emergency. My BP and EKG was not normal but they found elevated Tropomine level. So kept me under observation. While the doctor was examining me I got severe jaw pain along with shortness of breath and sweating for about a minute or two. Immediately I got some tablets and the pain subsided after about 15 minutes. Next morning it was discovered that the jaw pain was related to some changes in EKG. Immediate Angiography revealed a 90% blockage in the rt. coronary artey. I had angioplasty and a medicated stent. I came home after two days, with prescriptions of Clopidogrel 75mg, Metoprolol tartrate 50mg, acetylsalycylic acid 75 mg, Simvastatin 40 mg. My Total cholesterol was 5.3mmol/L on the next day after angioplasty, 9 hrs after eating. After coming home I never felt OK. My muscles are always pulling. I have pain allover my body, both bones and muscles. Specially for the last 3 days I am having jawpain with pain in years and teeth. Slightest sound or talking over tlf for 5 mins gives me pain in the jaws. I feel feverish too. I have hot flashes on my face and lips. Last sunday I had a chest pain spreading from left side of chest to whole left arm upto the fingers, also a tingling sensation on the same path. I went to the emergency, they found nothing wrong, said it is muscle pain, not heart related. Now I am very panicked with jaw pain. How can I distinguish between a jaw pain related to heart or not. why do I feel so weak, chilly, feverish and achy? Sometime feel dryness in my nose or breathing difficulty, I don't know.I want to mention that in my maternal grandmother's family almost everyone had died of heart attacks. My parents didn't. Should I go on taking 40 mg.Simvastatin without a blood test?
Posted Wed, 25 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 3 hours later
Hi Saxena,

Thank you for your query.

You had an Acute Coronary Syndrome on the 3rd of July. Since troponin was positive, this can be classified as a high-risk ACS (Non-ST elevation MI or ST elevation MI depending on the changes seen in the EKG) or in layman's terms, a heart attack. The reason for the attack was the blockage in the right coronary artery which has now been treated with angioplasty with a drug eluting stent.

Aspirin (acetyl salicylic acid) and clopidogrel are anti-platelet drugs which would prevent blood from clotting within the arteries and within the stent and thus, prevent another "attack". Metoprolol is a beta-blocker which helps in the pumping of the heart and also regulates the heart rate and BP. Simvastatin is a drug that helps reduce cholesterol, especially LDL which is the "bad" cholesterol. 40mg of simvastatin is usually given after an acute coronary syndrome so that there is stabilization of the deposited cholesterol plaque and if possible, regression of the plaque, as well as lowering of the blood cholesterol levels. The higher doses of simvastatin has multiple beneficial effects in this scenario that go beyond the lowering of blood cholesterol.

As far as your new symptoms are concerned, there could be other non-ischemic causes to explain them since the emergency evaluation did not reveal any fresh cardiac related issues. After an acute coronary syndrome, there is some inflammation of the coverings of the heart (pericardium) which manifests 2 - 6 weeks later and is characterized by fever, chest discomfort (often relieved by sitting up and bending forward), fatigue, muscle aches, etc. The other possibility is related to the simvastatin. At 40 mg dose, in some individuals, there may be an effect on the muscles causing muscle aches, fatigue, etc. The best way to identify this would be to do a blood test for serum creatine kinase (total). If this is elevated, you would need to stop simvastatin temporarily and if possible, restart it later at a lower dose OR switch over to another statin (atorvastatin/rosuvastatin). You will need to discuss this with your treating physician. Of course, it is also possible that you might be just suffering from an unrelated viral fever.

The repeat lipid profile blood test is usually done after 3-6 months only. Statin treatment is a long-term treatment since it takes time not only to reduce the blood levels of cholesterol but also to reduce the cholesterol that has already been deposited in the walls of the arteries. Since you have a strong family history, a recent ACS needing angioplasty and abnormal baseline lipids, it is probably better to continue a statin indefinitely. You may not need 40mg throughout, but that dose is needed at this juncture. As I said, this dose is dictated by the fact that you had an acute coronary syndrome and not just by your cholesterol levels.

I hope that I have been able to answer your queries. Feel free to get back to me if you need any further clarifications.

Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 5 hours later
Dear Dr. Varma,
Thank you for the answer. You have not answered about the jaw pain that I am suffering now, say for the last two days. The pain is more when I talk or someone talks to me. It stretches from below the ears up to the middle of the jaws. As it is hearing related, I am trying to suppress my panic.
Please tell me, the cholesterol deposits are pressed by the balloon during angioplasty and stent placement, but what happens to the clots? The surgeon told me that my blockage was 90%. How was I walking briskly even a day ago?
I want to confess that being tired of the muscle pains, two days in between I took 20mg. Simvastatin(pains were less), but now again taking 40 mg. for the last two days. Will it harm a lot?
The next day after angioplasty etc. I had a ultrasonography. The dr. told me later that although I had an attack, my heart muscles have not been affected. So I can resume slowly walking and stretching etc. after one week. I tried twice, once after a week, once after 2 wks. Both the times I got jaw pains, tooth aches and fever. I have become so weak and prone to infections.
How long time can it take to resume normal walking and Yoga?
If I get an infection can I take penicillins?
Do the statins lower C-R protein? If I am so endangered due to hereditary factors, how can I protect myself from further attacks? I was already taking fish oil and garlic capsules, but that didn't help. What else should I do? My mental trauma is far greater than the physical trauma.
Answered by Dr. Raja Sekhar Varma 11 hours later
Hello Ms Saxena,
Thank you for your response.
1)The jaw pain is probably not related to your cardiac condition. Local factors for the jaw pain need to be evaluated by an ENT specialist/dentist. It could also be that, due to stress, you may be clenching your jaws. You should reduce your anxiety levels by understanding that your blockage has been successfully removed without residual damage to your heart muscle!
2)The blood clots are either aspirated out during the procedure or they are dissolved by means of the body's own mechanisms and with medication including heparin or low mol wt heparin, antiplatelet drugs, etc. The cholesterol debris that is pushed to the side may be slowly absorbed/modified by the statin medicines over a period of time, usually months.
3)Usually, the lesion that causes an acute coronary syndrome is only of 50 - 70% severity (called as "vulnerable plaque"). The inner lining of the coronary artery may suddenly break and the plaque material is exposed to the blood. The blood suddenly forms a blood clot and blocks further blood supply acutely. This process of plaque rupture is the cause for the acute heart attack and happens over minutes. Thus, a block that was non-obstructive suddenly becomes a severe block. If it was 100% block, you suffer from ST elevation MI. If it is not completely occluded, you get a non-ST elevation MI, which is probably what you had. Since the lesion was non-obstructive till just before the acute event, you had no trouble during walking or other exercise.
4)About the simvastatin and your muscle pains, as advised earlier, please do a serum creatine kinase (total). This is a blood test and results will be available on the same day. Depending on the value, your physician will decide on the dose reduction/continuation of the drug.
5)You can return to normal activity and yoga in a phased manner. There is no hard and fast rule and you are the best judge about the level of physical activity. I can only advise you to slowly start walking. Start with about 5 minutes/day and slowly increase by 5 minutes every 3 or 4 days till you are able to walk for half an hour/day. Walk at a comfortable pace. Do not try to do too much too soon. At the same time, you should not be afraid of walking and resumption of exercise. Do not exercise during times of fever, etc.
6)You can take penicillins if you are not allergic to them.
7)Statins do help to reduce CRP.
8)While nothing can be done at present to change your genetic factors, you can reduce the risk of recurrent attacks by controlling BP, sugar, cholesterol, good diet, regular exercise, complete avoidance of smoking. There is no proof of efficacy of vitamin supplements, anti oxidants, etc. However, aspirin, clopidogrel statin and beta blockers have been proven to prevent events in large scale trials. While there is no single measure that can guarantee foolproof prevention, all the measures mentioned above are worth practising.
9) Lastly, I would say that you are lucky that you have survived a heart attack without any major damage. Accordingly, you should look at the positive aspects, invest in preventive healthcare, lead a healthy lifestyle and have a good time. Dont get bogged down by pessimistic thoughts and unnecessary mental tensions.

