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What causes chest pain and abdominal pain?

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Posted on Thu, 4 Sep 2014
Question: Hello,

I am a 34 year old XXXXXXX XXXXXXX female and I have been having chest pains and severe abdominal pain for the past month. I have been to the ER twice both times they did EKG and X rays both were normal and ran the standard blood tests they run in the ER , I dont have high blood pressure or diabetes but I am concerned about heart disease. the pain comes and goes with pain meds. I have attached my blood work is anything suggestive of heart disease. Thank you -oh by the way my bmi is about 34.5
doctor
Answered by Dr. T Chandrakant (37 minutes later)
Brief Answer:
Costo-chondritis

Detailed Answer:
Hi.
I can understand the plight you are going through due to this disturbing pain.

May I please ask you specific questions? please answer them after careful observations and remembrance...
-Is the pain in the lower chest 2 finger-breadth way from the mid-line and may be just bellow the breasts where the lower ribs are ? And the pain in abdomen is in continuity with this area?
-Does it come when you are free or there is a sudden stress?
-Is it relieved on the day when you are happy and everything is going on as scheduled and nothing happens against your will and wish?
-What are the factors that increase or decrease your pains?
-Anything else you would like to tell, please!

The EKG and X-ray chest done in ER are basically done to rule out any problem related to heart and lung. So if they are normal, you should be felling lucky and happy.

One of the most probable diagnosis I can think of is Costochondritis , meaning inflammation causing pain in the costal areas of the ribs and their joints with the sternum.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (23 minutes later)
here are responses to your questions

May I please ask you specific questions? please answer them after careful observations and remembrance...
-Is the pain in the lower chest 2 finger-breadth way from the mid-line and may be just bellow the breasts where the lower ribs are ? And the pain in abdomen is in continuity with this area?
The pain in my chest is sometimes in the middle between my breasts and on the left side above my breast and in my lower back middle. the pain in my abdominal just started about 2 weeks ago it comes and goes... I notice when i take pain meds it goes away and come back and when i panic over it I get chest pains.
-Does it come when you are free or there is a sudden stress?
it comes both sudden stress and free but mostly stress
-Is it relieved on the day when you are happy and everything is going on as scheduled and nothing happens against your will and wish?
on days when I am happy I dont feel it as much but the pain has been so intense the last few days thats all i can think about. I have attached my labs for you to look at
-What are the factors that increase or decrease your pains?
thinking about heart disease
I hat a ct scan of my abdominal everything normal
-Anything else you would like to tell, please!
I am scared to work out because I dont wanna have a heart attack. Please view my labs. Thanks
doctor
Answered by Dr. T Chandrakant (8 hours later)
Brief Answer:
Proper physical examination - pressure on painful

Detailed Answer:
Hi.
Thanks for your very well written feedback.

If the pain increases on pressure on these areas, the most probable diagnosis is costo-chondritis as I have already mentioned.

Get a proper diagnosis by a clinical/ physical check-up again.
Get proper medicine in the form of combination of Anti-inflammatory, oral steroids, anxiolytic, multivitamins, local rubrafacient liniments ( which make the area warm), Sound sleep, stopping the activities or the thoughts which cause more stress and pain ( which you might have noticed by this time).
You are going to be OK the moment you start following all these. Yes, you need a prescription for most of the medicines so you have to find a Doctor who understands your problem, with whom you can discuss this and get a complete prescription.

He will also help to rule out other causes of pain- you need a good clinical . physical examination and not the investigations at all. Nothing comes positive in costochondritis.

The blood reports are not attached yet, so could not see.
Feel free to discuss further, if you need to.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (12 hours later)
Here are a few of my labs from the past few months. As I said, I panicked and been to ER room several times. EKG normal chest exray normal but my mind is saying doctors dont know what they are talking about.

