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Suggest Treatment For Severe Chest Pain With Sore Ribd
Question: For the past six months I've had severe chest pain, jaw pain, left arm pain and slight neck pain and very very sore ribs and sternum
I have been seen by my gp and cardiology department who gave me an echocardiogram and non invasive angiogram which both showed my heart was fine
I was told I could have fibromyalgia and referred to rheumatology and that I could have costochondoritis or tietze syndrome but no pain relief or NSAIDs are helping what so ever
I am already on duloxetine for depression and I am already seeing a therapist
I am a XXXXXXX palliative nurse myself, the problem I'm having is no one is giving me a straight answer. My gp is convinced it's due to my anxiety/depression/fibro/costochondoritis all causing terrible pain however;
I have had normal ecgs and abnormal ecgs, my troponin level came back elevated at .44 but six hours later dropped down to normal (under .10) and remained that way
Troponin is only in the blood stream if heart muscle damage has occurred but I was told they can't explain why I had elevated troponin but I'm fine nothing wrong with my heart which doesn't make sense to me
I was refused a exercise stress test from my cardiologist because I would give a false positive and I was refused an invasive angiogram due to my age and so I was given the echocardiogram and the non invasive angiogram scan which both showed my heart was fine and I was discharged from cardiology
However I feel incredibly frightened that these heart attack symptoms are getting worse and have lasted six months
I have been to a and e and the dr there said I had had every test possible I was wasting his time as I was already proven to not have heart problems
Unfortunately I had to watch my aunt die after she was told she had anxiety and not the 95% blockage she actually had. I explained this and he said yours is anxiety you are a hypochondriac.
I told my gp all this and unfortunately he agreed with the dr and said my anxiety is causing the symptoms and I need to forget about my heart cos it's healthy
But surely anxiety cannot cause raised troponins and abnormal ecgs but he won't refer me to another cardiologist
So as you can see I am stuck as to what to do, I'm worrying myself sick and I have convinced myself I'm going to drop down dead of a heart attack like my aunt because people aren't listening to me
I would appreciate a very in depth answer, I cannot have an invasive angiogram or stress test as I have been refused twice already
I have been seen by my gp and cardiology department who gave me an echocardiogram and non invasive angiogram which both showed my heart was fine
I was told I could have fibromyalgia and referred to rheumatology and that I could have costochondoritis or tietze syndrome but no pain relief or NSAIDs are helping what so ever
I am already on duloxetine for depression and I am already seeing a therapist
I am a XXXXXXX palliative nurse myself, the problem I'm having is no one is giving me a straight answer. My gp is convinced it's due to my anxiety/depression/fibro/costochondoritis all causing terrible pain however;
I have had normal ecgs and abnormal ecgs, my troponin level came back elevated at .44 but six hours later dropped down to normal (under .10) and remained that way
Troponin is only in the blood stream if heart muscle damage has occurred but I was told they can't explain why I had elevated troponin but I'm fine nothing wrong with my heart which doesn't make sense to me
I was refused a exercise stress test from my cardiologist because I would give a false positive and I was refused an invasive angiogram due to my age and so I was given the echocardiogram and the non invasive angiogram scan which both showed my heart was fine and I was discharged from cardiology
However I feel incredibly frightened that these heart attack symptoms are getting worse and have lasted six months
I have been to a and e and the dr there said I had had every test possible I was wasting his time as I was already proven to not have heart problems
Unfortunately I had to watch my aunt die after she was told she had anxiety and not the 95% blockage she actually had. I explained this and he said yours is anxiety you are a hypochondriac.
I told my gp all this and unfortunately he agreed with the dr and said my anxiety is causing the symptoms and I need to forget about my heart cos it's healthy
But surely anxiety cannot cause raised troponins and abnormal ecgs but he won't refer me to another cardiologist
So as you can see I am stuck as to what to do, I'm worrying myself sick and I have convinced myself I'm going to drop down dead of a heart attack like my aunt because people aren't listening to me
I would appreciate a very in depth answer, I cannot have an invasive angiogram or stress test as I have been refused twice already
Brief Answer:
Anxiety can precipitate coronary spasm.
Detailed Answer:
Hello,
I understand what you are going through.
Just because you have anxiety and fibromyalgia, I am not prepared to write off a coronary artery disease in you especially with the Troponin being elevated on one occasion. The fact that it returned to normal ruled out a myocardial infarction. You may have had an acute coronary syndrome. Did you have a stress echo or just a transthoracic echo?
Do you have a copy of your EKG at the time when your troponin was elevated? If so you could scan and send to me.
Anxiety and depression are known to exacerbate several diseases like diabetes, hypertension and coronary heart disease. In fact I find it as a precipitating factor in some of my patients.
So being relaxed will definitely do you a lot of good.