I wish you all the best for a healthy life. Please feel free to discuss any other issues that worry you.
Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 4 hours later
Thank you so much Dr. Varma,
So nice of you. I feel somewhat relaxed after reading your second message. I think most of my queries are satisfied now.
Health Services here in Sweden and Norway is quite different. They don't tell much to the patients or don't give any test reports to us. Whatever informations I have I got only by asking them. I think generally patients also have little general knowledge as compared to India.
While I was in the hospital two days in succession they gave me some injection in my abdominal muscles. upon asking the nurse told me that it was a bloodthinner. Could it be a medicine for dissolving the clots? Here they give very few injections.
Today I have got a letter from the hospital for a cardiologist check up on 09.09.2011 and blood tests a week before that. In that I can see Krea and all lipid profile. May be Kreatinine but not what you suggested. In this Uppsala city there is no private cardiologist whom I can consult when I feel so. So it is a very relaxing news for me.
Now I am trying to be positive as you said. My lifestyle was always good except some forcing by friends or holidays. But now I shall handle them differently.
Thank you so much for all the help you gave me. Today I am a different person than I was for the last fortnight. God bless you.
With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 48 minutes later
Hello Ms Saxena,

Thank you for the feedback and your good wishes.

The injections given would have been subcutaneous injections of low molecular weight heparin (not into the muscles, but just below the skin). This is a drug that helps to reduce the blood clots.

For your muscle pains, it is worthwhile to do the serum creatine kinase test. I think a general physician should be able to help you out. Any laboratory would be able to do the simple blood test.

When you do XXXXXXX your cardiologist, you could discuss with him also about the muscle pains that you are having.

It has been my pleasure to have been able to help you at this time of your need.

Thank you again for all your good wishes.

Dr RS Varma.
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Follow-up: Is my jaw pain related to heart disease? 48 hours later
Thank You Doctor.
I have got my GP's appointment on 22nd of Aug. It is like this here.
Anyway what I want to ask you is about the continuing jaw pain. I don't want to see any dentist here. Two years ago one dentist fractured my tooth while feeling and drilling. A second one did root canal over that fractured tooth causing severe jawpains. Since then I suffer with my jaws. It was only in India that my dentist found that the tooth was fractured and removed that. Since then I forgot about this jaw pain.
But after this heart problem it has become a daily affair. I have marked that it starts with certain positions of the neck or even little cold wind, suppose if I lye on my back or the window is slightly open. I have some Cervical Spondylosis that I managed with Yoga, but I don't do them now. Is it OK to do some neck exercises? Earlier I used to take Ibuprofen. But now I am told not to take that. So what can I take for this type of pain or sometime inflammation elsewhere ?
You told me to walk upto half an hour. Can I walk more if possible, may be after six months?
I am supposed to go to Kolkata in November, if I live till then. Can you please suggest any good cardiologist in Kolkata for my further treatment?

We have to go to Norway for some official work because we are norwegian citizens. When can I sit in car for about six hours (may be with some break in between)? My husband will drive and the roads are very good.
I am still too traumatized and thinking of having another heart attack any time. I don't think I can get rid of that thought. What are the warning signs?
I cook in Olive Oil, don't eat butter, ghee or cheese, don't smoke or drink. Eat mostly fruits and vegetables, sometimes fish or chicken in very small amount. What more can I do?
Thanks for all the advices and supports you gave me. God bless you with everything you desire.

With all good wishes,
XXXXXXX Bose Saxena.
Answered by Dr. Raja Sekhar Varma 3 hours later
Hello Saxena,

Thank again,

Your jaw pain could be related to cervical spondylosis and it could also be related to your dental issues. A good clinical examination and relevant investigations depending on the clinical examination will help to diagnose the problem.

Yes, it is ok to do your neck exercises.

Naproxen is the anti-inflammatory analgesic that has been shown to have the least cardiac side-effects. In some countries, it is available over the counter, and in some others, it is a prescription drug. You will have to check with your physician for the prescription and dosage. Half an hour is the minimum recommended walking time. Avoid too much straining,.

While I do not personally know a cardiologist in Kolkota, the BM Birla heart research centre and the Apollo hospitals are reputed centres.

Yes, you can travel to Norway in a car. Have a relaxed trip and if possible, break the journey every 1-2 hours for stretching your legs.

I really think you should stop worrying about recurrent heart attacks. You have done well so far and you are on the best possible medicines to prevent a recurrence. Re-inforce your positive thoughts, take your drugs regularly and lead a healthy lifestyle to prevent a future attack.
You should be careful if there is any chest pain or a squeesing sensation in the chest, which may or may not radiate to the inner aspect of your left arm, or jaws. This may be associated with breathing difficulty or sweating. An ECG taken during the period of discomfort is usually diagnostic, especially if compared to your previous ECGs.

Rest assured that you are indeed doing everything you can to prevent an attack. While you should be aware that it could occur despite all precautions, such an event is not really under your total control.

So, do not worry about the future. Live in the present and enjoy the current moments of your life. Control of BP, sugar, cholesterol, diet and exercise, and the necessary drugs will help you in your fight against heart attacks.

I wish you all the best for a healthy life.

Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 6 days later
Dear Dr. Varma,
Forced to write you again because I never feel good. My neck pains are not due to spodilytis , because I know how it feels. Now all the muscles in my head, neck, nose and throat area are often pulling, getting worse day by day. Due to that I am having constant pain in my jaws and head. Pain is not increased while I eat. My hands and feet are getting cold. Sometime I feel out of breath and have to take a long breath. Sometimes I feel hot air coming out of my nose and throat. Today I got scared for an incident. Today is 21 degrees, but windy. After I got up in the morning, I was OK for some time. Later suddenly the problem started, my throat also got little choked. Still I decided to go out for a little walk, As soon as I went to the balcony to test the weather, all the muscles in the neck area started pulling vigorously. I came in immediately and dropped the idea of going out today because I felt like dying . On the day when I got the heart attack I was sitting under the A/C in the hospital for some time. Then also I got vigorous pain in my jaws. Right after that I got the attack. So I think it has some connection with heart. Or is it the side effect of some of the medicines that I am having? At that time the pulling of muscles was not there. My condition is deteriorating since I came home. I can't sleep either. Mostly I have running nose and choked voice, feeling sleepy most of the time, but sleep very little at night. Please advice what to do.
With all good wishes, XXXXXXX Bose Saxena.
Answered by Dr. Raja Sekhar Varma 2 hours later
Hello again,

Thank you for your query.

I think your running nose and choked voice may be due to a viral infection, a common cold or an allergic rhinitis.

It is possible that the muscle pains are due to the effect of the statin that you are taking. Have you been able to do the blood test (CK total)? What is the value mentioned?

It is known that blood vessels tend to constrict when you are cold. There may even be bronchospasm at these times. If you remain well covered and protected against the cold and the wind, you should feel better.

If you think that this is a recurrence of your angina, you should get an ECG taken during the time of discomfort. You could also consider doing a stress test to see if there is any recurrence of a coronary blockage. If the stress test is negative, you dont need to worry. If it is positive, you may need a repeat coronary angiogram.

I think that you are having a lot of worry and anxiety. I suggest that you discuss your fears with your physician. He may prescribe you an anxiolytic drug that could help you.

I hope I have been able to answer your query. Feel free to contact me with the details of the blood test, as and when you can get it done.

Wishing you all the best,
Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 12 days later
Dear Dr. Varma,
Thanks for your reply. Lot of things happened after that. So I could not write. On 1st of Aug, I went out with my husband.Just after 10 mins walk I got the jaw pain again. We went to the hospital emergency again. The ECG, BP and blood tests were OK. But I insisted for a 24 hrs. holter ECG. When the doctor talked to a cardiologist, he suggested to admit me. You know, being everything stateowned it is difficult to be admitted in a hospital here. Anyway, next day I had stress tests. I could not walk even for 5 mins, my jaw pain came back along with chest pain. So next day there was Angioplasty again. Another surgeon was there. He found some atherosclerosis behind the earlier bolckage, that was not properly visible. He repeated the Angio from the groin immediately to have a broader look with a broader catheter. After that I don't know what he saw, later I came to know that he has placed 5 more stents in a row. He was just looking everywhere, as I understood. Still now I don't know why he placed so many stents. While I was in the hospital , I was visited by Cardiologists who are medicine doctors. They also could not answer my question. But anyway, I feel better now. Except that I am little weak. After the Angio, I had fever, vomitting etc. So, I was in hospital for five days.They have added two more medicines. Ranitidine and Felodipine 2.5 mg. My Plasma Kreatinine is 51umol/L. Is it what you wanted to know? P-Cholesterol 140.4 mg/L (3.6 mmol/L), HDL 39 mg/L(1.0), LDL 78 mg/L (2.0 mmol/L) , Triglyceride 87.2(0.98mmol/L). No change in Simvastatin or other medicines. I want to bring down LDL to 60, and HDL up to 60.
I would like to have your advices.
With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 28 hours later
Hi again,

Thanks for writing back.

I notice from your your post that the problem in the heart has been tackled well now.The number of stents may be to prevent a large segment blockage.

The reading of the blood tests you mentioned are normal for you with some nonserious derangements. A low fat and a low salt diet with the medications you are on will suffice.

Also the serum creatinine value you have mentioned is within normal limit, need not worry.

Wish you good health.
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Follow-up: Is my jaw pain related to heart disease? 19 hours later
Dear Dr. Varma,
Thank you for your reply. I feel much relaxed after reading your opinion. Although I feel much better now, some little problem is there. That is jaw pain. I know this is not related to heart, but still it scares me. Now I still have some jaw pain, just below the ears, along with ear pain and upper and lower front teeth pains. Talking to telephone or hearing a loud sound triggers throbbing jaw pain. But the pain is not severe, it goes away with some massage , but comes back some other time. There is also cough running from nose to throat. Cold also increases the pain.This started after I came back from hospital.
So I could not tell them. I hope, after so much treatments and monitoring it can't be for heart. What do you think?
Thanks again. With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 9 hours later
Hello again,

Typically pain around a tooth, jaw pain, just below the ears, along with ear pain and upper and lower front teeth pains are caused by a dental problem, such as a dental cavity, a cracked or fractured tooth, an exposed tooth root, or gum disease.

Sometimes diseases of the jaw joint (temporomandibular joint), or spasms of the muscles used for chewing can cause jaw pain like symptoms.

The pain can range from chronic and mild to sharp and excruciating pain. It can be a dull ache or intense pain. The pain may be aggravated by chewing or by thermal foods and liquids which are cold or hot.

A thorough oral examination, proper tooth testing and evaluation, along with appropriate dental x-rays, can help determine the cause.

What we want to know is whether the toothache is really coming from a tooth or somewhere else.

Sometimes it involves the ears (such as inner or external ear infections), and sinuses (air passages of the cheek bones) such as sinusitis (infection of the sinus cavities).

Touching a specific spot in or near your mouth triggers a sharp, jabbing pain lasting a few seconds. Sometimes talking may also cause this to occur.

Possibly it could be a neurological condition known as Trigeminal Neuralgia.

See your dentist or endodontist to rule out a possible dental cause. You will most likely be referred to dentist who treats this type of pain or physician such as a neurologist. Neurologists specialize in treatment of nerve problems.

After doing all tests and treatment for the heart related problem, I doubt it could arise due to it again.

Wishing you good health.

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Follow-up: Is my jaw pain related to heart disease? 11 days later
Dear Dr. Varma,
Hello! Once again problem. I value and trust your evaluations, so I am writing to you again. I was recovering slowly, except the nagging jaw pain that was coming and going.
On 23rd at 2 am I got up with severe chest pain (only Upper chest). I tried nitro, it didn't help. then I rang to medical Advice phone number here. Nurses are posted 24 hrs for advice. She told me to go to the hospital by ambulance. We called ambulance. In the ambulance they did EKG and said it was normal. But still they took me to the Emergency. Blood Test was also OK. After long wait, a cardiologist examined me and when she pressed my chest, I had very much pain allover the chest. She said these are muscle pains, I should do exercises to relax my muscles.
Today while trying some simple strech, I felt a strong pain at the middle of the chest, just below the heart. The pain shot up to the jaws immediately. The jaw pain lasted for about two hours. In the mean time I took 3 nitro s, because I didn't want to go to the emergency again. I also took 1 Ranitidine. Now it is six hrs after that, I don't have the pains, but if I talk I have the same pain in upper chest, ear, throat and neck muscles. Also the jaw bone, like I had during the stress test. For the last 4-5 days I have a hidden pain just below the chest, same point. If that point is pressed while doing something, I feel pain, that sometime spreads to the upper chest and lasts for hours. The pain is felt if I sit staight on a chair , and spreads to the upper chest. If not disturbed, the pain is very slight, or may not be felt. I have tried paracetamol 1000 mg as suggested by the doctor, it doesn't help. Can you please tell me what could it be? Do you think it is serious?
It is not possible to consult a cardiologist here before the Sept.9th. For anything related to heart I have to go to the Emergency. They will say the same thing. If nothing is found in EKG or Blood test they won't do anything. I can talk to a cardiologist if the general physician thinks so.
Now I can slowly walk for 20 minutes and do the cooking etc. No breathing trouble or lack of energy. But when these pains start I can't do anything for hours. What should I do?
Thanks for your sincere help.
With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 11 hours later
Hello Ms Saxena,

Thank you for writing back.