Component Results
Component     Standard Range      Your Value
WBC     3.5 - 9.9 x(10)3/uL      7.5
Rbc     3.70 - 5.00 x(10)6/uL      4.56
Hemoglobin     12.0 - 15.0 g/dL      12.9
Hematocrit     36.0 - 45.0 %      39.5
Mcv     78.0 - 100.0 fL      86.6
Mch     27.0 - 33.0 pg      28.3
Mchc     32.0 - 36.0 g/dL      32.7
Rdw     11.5 - 14.5 %      13.7
Platelets     150 - 400 x(10)3/uL      277
Mpv     7.4 - 10.4 fL      8.5
% Neutrophils     45.0 - 74.0 %      48.9
% Lymphocytes     15.0 - 44.0 %      40.1
% Monocytes     2.0 - 12.0 %      8.5
% Eosinophils     0.0 - 6.0 %       1.6
% Basophils     0.0 - 2.0 %      0.9
Abs Neutrophils     1.7 - 6.4 x(10)3/uL      3.7
Abs Lymphocytes     1.5 - 3.5 x(10)3/uL      3.0
Abs Monocytes     0.1 - 0.9 x(10)3/uL      0.6
Abs Eosinophils     0.0 - 0.7 x(10)3/uL      0.1
Abs Basophils     0.0 - 0.1 x(10)3/uL      0.1
The above 20 analytes were performed by JMMC-Walnut Creek Campus1601 YGNACIO VALLEY RD.,WALNUT CREEK,CA 94598
General Information
Collected:

06/26/2014 5:25 PM
Ordered By:
XXXXXXX BENSON, MD
Result Status:

Final result


Component Results
Component     Standard Range      Your Value
Creatine Kinase (Ck/Cpk)     38 - 234 U/L     124
Ck-Mb     0.6 - 6.3 ng/mL      0.7
Ck-Mb Index     0.0 - 3.0 %      NA
Troponin-I     0.00 - 0.03 ng/mL      <0.03
0.03 ng/mL represents the 99th percentile of the upper referencelimit (URL) defined in a population of apparently healthy adultswith no known diseases of the cardiovascular system or otherserious acute or chronic disorders. This Beckman Coulter
Troponinassay demonstrates a total CV <10% at the 99th percentile URL.The above 4 analytes were performed by JMMC-Walnut Creek Campus1601 YGNACIO VALLEY RD.,WALNUT CREEK,CA 94598
General Information
Collected:

06/26/2014 5:25 PM
Ordered By:
XXXXXXX BENSON, MD
Result Status:

Final result



lucose     70 - 99 mg/dL     86
Normal (Fasting) 70-99 mg/dlPrediabetes or impaired glucose metabolism (Fasting) 100-125 mg/dlDiabetes Mellitus (Fasting) >125 mg/dl on two occasions.Diabetes Mellitus(Non-fasting)>200 mg/dl with appropriate symptoms
Urea Nitrogen     5 - 26 mg/dL     16
Creatinine     0.44 - 1.10 mg/dL     0.78
Egfr-Nonafrican XXXXXXX 60 - 300 mL/min/1.73m2     >60
Egfr-African XXXXXXX 60 - 300 mL/min/1.73m2     >60
eGFR Reference Range: >60 mL/min/1.73m2
Sodium     135 - 145 mmol/L     138
Potassium     3.5 - 5.1 mmol/L     3.6
Chloride     95 - 110 mmol/L     109
Carbon Dioxide     22 - 32 mmol/L     23
Anion Gap     7 - 16 mmol/L     6
Calcium     8.6 - 10.5 mg/dL     9.2
Protein-Total     6.1 - 8.3 g/dL     7.8
Globulin     2.1 - 4.3 g/dL     3.9
Albumin     3.4 - 5.0 g/dL     3.9
Ast (Sgot)     15 - 45 U/L     24
Alt (Sgpt)     10 - 54 U/L     19
Alkaline Phosphatase     35 - 115 U/L     53
Bilirubin-Total     0.0 - 1.3 mg/dL     0.4
The above 18 analytes were performed by JMMC-Walnut Creek Campus1601 YGNACIO VALLEY RD.,WALNUT CREEK,CA 94598
General Information
Collected:

06/26/2014 5:25 PM
Ordered By:
XXXXXXX BENSON, MD
Result Status:

Final result




Component Results
Component     Standard Range     Your Value
Glucose     70 - 99 mg/dL     99
Normal (Fasting) 70-99 mg/dlPrediabetes or impaired glucose metabolism (Fasting) 100-125 mg/dlDiabetes Mellitus (Fasting) >125 mg/dl on two occasions.Diabetes Mellitus(Non-fasting)>200 mg/dl with appropriate symptoms
Urea Nitrogen     5 - 26 mg/dL     13
Creatinine     0.44 - 1.10 mg/dL     0.78
Egfr-Nonafrican XXXXXXX 60 - 300 mL/min/1.73m2     >60
Egfr-African XXXXXXX 60 - 300 mL/min/1.73m2     >60
eGFR Reference Range: >60 mL/min/1.73m2
Sodium     135 - 145 mmol/L     136
Potassium     3.5 - 5.1 mmol/L     3.5
Chloride     95 - 110 mmol/L     106
Carbon Dioxide     22 - 32 mmol/L     22
Anion Gap     7 - 16 mmol/L     8
Calcium     8.6 - 10.5 mg/dL     9.0
Protein-Total     6.1 - 8.3 g/dL     7.6
Globulin     2.1 - 4.3 g/dL     3.6
Albumin     3.4 - 5.0 g/dL     4.0
Ast (Sgot)     15 - 45 U/L     18
Alt (Sgpt)     10 - 54 U/L     15
Alkaline Phosphatase     35 - 115 U/L     49
Bilirubin-Total     0.0 - 1.3 mg/dL     0.7
The above 18 analytes were performed by JMMC-Walnut Creek Campus1601 YGNACIO VALLEY RD.,WALNUT CREEK,CA 94598
General Information
Collected:

08/07/2014 1:58 AM
Ordered By:
XXXXXXX XXXXXXX MD
Result Status:

Final result
Back to the Test Results List
Back to the Home Page
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Normal study.

Detailed Answer:
Thanks for your posting detailed reports.
And as I said they all are within normal limits and of less importance in case of suspected costochondritis.

Component Results
Component Standard Range Your Value
Creatine Kinase (Ck/Cpk) 38 - 234 U/L 124
Ck-Mb 0.6 - 6.3 ng/mL 0.7
Ck-Mb Index 0.0 - 3.0 % NA
Troponin-I 0.00 - 0.03 ng/mL <0.03
0.03 ng/mL represents the 99th percentile of the upper reference limit (URL) defined in a population of apparently healthy adults with no known diseases of the cardiovascular system or other serious acute or chronic disorders
This along with normal EKG and X-ray chest and CT scan Abdomen says you have no heart ailments at the moment.

You should be very happy to see this result.

Please follow as suggested already.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (3 minutes later)
what about heart disease are any of this reports suggestive of heart disease. Yes i will follow up with my doctor and try the suggestions especially vitamins. I have a RX for ativan 0.5 once per day . Thank you
doctor
Answered by Dr. T Chandrakant (7 minutes later)
Brief Answer:
This report is related to heart= NORMAL

Detailed Answer:
Component Results
Component Standard Range Your Value
Creatine Kinase (Ck/Cpk) 38 - 234 U/L 124
Ck-Mb 0.6 - 6.3 ng/mL 0.7
Ck-Mb Index 0.0 - 3.0 % NA
Troponin-I 0.00 - 0.03 ng/mL <0.03
0.03 ng/mL represents the 99th percentile of the upper reference limit (URL) defined in a population of apparently healthy adults with no known diseases of the ****cardiovascular system ******

Cardio means heart... And it is normal.

YOUR REPORT SAYS ''TROPONIN-I IS LESS THAN < 0.03 MEANING NO HEART PROBLEM AT ALL.

If the pain increases on pressure on these areas, the most probable diagnosis is costo-chondritis as I have already mentioned.

Get a proper diagnosis by a clinical/ physical check-up again.
Get proper medicine in the form of combination of Anti-inflammatory, oral steroids, anxiolytic, multivitamins, local rubrafacient liniments ( which make the area warm), Sound sleep, stopping the activities or the thoughts which cause more stress and pain ( which you might have noticed by this time).



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (3 hours later)
I am trying not to worry as I don't think I have ever had my cholesterol checked before and I have belly fat and overweight after having a baby 20 months ago. I meet 2 risk factors for heart disease. I scheduled a consultation with a cardiologist. do you think he will do a stress test I don't know really whats involved but I'm freaking out about that as well
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
Cardiologist will certainly help you.

Detailed Answer:
Hi.

I can understand your enthusiasm and worry as you are Mother of 20 months baby and may be really worried about the baby.

Was their any heart problem recently in the family members or friends or their family.

Very true, please request your cardiologist for a stress test, he would certainly do it and a the test result would help you come out of your problem. All people with belly fat and who are overweight do not get heart problems. He will also get lipid profile including cholesterol.

I hope you are doing some exercises and diet control for the reduction of your belly fat and to reduce weight. Also get your Thyroid profile done.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (37 hours later)
There are no none heart problems or history of heart disease on my Mothers side of the family, I am not sure about my fathers side. My hysteria stems from I was recently diagnosed with mild sleep apnea and its been a downward spiral since then. I do have a friend who is 37 with heart disease but he also has diabetes, kidney failure and a host of other aliments. yes I have started a workout plan but I am scared that I will have a heart attack
doctor
Answered by Dr. T Chandrakant (57 minutes later)
Brief Answer:
Females of your age do not get heart attacks

Detailed Answer:
It is really scary to have a scare.. I hope you understand what I mean by. Now you please tell me how can one really sooth your mind- obviously yourself.

As I suspected there is a history of the heart ailment in near and dear or a known person which make one think about such things 24/7.

Maximum number of people have a mild sleep apnea and you are one of them. So what? Go on reducing the weight and belly fat by a nice balance of diet and exercises. Cuddle your 20 months baby more often to get involved into more positive things and be away from the stress if you really care for your baby.

Do you?

And for your kind information the Almighty has given all the mothers the greatest of the heart and by virtue of your hormones the females of your age, never get heart attacks..
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. T Chandrakant (3 hours later)
Yes I do love my son and I do not want to live in fear every time something hurts me. I am just panicking because its around my heart area and I thing the worst. I will go get proper evaluation through a cardiologist and I will let you know the results of my TMT. Thank you I bet your patients are very happy with you. Thank you for being rational
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
Most welcome

Detailed Answer:
Most welcome and thanks for your compliments.

I am near-sure that the cardiac evaluation is going to be normal, yes but promise one thing to me and yourself- you are going to stop worrying.

Have a change of place, atmosphere, may be a vacation away from the area you live in, really helps a lot. Please observe, if you are happy your friends and relative too are; if they see your sad face they too become cautious, including your son who is just 20 months. He must be feeling very wave you have in your brain and heart.

get going nicely, willing to hear good news from you and your Cardiologist.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. T Chandrakant

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What causes chest pain and abdominal pain?

Brief Answer: Costo-chondritis Detailed Answer: Hi. I can understand the plight you are going through due to this disturbing pain. May I please ask you specific questions? please answer them after careful observations and remembrance... -Is the pain in the lower chest 2 finger-breadth way from the mid-line and may be just bellow the breasts where the lower ribs are ? And the pain in abdomen is in continuity with this area? -Does it come when you are free or there is a sudden stress? -Is it relieved on the day when you are happy and everything is going on as scheduled and nothing happens against your will and wish? -What are the factors that increase or decrease your pains? -Anything else you would like to tell, please! The EKG and X-ray chest done in ER are basically done to rule out any problem related to heart and lung. So if they are normal, you should be felling lucky and happy. One of the most probable diagnosis I can think of is Costochondritis , meaning inflammation causing pain in the costal areas of the ribs and their joints with the sternum.