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Dr. Andrew Rynne

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What causes pain in the chest upon exertion?

Answered by
Dr. Sagar Makode


Practicing since :2013

Answered : 1717 Questions

Posted on Wed, 8 Mar 2017 in Hypertension and Heart Disease
Question: I am trying to decide if i should continue to seek answers or just let go and accept what the drs ive seen have told me as thats what they advice. Ive had slight pains/feelings in my chest, but more so lower along my bottom left rib to the left of thr bottom of sternum. It sometimes goes up in the middle of chest but then tyoically is more "zappy" or qucik like and then gone. The bottom left rib area is more consistsnt in location. That too dont last long, but longer then the few second zapph feelings the occur higher in the chest. This started thr end of november- i was under a ton of stress at the time. I started gojng to drs the following week, they gave me stress test, which the computer read positive but the carsiologist read negative (said probably a loose wire) they did blood test of protien sensitivity and that was good. Theyve done numerour ekgs that were good. They also did an ecocardiogram with was good. They told me it must be stress, not to worrh aboht cardiac issues. 2 weeks later I went to another carsiologist, he did an upper gi xray series and a galbladder uktrasound. All was normal. He said we could do a nuclear stress test just to be sure. The treadmill oart of that was good but the pictures didnt line up. He said that normally indicates a blockage on the right side of the heart which can cause pain in the lower part of my chest. He said we should do a coronary angiogram. They did that the next day, thy found nothing. He said everything was completly clean and zero build up. He said probabkh anxiety and i need to let go of the thoughts and it will orobably clear up. 3 weeks later (still feeling these sensations in the chest and lower rib area) i decided to go to a 3rd cardiologist. He reciewed all the test the others did and he did his own ekg. He said also that everythig looked great in relation to the heart. He showed me the angiogram and explained how it works and how its about nearlh 100% in accuracy. He didnt realky comment on why i maybe having these pains and feelings still uust reassured that its not my heart.

I know i should feel good from all
Of thus but i think about it still everyday since i keep having the feelings. People tell me thats why i still it because ive stressed myself out so much that untilk i whit thinking about i will contine to have physical symptoms from the stress/anxiety and over sensitiviry i have created myself. A chiropraric said it could be rib stuff from my back fom being tense (even tho i mah not realixe the tenseness). A physical therapist ive seen tells me it coukd be nerve pain from the muscles between the ribs. They all say youve ruled out the heart so i shoukd calm down.

I just wish the feelings would go away. I read stuff online and it says you can still have cardiac issues with a clear angiogram so that makes me wonder if i should keeo seeking answers. Should i be concerned after all this? If so would i see yet anther cardiologist or a diffeent type of dr?

Im told be pains arent reflected as angina pains becusse angina is usualy more oainful and more an all over feeling starting from the middle of the chest where you ccant pin point exact location of the pain and it usually lasts a minimum of few minutes up to 30 mins and not short and quick and in soecific spots as i explain it.

I guess im looking for yet another form of reassurance or some direction in who i would see next if i shoukd jeep searching for answers. I do take clonazepan that they gave me, i take .5 mg once a day. Can stress and anxeith really be the cause of this?
Answered by Dr. Sagar Makode 52 minutes later
Brief Answer:

Detailed Answer:
Listening to your entire history, pain doesn't look like a cardiac pain. Cardiac pain typically occurs on exertion and relieves with rest, persist longer. Also, angiography is gold standard test. In some cases, patients have anginal pain and normal angiography, those patients have microvascular angina but they will show some abnormalities in other tests. Atleast some of the tests like nuclear scan should have shown some changes in patients with microvasculature angina. So I think you should not worry about it to be a cardiac pain.
The first possibility, I would keep is of reflux disease. Stress and anxiety can very well cause and increase this problem. Acid Reflux causes esophageal spasm and bouts of pain. Sometimes patients can have symptoms of gastritis as well like upper abdominal pain nausea vomiting bloating and burping etc. I guess there is no relation of pain to deep breathing, ruling out respiratory cause of pain, so whatever is left is esophagus. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Elevate head end of bed during sleep or rest. Avoid smoking and alcohol if any.
You can get prescribed tab Pan DSR 40 mg beforebreakfast once a day for 2 weeks. Also, syr sucral O or gelusil two teaspoon three times a day for a week. You can visit gastroenterologist and one endoscopy should be considered.
Does this can be reproduced with movements or application of pressure over chest ? So you should not worry, and get back if you have any further doubts.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Sagar Makode 18 minutes later
Thank you for your response. It does not seem to change with movements really. Someones i think do a little bit bjt jt alsk does jr for no apparent reason too. Does seem to happen more with regular daily activities vs total rest but actual exertion dosnt seem to make it worse. Maybe im just more relaxed when resting. I smoked for 3 years of my life and havent for 2 years now. I have factor 5 blood and i have slee apnea. I am only 33 years old. You mention that one tyoe of agina, but some other tests should have been positive- the nuclear "picture" portion was off - but they said alot of things can cause that. False positives do happen ans thats what that was since the angiogram was negative. I drink socially- not a lot, a few drinks every couple weeks.
Answered by Dr. Sagar Makode 15 minutes later
Brief Answer:
See the description

Detailed Answer:
none of things including age points towards heart as a cause of discomfort. I think you should try pan DSR, make yourself assured that it's not cardiac, try to ignore it. Get relieved of stress with relaxation techniques like yoga and meditation, deep breathing. You continue antianxiety medicine.
If it does not respond even then, you can get one screening ct scan of chest done to look for other causes.
Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

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