What cause pain and pressure in the chest?

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Posted on Sat, 27 Jan 2018 in General Health
Question: Hi again Sir :)

I have a question about something that is very hard to describe. If I were to come to your office to describe the problem, I would start by saying: There is just something wrong. Something doesnt feel right.

So. this is in center of the chest. It is an area of maybe a couple centimeters wide, and a couple centimeters long. It is not pain, but it is like the feeling you get when you have butterflies in the stomach perhaps, but in the center of the chest. Its like a tickling, like a physical - not psychologiccal - anxiety-feeling dead center of the chest. It is unbelivably uncomfortable. And VERY hard to explain.
Perhaps you can compare it to beeing really scared, or having a slight bloodpressure drop, the way your arms would feel a bit drained for blood and shaky. Perhaps also the way yopu would feel in the stomach-area if your adrenals would release a tiny bit of adrenaline. But this feeling in the chest just keeps on staying there. Gone for some time, and then returns.
Like a murmur in the heart itself. I do not feel any diffrence in pulse/heartbeats, but i just dsont feel right. Its like a "okay, nevermind the ectopics. This is a clear sign something is going to happen". And I do not want to make this sound like anxiety, because it presents itself in a way that is not linked to anxiety. Believe me, I know how that feels.
I have wondered if it might be from the stomach, but it feels way to high up in the chest. Also thought it might be muscular, but iof certainly feels like it is behind the chest wall, and in an organ.
I would also say that i feel pressure like a weight on the chest in the same area at times.
This is the kind of uncomfortable feeling that feels like its driving you mad.
Do you have any idea of what it may be?
Clogged arteries?
WPW or some rythm disorder that is not detectable on my wrist/neck pulse?
I also add that even though we are heading to winter, I am extremely cold on my fingers and toes, even when inside the house. So I am thinking bloodcirculation is poor, perhaps because of clogged arteries etc.
I recently went for a long walk which was pretty hard for me. I had pressure in the chest and ectopics. I did wear a holter, which after said: supra ventricular and ventricular. Worries me a bit that these whopwed up while exercising.
Now these I feel. But this weird feeling I am asking about now, doesnt affect my rythm.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear Kaj,

I am glad to discuss with you again on HCM!

I passed carefully through your question and understand your concern.

Considering all your performed tests, I would recommend performing a cardiac stress echo with contrast. This would be the best test to examine your myocardial wall contractility and blood perfusion, especially during stress.

I agree with you on the fact that your stomach may mimic such clinical scenario. You should know that in the upper chest lays the esophagus, just next to the stomach. Gastro-esophageal reflux or esophageal spasms can cause similar feelings and pain in the upper chest.

For this reason, I would recommend performing a fibrogastroscopy, in order to exclude possible reflux, esophageal spasms or a hiatal hernia.

Regarding WPW, your Holter monitoring has not revealed any possible signs of this syndrome. But a prolonged monitoring like Loop monitoring would help exclude this syndrome with a higher certainty.

Hope you will find this answer helpful!

You should discuss with your doctor on the above tests.

I remain at your disposal, whenever you have any other questions!

Kind regards,

Dr. Iliri




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Thanx sir!
Do you think this described feeling of tickling or butterflies or whatever can be caused by : Considering all your performed tests, I would recommend performing a cardiac stress echo with contrast. This would be the best test to examine your myocardial wall contractility and blood perfusion, especially during stress
I mean:
Would you think there is a possibility for this beeing Angina, or clogged arteries then?

A contrast thing will mean invasive procedure I guess.

I did a CT scan called calcium score. But with no contrast.
doctor
Answered by Dr. Ilir Sharka 16 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I don't think that your symptoms are related to angina.

But, this test would help totally exclude this possibility and also calm your anxious mind about this issue.

All your actual tests have excluded angina. But, as you know every tests has its specificity and sensibility.

This is not an invasive procedure. The contrast is taken intravenous, but it is far away from the coronary angiogram, as an invasive test.

The coronary angio CT scan is another type of procedure, which imposes you not only to intravenous contrast, but also to radiation risk .

Anyway, you should't feel obliged to do this test, as it is just an additional test to help totally exclude this issue. Besides, your symptoms are not really typical of angina.

I would also encourage you to perform the fibrogastroscopy, in order to exclude a possible acid reflux or any other esophageal disorder, which could mimic all this clinical scenario.

Hope to have clarified some of your uncertainties!

Let me know about everything!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7254 Questions

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