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Dr. Andrew Rynne

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What causes chest pain, fatigue and sleeplessness?

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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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Posted on Wed, 28 Dec 2016 in Hypertension and Heart Disease
Question: I am currrently ill with chest pain (heavy central sensation and pain on taking a deep breathe) and been suferring from Fatigue and difficulty sleeping in the night. I had an ECG back in XXXXXXX which led my doctor to send me to a cardiologist for a echo gram. The Cardiologist saw a peculiarity in the Echogram and I had an Angiogram on the 27th of October 2016. The result was clear, no main blockages. However, my symptoms persisted and beane worse to the extent that I would walk to the shiops and come back and be on the verge of collapse adn pain in my shoulders, back and neck. THe pain used to be alleviated by lying down, but this is no longer working, hence my trouble sleeping. Now I went back to the cardiologist again t the DOctor's referal andhe said that my condition was due to my being obese and overweight adn that I should go to weight watches to lose weight in order to get better. I am asthmatic and have lynpodema mainly i my right leg and have had several infections over the last year. I have just recoverd from a UTI and find it hard to believe that my weight is the issue. I am 19.5 stonbes and was 22 stones two years ago. I am now getting cramps in my calf muscles whilst walking and sleeping. these are painful. Today I started toget a throbbing sensation in the bend of my elbow and behind my left knee. I am scared that I am going to havea heart attack and die. What should I do?
doctor
Answered by Dr. Rishu Saxena 33 minutes later
Brief Answer:
Cervical or thoracic origin pain

Detailed Answer:

Hi XXXXX,

Firstly thanks to you for selecting HCM to ask your query!
Have noted all your details and have seen all your reports.
Your angiogram is normal.Coronary angiography is a gold standard test to rule out coronary artery disease,its sensitivity is almost 99% .So don't worry you are not going to have a heart attack as your coronaries are perfectly normal.

History of severe pain in shoulders ,neck and back in a obese person points toward a pain of cervical ot thoracic in origin.

Back pain can be because of overuse of muscles, muscle strain, or injury to the muscles, ligaments, and discs that support your spine.Poor posture(using pillow and soft mattress while sleeping). Pressure on the spinal nerves from certain problems, such as a herniated disc.

The vast majority of cases of upper back and Neck pain are due to one (or both) of the following causes:
Muscular irritation (myofascial pain)
Joint dysfunction

As the pain in your case migrated to neck and shoulders also ;it can be Cervical pain also.
Its not always necessary that pain follows a episode of trauma or twisting,as we age our muscles get week,many a times even a normal amount of strain or a poor posture while sleeping or sitting can trigger the pain (especially when patient is over weight).

I would suggest you to go for a X ray cervical and thoracic region AP and LATERAL view, to rule out the above mentioned possibilities.3 days of complete bed rest is advised ,don't try any exercise or physiotherapy till you are normal,give complete rest to your body.

Don't use Pillows and soft cushions on bed ,sleep on a hard surface.

I would suggest you to take a combination of seratiopeptidase +diclofenac potassium+paracetamol in combination with a potent corticosteroid like methyl prednisolone for 3 days at least ,you can discuss the dosage of the drugs with your physician.

This pain is not related to your previous infections or lymphadenopathy.

I would like to know if you ever have acid peptic problems or heartburn! If answer is no ,then follow my advice ,get a X ray done ,discuss the possibilities i have suggested with your treating doctor.Take the medicines i advised in doses prescribed by him.

In case you have more queries ,feel free to ask,i would be happy to help you!

Don't panic just follow my advice and you will feel much better in few days!

Thank you,
Dr Rishu Saxena
Cardiologist and Physician


Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Rishu Saxena 55 minutes later
Thank you for your response. No I have not had heartburn. Though I am burping more than normal and I have pain in my fat stomach, just below my left ribs when I bend down. My belly button is distended as well and painful to the touch. I will see my GP tomorrow and discuss your treatment option. So there is absolutely nothing wrong with my heart including Coronary Microvascular Disease?This can be ruled out?
doctor
Answered by Dr. Rishu Saxena 44 minutes later
Brief Answer:
It can be microvascular angina but first rule out more common problems

Detailed Answer:
Hi,
Dear

Microvascular angina is a diagnosis of exclusion, when all the causes of chest pain are ruled out ;then we can treat it as microvascular angina,unfotunately at present there are no test to rule out the diagnosis of microvascular angina,and the treatment part of it is not very effective.
For your query that means there is absolutely nothing wrong with my heart?
My answer is that no test has 100% sensitivity rate and no one can give you a gaurantee, the golden rule of medical sciences is that there is no rule, So most likely your heart is normal,but no one can give a gaurantee,Rare things are rare but they do occur.
So our initial workup should be to rule out more common causes of chest pain .

you are dyslipidemic and obese yet , going through your history and your symptoms i would suggest you to go for the tests which i have advised and to follow the medicines.

Rare things are rare ,hence initially we should consider things which are more common.
As you have gas and burping problem and you feel like your stomach is distended, kindly ask you physicians to add a proton pump inhibitor(like pantoprazole) .

In case you have any other query,feel free to ask ,i would be happy to help you!

Advice
Follow up with reports

Thanks
Dr Rishu Saxena

Above answer was peer-reviewed by : Dr. Nagamani Ng
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