It is apparent from your history that this current problem is of a musculoskeletal nature. The fact that the pressing over a particular point elicits the same pain is characteristic.

A common cause for this is an inflammation of the costochondral joint (costochondritis), i.e. the joint made by the rib with the cartilage from the bone in front of the chest. This is a harmless disease, except for the discomfort due to the pain.

Since the EKG and the blood tests done during the episode of pain were normal, it is very unlikely that the pain is due to the heart problem.

Is it possible for you to upload the EKGs on this website? Also, they must have given you reports of the angiogram and the angioplasty procedures. Please upload them as well. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

If the pain now is a musculoskeletal pain, it will get relieved with analgesics. Also, you could use analgesic ointments (like Diclofenac gel) for immediate relief. While you should not take analgesics on a regular basis, an occasional tablet to relieve severe pain is acceptable.

I hope this answer helps you. Please get back to me with the reports.

Awaiting your response.

Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 32 hours later
Dear Dr. Varma,
Thank You for the answer. Here they don't give us any copy of EKG or reports. Still I have got some reports about the stents because I wanted them while I was in hospital. I need to keep them because if I am sick in another country I have to show it to the doctors. Here they have everything in the database, and whoever treats me will see there. Moreover all the documents are in Swedish Language. I am sending three papaers. Some of them may be selfexplanatory from the pictures. Others you may try to read by using google translator.
I can feel that my muscles have become so soar and stiff that whatever I do I feel pain. I feel pain in my throat and breast muscles when I talk. Is it due to that I have reduced my Vitamin E and fish oil suppliments because I read somewhere that they are also blood thinners? They should not be taken with bloodthinners. Is it true? Although they could not save me from the attack, but now I am afraid of everything. Earlier I used to take garlic capsules also, that too I have stopped since the heart attack.
I have the diclofenac ointment at home, little improvement after using that.
Please write your suggestions.
With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 4 hours later
Hello Ms Saxena,
Thank you for the reply.

From the picture, it is evident that you had blockages in the Right Coronary artery and drug-eluting stents were used to treat that. However, I could not understand the Swedish language notes. Since all the three reports are in .jpeg format, it was not possible for me to use Google translator. I think you need to scan the reports such that the words can be selected and copied into the google translator (editable .pdf format). Otherwise, you will have to give me a translated version.

The muscle pains could be related to the statin that you are taking. You could reduce the dosage and see the response. There is no need to reduce the Vit E dosage. Vit E may protect the muscles from the side effects of statins. I also feel that the Creatine Kinase test should be done. It is different from the Serum creatinine that was done.

I wish you a speedy recovery. Please get back to me with the reports.
Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 19 hours later
Thank You Dr.Varma,
I can tell my Noregian Dr. to do this Kreatin Kinase. I am scheduled to see her on 14th of Sept.Here they have sent me the list of tests that will be done this week. I cant see this name.
I could not translate with google. Anyway I translated it myself. Many english words are written with different spellings in Swedish If you read them pronunciation is same. I have tried to translate as many words as possible. Please write if anything is unclear.
Thank You so much for your wishes. I am trying to come up. But I dont know how much time I shall need. Since last evening I was feeling dizzy. This morning I had the same feeling. I measured the BP with our home Omron Comfort. It was 157/99.
After resting it has come down to 137/76. I dont understand why these things are happening.
Thank You so much for your help.
God bless you. XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 3 hours later
Hello Ms Saxena,

Thank you for the reply. The reports clarifies a lot of things.

You had a minor attack in July. There was a blockage in the right coronary artery which was treated with angioplasty and drug eluting stents were used to clear the blockage. During the 2nd time, further blockages in the same artery were found which were also cleared with angioplasty and stenting. The left sided arteries apparently dont have any significant blockages, so there is no worry on that account.

