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Suggest Treatment For Severe Chest Pain With Sore Ribs And Sternum

Posted on Mon, 29 Sep 2014

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've had ecg, chest x ray, echocardiogram and ct scan of my heart and the drs ruled out cardiac problems and told me I could have tietze syndrome or costochondoritis

I also have fibromyalgia and have been referred to a rheumatologist it's just a long way off and my pain is getting worse everyday

I just wondered if my symptoms sound like what I have been told it could be

Answered by Dr. Dr. Muhammad Sareer Khalil (1 hour later)

Brief Answer:
Explained

Detailed Answer:

Hello and Welcome

I appreciate your concern.

The fact that the ECG, chest x ray, echocardiogram all came normal indicates that its not a cardiac issue,
But the fact that you still experience severe chest pain, jaw pain, left arm pain and slight neck pain and sore ribs and sternum , warrants that option of ANGIOGRAPHY be discussed with your cardiologist. I would also advise an ETT ( Exercise tolerance Test ) and HBA1C plus FBS to screen for diabetes. A Lipid profile may also be done to assess the need for lipid lowering drugs or statins etc

Fibromyalgia is a disorder of chronic, widespread pain and tenderness. It typically presents in young or middle-aged women but can affect patients of either sex and at any age.

Poor sleep is virtually universal in fibromyalgia and contributes importantly to pain, depression, and fatigue. Accurate diagnosis and pharmacologic and non pharmacologic management are essential Trigger point injections, acupuncture, chiropractic manipulation, and myo fascial release are usually well received by patients and can be beneficial.

I would also suggest you to consult a psychiatrist
so that a XXXXXXX mental state exam is performed
to look for depression and or anxiety,
Meds can be adjusted afterwards in addition
to cognitive behavioral therapy. Yoga and meditation , too have proven benefit
in addition to relaxing exercise in this regard as a holistic approach.

Let me know if you have any query

wishing you best of health

Thanks

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Muhammad Sareer Khalil (15 hours later)

Thank you for your advice

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'm a nurse and 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 hyprecondriac.

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

Answered by Dr. Dr. Muhammad Sareer Khalil (1 hour later)

Brief Answer:
explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

Troponin levels can be mildly raised in a number of conditions including , anxiety and stress. The mild rise will be fine if the CK MB was normal in the first few hours of chest pain.

ETT will do no harm, a stress echo will also be a good option in your case. I don't understand why a conventional angiogram isn't done for you as the recurrent chest pain is mimicking a cardiac event.

I would advise you to consult another doctor, though you should go for a two week of effective therapy for your symptoms empirically including
Ibuprofen , gabapentin and PPI cover to see for improvement.

Please do not worry, anxiety and fear is a natural phenomenon if you let yourself loose by admitting and reinforcing that you may die of this problem, I would encourage you to be strong and face the situation head on and boldly.

wishing you best of health

Thanks

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad