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Dr. Andrew Rynne

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What causes chest pain, shortness of breath and fever?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7017 Questions

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Posted on Fri, 12 Jan 2018 in Hypertension and Heart Disease
Question: I have anterior neck pain and upper chest (shoulders feel very tight). Started a week ago with chest pain, shortness of breath and fever. I went to the ER. At the beginning ST was elevated but Chest x-ray were normal. Cardiac enzymes normal.
I had had a barking kind of cough third week of September with no other symptoms. Cough was really bad (like choking). No symptoms for a couple of week until this pain started. Cardiologist discarded heart attach or other heart related conditions (EKG and sonogram). Pain started to be more localized in anterior neck. Fever subsided three days ago and I still have quite a bit of pain in my neck. It was painful with deep breathing, swallowing (no throat pain) and coughing. Cough has come back and had a bad bout a couple of nights ago but is much better. Cough is sometimes prompted by eating dry foods (again, feels like choking or like when a drop of water goes through the wind pipe). I'm not taking any medication (haven't in 25 yrs)
My blood pressure is normal (110/75) - Heart rate is 95 right now, feels even. Breathing rate is 8/min (was up to 18 while in the ER) - I'm 68, vegetarian, don't drink alcohol. I exercise daily (walk).
what do you suggest?
doctor
Answered by Dr. Ilir Sharka 54 minutes later
Brief Answer:
I would explan as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your recent concern and would like to explain that your actual clinical scenario may be related to pericardial or pleural-pericardial inflammation.

In such case, an acute viral infection of the upper airways may be complicated with inflammation of the pericardial layers (surrounding the cardiac muscle) and sometimes also the adjacent pleura.

That's why your chest pain is irradiated to shoulders and neck area; it is also modulated by deep breathing, coughing and body position.

Dynamic ST segment deviations on ECG, without cardiac enzymes elevations are frequently seen in pericarditis (pericardial layers inflammation).

Cardiac ultrasound may sometimes reveal variable amounts of pericardial fluid; but most commonly we have to do with a dry pericarditis and no signs of pericardial fluid or pathological findings are detected.

Considering all the above statements, I would suggest performing some lab tests as follows:

- complete blood count with leukocytes formula,
- PCR and ESR,

and discuss with your doctor on the possibility of starting at least a short cycle (one week) of non-steroidal anti-inflammatory drugs, like Ibuprofen, Naproxen, etc. It will help relieving your pain and also lower any existing inflammatory response.

You should discuss with your attending doctor on the above mentioned issues.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 35 hours later
Thanks Doctor Sharka for explaining the symptoms. Your explanation seems quite accurate to me (I am a doctor myself but quit practice to become a psychotherapist several yrs ago).
I actually had a pericarditis three yrs ago, with PVCs that lasted for a yr. I try not to take any meds. I used natural antiinflammatories (Protandim) and Arginine (natural beta blocker) and they eventually disappeared.
I had an echocardiogram a couple of days ago and the doctor was not conclusive with his diagnosis even though there was a bit of fluid but he considered the finding "trivial." The EKG at his office (after the ER's showing ST elevation) seemed normal to him except for signs of a possible left atrial enlargement. Axis was right. Because he didn't come up with a diagnosis or an explanation of symptoms, I decided to consult this way. It's not a good idea to try to diagnose self.
Even though Ejection Fraction was normal according to the echo (about 66%), there are other signs that could indicate heart failure... I don't have a fever any more but I keep having tachycardia (right now, at rest, 90 - my normal would be 65-70). BNP was elevated in two consecutive blood works...first at 137 pg/ml and then at 641.
Potassium was 3.3 mmol/L. I don't have any swelling of my legs and I am not aware of having hepatomegalia. I have polypnea though (about 18 per minute when my normal is 6-8). I wonder if the cough... Thorax X-ray seemed normal.
Would the pericarditis explain the pain around larynx, which is worse when I breath deeply?
Thanks again. I look forward to hearing back from you.


doctor
Answered by Dr. Ilir Sharka 13 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Regarding your recent symptomatology, I would explain that pericarditis may explain in a certain degree the chest and neck pain, related to respiration.