It is essential to do the serum creatine kinase test. This is an enzyme which is released from the muscles into the blood if there is any injury or inflammation of the muscles. If there is a significant rise in the level, the statin dose may need to be adjusted.

During any time of stress, the BP, especially the systolic BP is bound to increase. You should not worry about it. Instead, try to avoid stressful situations and resolve the anxiety by analyzing it and understanding the fact that unnecessary tensions and anxieties are not good for your physical and mental health.

Drink lots of water and keep yourself well hydrated to avoid any postural fall in BP. This may be a reason for giddiness. There are many other unrelated, noncardiac causes of dizziness as well. Please see if the giddiness occurs randomly or if it is associated with certain movements of the head, or getting up from a lying down position, etc.

BP taken during lying down position and while standing, as also seeing the pulse rate during the episode can help. If the giddiness persists, please consult your treating physician who will do a thorough examination to identify the cause of dizziness.

I hope this helps. I wish you all the best.

Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 25 hours later
Dear Dr. Varma,
Thanks for your supportive and relaxing answer.Yesterday I went to the hospital because the Medical Support Line told me to do so. Later on my BP became 167/102. So my husband rang to the Help Line. The usual blood tests and EKG were OK. Today they did a Stress Test (Trade Mill)too. This time I could walk for 14 minutes and surprisingly my BP was 135/75 throuhgout, no abnormality in EKG during that period. So the Cardiologist reffered me to a Neurologist. He also found no abnormality. He said it is not Neuralgia, because the pathway of nerve is different. He thinks this is post traumatic, because I suffered a lot during the last two months.No medicine needed.
My muscle pains are much less after reducing the Simvastatin. A test is due this week before the doctor's apptt on 09.09.11.
I feel somewhat relaxed now. Let us see and hope for the good.
Thank you so much for your sincere support.
God bless you. With all good wishes, XXXXXXX Bose Saxena
Answered by Dr. Raja Sekhar Varma 20 hours later
Hello Ms Saxena,
Thank you for the feedback.

It is good to know that you are feeling better. It is comforting to know that you could walk so much and have a negative TMT. Neuralgia was not really a likely diagnosis and the neurologist has confirmed that.

Since the muscle pains are better after reducing the dose of simvastatin, it is probably statin-related myopathy.

There is no cause for worry now, since there is improvement on all fronts. Please continue your diet, exercise regimen and all appropriate drugs to stay healthy.

With best regards,
Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 58 days later
Dear Dr. Varma,
Happy Diwali!
Since long time I was thinking to write to you. I got a copy of my ECG which I wanted to show you. Because of some problems, I Can't say how I feel now. On 05.10. my Total Cholesterol was 109.2 mg/L, LDL 54.6 mg/L, HDL 39mg/L, Triglycerides 80.1mg/L. Then I got 5 mg Crestor. Another test is due on 02.11. But with crestor my muscles became worse. There is often a pain spreading from left underarm or shoulder to the left ear or jaw. Sometime the neck and jaw muscles contract so as to keep my head lowererd for several hours. Paracetamol does not help.Massage helps a little. Sometimes the area below the chin and throat area is burning with slightest heat or light. One day the burning spread from there to the chest and left arm. I went to the emergency. The doctor said it was due to acid and gave me a liquid anatacid. Since then it happens almost once or twice everyday. I try to convince myself that this is not due to heart. But everything happens in the neck or jaw area so as to make me panicky. I feel too much blood circulation in my jaws or hands. is it the side effect of some medicines? Because of these problems I have to pass through many sleep disturbances during the nights.

We have purchased tickets for Kolkata for 16th Nov. Qatar Airways journey is for 14 hours via Doha. Still I am worried if I can make it. Due to long walks in the airport, he has ordered a wheelchair for me.
Now I can walk for about half an hour, but as these pains are starting any time, I can't judge if my heart is OK or not. There is often pain in the jaw joint or the jaw bone eitself, even if touched. I know this can't be from heart, otherwise I would have collapsed by now. Still they limit my walking, because I can't cover my face when I go out. My GP has found that I have low Vitamin D, which is commomn in this part of the world. I am taking Vitamin D suppliments for some years.
Can you please comment on my ecg ? I am worried for the burning in the jaw area and the spreading pain from the arm to jaw. Please help me. Are they serious? Can I take the journey?
With all good wishes, XXXXXXX Bose Saxena.
Answered by Dr. Raja Sekhar Varma 2 hours later
Hello Mrs Saxena,

Thank you for your kind wishes. I wish you and your family a very Happy and Prosperous Diwali too.