If you do not have any contraindications, you could try a small dose of beta blocker like Inderal and see if it has any effect on your chest pain. If the pain returns, try a tablet of GTN ( Glyceryl trinitrate) under your tongue and see if it makes any difference. This would be a therapeutic trial. If there is no difference in the pain frequency and severity with these medications, then probably you do not have a coronary artery disease. If there is a change then you may require further investigations.
If you have further queries, I shall be available to answer them.
Good day!
Dr. Noble Zachariah
Anxiety can precipitate coronary spasm.
Detailed Answer:
Hello,
I understand what you are going through.
Just because you have anxiety and fibromyalgia, I am not prepared to write off a coronary artery disease in you especially with the Troponin being elevated on one occasion. The fact that it returned to normal ruled out a myocardial infarction. You may have had an acute coronary syndrome. Did you have a stress echo or just a transthoracic echo?
Do you have a copy of your EKG at the time when your troponin was elevated? If so you could scan and send to me.
Anxiety and depression are known to exacerbate several diseases like diabetes, hypertension and coronary heart disease. In fact I find it as a precipitating factor in some of my patients.
So being relaxed will definitely do you a lot of good.
If you do not have any contraindications, you could try a small dose of beta blocker like Inderal and see if it has any effect on your chest pain. If the pain returns, try a tablet of GTN ( Glyceryl trinitrate) under your tongue and see if it makes any difference. This would be a therapeutic trial. If there is no difference in the pain frequency and severity with these medications, then probably you do not have a coronary artery disease. If there is a change then you may require further investigations.
If you have further queries, I shall be available to answer them.
Good day!
Dr. Noble Zachariah
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much for your advice
It was a resting echocardiogram and I don't have a copy of my ecg from the time of raised troponin however the dr showed me the ecg which he said was perfect that time and he was actually going to let me go home without blood tests but I insisted and it showed the slightly elevated troponin at .44 which he did say he couldn't explain but could be from my severe anxiety causing strain or esophical spasms?
Could you inform me a little bit about esophical spasms? I know it is closely located to the heart
I have a gtn spray which was given to me when they were testing me for angina before the non invasive angiogram
It does help but not everytime, some days it makes no difference, others it slightly improves the pain. I do suffer from feelings of missed heart beats in the centre of my chest or up towards my throat
I would be so relived if it was just anxiety but I cannot convince myself it is
I am beta blockers but find they only make a slight difference also
It was a resting echocardiogram and I don't have a copy of my ecg from the time of raised troponin however the dr showed me the ecg which he said was perfect that time and he was actually going to let me go home without blood tests but I insisted and it showed the slightly elevated troponin at .44 which he did say he couldn't explain but could be from my severe anxiety causing strain or esophical spasms?
Could you inform me a little bit about esophical spasms? I know it is closely located to the heart
I have a gtn spray which was given to me when they were testing me for angina before the non invasive angiogram
It does help but not everytime, some days it makes no difference, others it slightly improves the pain. I do suffer from feelings of missed heart beats in the centre of my chest or up towards my throat
I would be so relived if it was just anxiety but I cannot convince myself it is
I am beta blockers but find they only make a slight difference also
Brief Answer:
Esophageal problems discussed
Detailed Answer:
Hi once again.
Esophagus is situated right behind the heart and any inflammation in the esophagus would produce a pain similar to the heart pain. I see many such patients with esophagitis who are worried about the pain being from the heart.
Esophageal spasm is a sudden contraction of the esophageal muscle which leads to severe chest pain. It occurs occasionally and is often associated with difficulty in swallowing. If you are able to get a barium swallow done at the time of pain it would show the typical contractions.
If you have tried beta blockers and nitrates and they have not helped , it may not be cardiac. If the barium swallow is not suggestive of esophageal spasm, try a proton pump inhibitor twice a day and if it brings relief it is likely to be esophagitis.
I shall be happy to answer if you have further queries.
Best wishes,
Dr. Noble Zachariah
Esophageal problems discussed
Detailed Answer:
Hi once again.
Esophagus is situated right behind the heart and any inflammation in the esophagus would produce a pain similar to the heart pain. I see many such patients with esophagitis who are worried about the pain being from the heart.
Esophageal spasm is a sudden contraction of the esophageal muscle which leads to severe chest pain. It occurs occasionally and is often associated with difficulty in swallowing. If you are able to get a barium swallow done at the time of pain it would show the typical contractions.
If you have tried beta blockers and nitrates and they have not helped , it may not be cardiac. If the barium swallow is not suggestive of esophageal spasm, try a proton pump inhibitor twice a day and if it brings relief it is likely to be esophagitis.
I shall be happy to answer if you have further queries.
Best wishes,
Dr. Noble Zachariah
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Above answer was peer-reviewed by :
Dr. Raju A.T
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