Tuesday, September 25, 2012

Chest Pain? Palpitations? GI problem?

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For the past year I have been having episodes of severe chest pressure that lasts 5-20 minutes it goes straight through between my shoulder blades. It leaves me feeling worn out for hours. It only occurs at rest, sometimes waking me from sleep. I have gone to the ER and had EKG, chest Xray, and stress test which all came back normal. I had 2 EKG's done in the ambulance during the pain and they both came back abnormal says possible inferior infarct of undetermined age. the ER staff acted like they were never made aware of this, even though I heard the EMT tell them twice. The pain is relieved with nitro, but I usually just ride it out med free. I have about 6-10 episodes a month now.  Should i see a cardiologist first or a gastroenterologist? My NP is clueless and not sure where to send me.
I have also recently starting getting these flip flop feelings in my chest. They are happening more often they take my breath away for a few seconds then they are gone.

Gender: Female
How tall are you (feet and inches)?: 5'9"
What is your weight in pounds?: 219
How old are you?: 34
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Chest Pain
What have you done so far to remedy this condition? Please include tests and relevant studies here.
Chest Xray, abdominal ultrasound, chest CT to rule out aneurysm, stress test, EKG, cardiac enzymes
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): tubal ligation, gall bladder removal, tendon repair in foot

Check all conditions present in your immediate family... :
Cancer
Cardiac Disease
Diabetes
Hypertension
Stroke

Please list any medication allergies that you have : : none
Please list any medications you are currently taking (and dosage if known) :: lisinopril 5 mg
When was your last menstrual cycle?: 1 week ago
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely


Which type of doctor should I see first?
Can i go to a cardio and request an event monitor or a cath?
May we send you a satisfaction survey after your question is answered? It takes a minut to fill out.: Yes

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GREAT QUESTION. I THINK YOU SHOULD SEE BOTH A CARDIOLOGIST AND A GASTROENTEROLOGIST. INSIDE THE CHEST WE DO NOT FEEL PAIN LIKE WE DO ON OUR SKIN. IN OTHER WORDS, PAIN FROM THE STOMACH OR ESOPHAGUS CAN BE EXPERIENCED AS CHEST PAIN, AND, PAIN FROM THE HEART CAN BE FELT IN THE ARMS, JAW, OR THE STOMACH. ALSO, NITROGLYCERIN RELIEVES PAIN FROM THE HEART AND ALSO, OFTEN, PAIN FROM THE GI TRACT. IF YOU WERE MY PATIENT I WOULD HAVE YOU ON A HOLTER OR EVENT MONITOR TO CAPTURE THESE PALPITATION EPISODES ON A COMPUTER DEVICE SO A DOCTOR CAN REVIEW IT AND SEE IF YOUR HEART RHYTHM IS CHANGING WHEN YOU HAVE THESE EPISODES. YOU ALSO NEED AN ECHOCARDIOGRAM (ULTRASOUND OF THE HEART) AND YOU NEED AN UPPER ENDOSCOPY BY A GI DOC. THE REASON YOU NEED THE ECHO IS TO SEE IF YOUR HEART AND IT'S VALVES ARE ALL NORMAL. IF YOU HAVE HAD AN OLD INFERIOR INFACT THIS WILL SHOW IT, THOUGH THE EKG IS NOT THE WAY WE DIGANOSE AN OLD INFARCT (HEART ATTACK). THE FACT YOU HAVE PASSED A STRESS TEST POINTS AWAY FROM YOUR HEART AS A CASUE BUT DOES NOT RULE IT OUT. ALSO, THE TYPE OF SYMPTOMS YOU DESCRIBE ALSO SUGGEST YOU MAY HAVE ESOPHAGEAL SPASM AND THIS IS WHY YOU NEED THE GI DOCTOR TO LOOK AT YOU AS WELL. I THINK WITH THESE SYMPTOMS I WOULD START WITH THE CARDIOLOGIST, AND, IT WOULD BE GOOD TO HAVE THE HOLTER OR EVENT MONITOR DATA BEFORE YOU GO AND SEE HIM. SECONDLY, I WOULD SEE THE GASTROENTEROLOGIST. I HOPE THIS HELPS!

BEST

DOC1

1 comment:

Space doc said...

Dear chext pain/ palpigations/ g.i. propblem?

I think MDSTAT ER DOC 1 covered the situation very nicely.

With the abnormal ekgs during the pain I agree the cardiologist would be the first step. The nitroglycerine can relieve any spasms of smooth muscle whehter it is from coronary artery smooth muscle or from any smooth muscle in the g.i. tract.( i.e. the esophagus).

My only other thought is that the pancreas can give you pain that radiates to the back and can give you solar plexus (epigrastric) &/or chest pain.

Sometimes the gall bladder can cause this type of pain---with some back-up from stones or biliary material that can aggravate the pancreas .

As MD STAT 1 said an ultrasound of the heart could be frollowed by an ultrasound of the upper abdomen
to check on the gall bladder and the pancreas. Blood tests for tne pancreas such as serum amylase and /or lipase plus blood tests for the gallbladder / liver
could also be done

There are some problems with the aortic artery that could cause back and chest pain, but these are acute and very severe. (also could be seen on ultrasound.)

I think the cardiologist would be the first step.

By all means you need to get off the cigarettes which can cause coranary heart problems as well as arrythymias and can aggravate many gastric symptoms.

Best of Luck!
Space Doc.