I have reviewed the ECG that you had uploaded. I feel that the ECG is quite normal. The rate, rhythm, QRS axis, PR interval, QRS duration, QT interval are all normal. There are no significant ST T changes.

In the inferior leads, there is a nonspecific intra-cardiac conduction delay which might have been related to the mild heart attack that you had before. It is reassuring that there are no abnormal Q waves, and thus, there is very little chance of having suffered any great damage.

In short, your ECG is completely satisfactory.

Since you have a recurrence of your muscle symptoms on starting Crestor (rosuvastatin), and since your lipid levels are quite low and absolutely normal, I feel that you can stop the statin as of now.

Vitamin D deficiency also is well known to produce the muskuloskeletal pain symptoms that you are describing. It can also worsen the muscle pain symptoms secondary to the statin. Hence, adequate correction of the vitamin deficiency is essential. In case supplements alone are not helping, the reason for the deficiency must be diagnosed and alternative drugs to influence Vitamin D metabolism should be taken.

I think that you can undertake your trip with minimum risk. Qatar airways is a good airline that provides excellent services. Also, as a cardiac patient, you will receive all help at the airports. I would recommend that you take your regular diet at the appropriate times. During the flight, it is recommended that you keep yourself active, with some simple exercises of the legs, hands and neck and an occasional walk down the aisle. This is needed to prevent XXXXXXX vein thrombosis. I also recommend that you continue your regular medicines at the correct times.

I hope this answers your query. Feel free to contact me for any further clarifications.

I wish you a safe journey and a healthy, positive life.

With regards,
Dr RS Varma
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Follow-up: Is my jaw pain related to heart disease? 41 hours later
Dear Dr. Varma,
Thank you for your reply and the wishes. I will certainly follow your suggestions. My norwegian GP has told me to buy a pair of special socks for the flight. I have not found that yet.
I have still some queries in my mind. I shall be relaxed if you answer them.
1.Even with this satisfactory ecg, how much damage or abnormality the heart is suffering for living with four stents? What precautions are necessary for that?
2.With what stain dose I can maintain the current cholesterol levels? Currently I am not eating sugar, sweets and animal fats except 0.5% fat probiotic yoghurt everyday and salmon sometimes.
Thanks again. With all good wishes,
XXXXXXX Bose Saxena.
Answered by Dr. Raja Sekhar Varma 3 hours later
Hello Ms Saxena,

Thank you for the reply.

1) The degree of damage is likely to be extremely small. The precautions that you need to take are to continue your medications, especially the anti-platelet drugs Aspirin/Clopidogrel, regularly without omitting any dose. Your diet is adequate and you need to walk for half an hour daily.

2) Your current cholesterol levels are extremely good. You may continue with the diet control and exercise as above. Statin may not be needed if you can maintain the same levels. If at all required, you could try 5 mg of Rosuvastatin twice a week, if you are able to tolerate that. If you do get significant muscle pains, you may not be able to take a statin.

I hope this answers your query.

I wish you a safe flight and a happy vacation.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Is my jaw pain related to heart disease? 2 hours later
Dear Dr. Varma,

Thank you so much.

How long should I continue with Clopidogrel and Aspirin (Thrombyl here)? I have been told here to take Clopidogrel and Metoprolol for one year and Aspirin for the rest of my life. Do you think I should continue with clopidogrel also?

With all good wishes,
XXXXXXX Bose Saxena

Answered by Dr. Raja Sekhar Varma 22 hours later
Hello Ms Saxena,

Thank you for the query.

In India, we usually instruct the patients to continue Aspirin, Clopidogrel and beta-blocker lifelong.

As per the American Heart Association guidelines and the European Society of Cardiology guidelines, it is possible to stop the Clopidogrel tablets after one year. Aspirin and beta-blocker should be continued lifelong, unless there are specific contra-indications.

I hope this answers your query. Wishing you all the best.

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