What I am concerned about is the possible etiology of pericarditis, which not rarely is difficult to tackle.

The next point is your polypnea, increased heart rate and BNP. It is easy to conclude that all those three may be triggered by inflammation.

This may be the cause of pericarditis as well.

But to be sure that no other reasons are related, several tests should be done to exclude, as follows:

- possible thyroid dysfunction
- kidney dysfunction
- metabolic disorders (including amyloidosis, etc.).

Regarding BNP, it is true that it represents an important screening test for heart failure and it is proved to have a satisfactory predictive value that is when it results normal, we can exclude at a high certainty heart failure.

But, from the other side, it has a low positive predictive value that means that when it is abnormally increased, besides heart failure other cardiac and extra-cardiac causes could be accused.

It is very important to have a detailed information by the cardiac ultrasound, because what you have stated above (some trivial pericardial fluid, atrial enlargement, right QRS axis on ECG), may be the only signs of a small congenital heart defect (interatrial septal defect), which sometimes is not promptly detected by sub-optimal views of trans-thoracic echo.

In such case, it is recommended a trans-esophageal cardiac ultrasound.

To conclude, as you can see, there are several reasons and diagnostic steps for arriving to the right diagnostic conclusion.

It is difficult to realize this online, but you should discuss with your attending physician on the above issues.

In addition, if none of the above is confirmed, I remain of the opinion that a short term treatment with non-steroid anti-inflammatory drugs would be necessary.

Hope you will find this answer helpful!

Wishing good health,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 3 hours later
Dr Illiri, I highly value the time you've taken to answer my questions. Talking to a doctor is a luxury these days. You've provided me with important insight and advise. I will take a natural antiinflammatory such as Turmeric/curcumin. I also notice that when I take Magnesium (I take a country life Nerve and Osteo support supplement occasionally), the pain eases significantly. I think this might indicate that pain creates spasms and more pain and therefore the relaxation brought by the magnesium alleviates me. I am waiting for the T3-T4 numbers, TSH is a bit elevated but lower that where it was a year ago.
I did have symptoms of a metabolic syndrome (cholesterol and TG elevated a yr ago). I stopped using honey (I was perhaps using too much in teas) and in 3 months lost 10 pounds and brought TGs from 200 to 54. I'm also more carful with diet and try not to eat after 6 p.m.
Thanks for explaining how to read the exams in a context. That helps a lot. They wanted to do a CAT scan with contrast to discard pulmonary embolus when there was nothing in my background or correlated symptoms to support the Dx. They had misred the d-DImer test. It was normal, they thought it was 630!
Last question is, with what you know, do you think it'd be okay for me to travel in a couple a weeks to Bogota (8,000 feet high) for dental surgery?
Anyhow, thanks and more thanks.
doctor
Answered by Dr. Ilir Sharka 14 hours later
Brief Answer:
I would explain:

Detailed Answer:
Hello!

I don’t see any medical reasons why you shouldn’t or couldn’t travel where you want (including Bogota).

From the other side, I consider taking supplements a good alternative for inflammation as well. It may help in different ways to address your recent clinical symptomatology.

I do encourage you also to use anti-inflammatory medication at least for several days to relieve the disturbing pain.

As you have a long history of pleural effusion, it is necessary to explore for a possible underlying cause; first exclude thyroid dysfunction; then any potential persisting inflammatory/autoimmune disorder.

But what is necessary at the same time would be to confirm a normal cardiac structure; and in this regard several imagine tests would be advisable.

It is important to rule out constrictive pericarditis in front of a chronic pericardial inflammation.

I am glad to have been helpful to you!

Meanwhile, I remain at your disposal for any further discussions.

Best regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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