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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for constant chest pain

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6315 Questions

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Posted on Sat, 18 Mar 2017 in Hypertension and Heart Disease
Question: I am scheduled to see a cardiologist on 3-15-17 due to recent dx of diastolic dysfunction following an ER visit on 12-26-17 during which I was hospitalized for further tests. The nuclear stress test aborted due to a ruptured IV.
During the follow up stress test on 2-24-17 the tech had me repeat the initial lying down scanning twice, because, as she showed me on the screnn, an intestine was touching my heart. I have no hx of hernia.
The tech did not explain or comment other than asking have a had a hiatal hernia
My experience with local medical staff is that they are less than forthcoming with explanations. So I am asking for expert advise/opinion before I see the local cardiologist

Other than Levothyroxine and the occasional Ibuprofen, I take no medication
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXX!

Welcome on HCM!

I passed carefully through you medical history and the uploaded medicla reports.

Considering your clinical symptomatology (prolonged chest pain that is lessen rapidly while getting up), it may be concluded that it is quite non-specific for any cardiac related issue.

You should know that prolonged chest pain that is modulated by posture change, breathing or coughing is unlikely to be caused by an ischemic cardiac disorder.

Instead, other potential alternatives should be excluded as well:

- backbone discs degenerative disorders may be an explanation of your prolonged chest pain modulated by posture. Spine MRI is indicated for detecting the underlying lesions.

- also, such a chest pain pattern could be rationally explained by a pulmonary disorder (affecting pulmonary vasculature, pleural surrounding surface, etc.). Pulmonary angio CT, ventilation/perfusion lung scan, pulmonary function test, etc. would be helpful in investigating possible disorders.

- other extra-cardiac disorders, such as gastroesophageal reflux, or even a hiatal hernia, or costochondritis could produce similar symptoms. Fibrogastroscopy and inflammatory tests (PCR, ESR, etc.) may detect the presence of these disorders respectively.

Regarding your nuclear stress test (which was aborted), I would explain that there are other alternatives for exploring a hidden coronary disorder, such as:

- coronary angio CT,
- dobutamine stress echo,


In addition, anxiety and thyroid disorders may exacerbate the above mentioned responsible causes.

Regarding diastolic dysfunction, I would explain that at your age it is normal to have some degree of ventricular relaxation impairment (diastolic dysfunction); so nothing to worry about.


As, the other performed tests have not revealed any evidence of myocardial injury you shouldn't worry about. Just try to relax and discuss with your doctor on the possibility of performing the above mentioned tests in order to definitely
conclude on the right responsible cause.


Hope to have been helpful to you!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 19 hours later
Thanks Doc.
That's quite a detailed explanation. And, I am not worried, I expect there to be physical deterioration given my age. I am though very sick and tired of feeling the excrutiating anxiety and periodic pains, despite living a healthy life (yoga, not overeating, cooking organically from scratch not much meat, no smoking, alcohol or drugs);

My concern is that being that I'm on medicare, I cannot afford all those expensive tests. And, seeing the intestine touching the heart gives me the creeps, lol

In view of what you know about me so far, is there any way you can recommend one, maximum two tests that might reveal an organic underlying issue ?



doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
My suggestions:

Detailed Answer:
Hello again, dear XXXX!

You seem to be on the right way of living a healthy life. I would like to congratulate you and encourage continuing with this life style, dietary profile and physical activity.

As you have performed a previous backbone MRI in 2016, where degenerative discs disorder was revealed and as a PFT (pulmonary function test) is programmed, then I would recommend to consider focusing in the possibility of a gastroesophageal disorder (hiatal hernia, gastroesophageal reflux).

Coming to this point, one of the following tests:

- fibrogastroscopy,
- gastroesophageal X ray study with contrast (barium), whichever is less expensive.

Another way to confirm indirectly gastroesophageal reflux presence would be to try any gastric anti-secretor drugs (like Omeprazole, Pantoprazole) and see if the complaints will be relieved.

You could discuss with your doctor on the opportunity of performing one of these tests.

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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