Chest Pain? Abdominal Pain? What Gives?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.


On Saturday I was carrying in some groceries, when I noticed a strange pain at the bottom of and/or slightly behind my ribcage on the right side. – immediately to the right of my sternum.  I wondered if I had pulled some nameless muscle, although it did not feel like a muscle pull (having been an athlete I am very familiar with muscle pulls), but I thought it may have been some deep "core" muscle that gives a different sensation when pulled. But over the next 24 hrs as I tried to locate the offending muscle group it became clearer to me that it was not muscular because it seemed "tender" to the touch - a feeling half way between a runners "stitch" and a soreness due to inflammation.  It kind of felt like maybe some gas trapped in an odd place.

On Sunday eve the pain was about the same, maybe a tiny bit greater, I was getting a wee bit concerned because I figured a stitch was out of the question, and I was seriously doubting a sore muscle pull.  At some point my 5 yr old hit me right in the old solar plexus – not really, but he hit me right on the money spot below my ribs, it was a fairly typical 5 yr old playful punch- not much force.  The pain was so sharp that I yelled so loud that it sent my son screaming for mommy, and it even surprised me.  This is no muscle pull.  About 3 hrs later I started experiencing a very sharp pain when trying to breath deeply.  Also only on my right side but about 2 inches below my nipple (too high for any gastro-intestinal pain I am assuming) that was, once again similar to a side stitch -  the kind that hurts to breath deeply,  but about 2 -3x more intense and after a few hours it is still here. 
The pain is way to intense to “fight through the pain”, if I try to complete a breath, the pain is so sharp that my body reacts reflexively and forces me to stop.  I don’t mean a reflex like when your knee is tapped, I mean it is as if tried to keep your hand on a stove as it slowly got hot, at some point you will take your hand away no matter how much you try to will yourself not to – your body just takes over.

When I push straight into my stomach (liver? kidneys? gall bladder? Isles of Langerhans? gut? Whatever is located at the bottom of the rib cage) just below the rib, the pain starts about 1 inch to the right of my sternum and ends about 5 inches to the right of the sternum.. As I push it feels as if something is bloated, and if as I push into my body I angle my fingers up underneath the rib cage that seems to be the locus of the pain, maybe about an inch or 2 up from that lowest rib.

Also if I try to arch my back (not while inhaling) I feel both the sharp pain near my nipple and the “tender” achy bloated-y pain near the bottom of my ribs.

Could this be an old debate-team injury manifesting itself 30 years later?  Or is this merely mean I have to talk to my wife about her “cooking”?  Seriously though, I would like know if this is the beginning of appendicitis or pleurisy that me be a symptom of some underlying and serious condition, or if this is something I can ride out for a few days.

Thanks and Happy New Year

Update on the breathing pain.  I awoke this morning and found that lying on my back or left side gave me pain breathing with shallower breaths, and it just hurt to be in those positions.  When standing or sitting, only pain with deep breaths.  At 3pm I took a deep breath without the stabbing pain.  It is now 345 and still no more stabbing pains. But when I breath deeply I can feel a very mild pain where the sharp pain was, and I can feel a small to medium increase in the "tenderness" pain at the bottom of my ribs. It is wonderful to be able to breath, yawn, cough, sneeze without stabbing pain. BTW, any movement that is even slightly jarring Running dancing, twisting quickly) brings on a small to medium increase in the pain at the bottom of my rib cage.

Oh I was googling stuff last night and I realized in may be relevant that I have been having headaches quasi-regularly for about the last 3 weeks.  I rarely get headaches and almost never take pain killers but I have taken pain killers 3 times in the last 3 or so weeks.

Thanks again
Gender: Male
How tall are you (feet and inches)?: 6' 1
What is your weight in pounds?: 215
How old are you?: 50

How long has this been going on?: A few days
Check all symptoms you are currently experiencing:
Abdominal Pain
Difficulty Breathing
Chest Pain

Please list any medication allergies that you have : : None
When was your last menstrual cycle?: I'm a man, baby!

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: Within the next few days
Given that the sharp pains have subsided what should I do?
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Sir,
You need to proceed directly to the ER. You have two if not three potential life threats. The comments below are very good, but basically I am very concerned about the possibility of this being a blood clot in your lungs. It could be pain from your heart... it could be a collapsed lung.... it could be a lot of things. But, as long as the pain is as you describe all guessing is pointless. You could be in grave danger tonight. You need to go to the ER now. Now. Stop guessing about this pain and go get it looked at.

High Blood Pressure, Chest Pain, and All that Jazz.....

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

My question has to do with high blood pressure.  I have been taking my blood pressure with a home wrist machine.  It ranges anywhere between 145/90 and has been as high as 175/110 a few times.  Most of the time it ranges in the 150/100 ish.  This has been going on for about 2 years now.  More recently, I have been experiencing a racing heart when I'm at rest.  It's like my heart goes out of control before it corrects itself back to a normal heartbeat.  Within the last couple of months, I have been experiencing heart burn.  I don't know if it is severe or not because I don't have anything to compare it to as I have never experienced heart burn before.  Lastly, and also within the last couple of months, I have experienced pain under my ribcage in the front and up through my right shoulder-blade.  I don't know if this is all related or a coincidence that these have all happened about the same time.


I have no shortness of breath and can exercise without tiring.   My weight is proportionate to my height (5"3, 125 lbs) so my high blood pressure is not a result of being too heavy.

Gender: Female
How old are you?: 52
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Chest Pain
Palpitations

What have you done so far to remedy this condition? Please include tests and relevant studies here.
: Eat healthy and exercise.  I typically stay away from junk food except for once in a while.  My diet consists of fish and whole foods, not processed.  Fruits, vegetables, brown rice and fish make up most of my diet.  Vegetables are fresh, not canned.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): None.

Check all that apply to you or your immediate family (parents, siblings, grandparents):
Cardiac Disease
Hypertension

Please list any medication allergies that you have : : None.

Please list any medications you are currently taking (and dosage if known) :: Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks! NONE

When was your last menstrual cycle?: I no longer have a menstrual cycle

Are you currently using or do you have a history of tobacco use?: No

Are you currently using or do you have a history of illegal drug use?: No

Please describe your alcohol consumption :: Occasionally

So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response.

My high blood pressure is untreated because I am uninsured.  Until I am covered under insurance again, I would like to know what I can do to help prevent a heart attack.  I realize that I will need to be seen but at the moment, that is not possible.  Other than baby aspirin and my diet/exercise, is there anything else I can do to tide me over until I can be seen?  I'm just looking for some advice that can help tip the odds in my favor until I can be seen by a physician.

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Ma'am,

My board certification is in Emergency Medicine. From our perspective and training EVERYONE has a life threatening condition until we prove they don't. Therefore it is from this perspective of 'worst case scenario' that I am going to provide an initial answer. My colleagues will follow, I'm sure, shortly.

Three things.....

1. You are at risk of heart attack and are having some symptoms that might be angina. Your blood pressure is all over the place, and the device you use may be part of the problem. You can get a three day blood pressure check at the health department or even at the fire station down the street using a manual cuff and a set of real human ears. This average measurement will be much more telling of your real blood pressure. Also, you would feel pretty silly if you showed up in heaven and St. Peter said, "Oh! You are here early!" And you found out that the blood pressure medicine you are now missing costs four dollars for a month's supply, and that a visit with a primary care physician who could give you the once-over and get you back on some inexpensive and efficacious medicines would be about $125. Not trying to scare you, just saying that you have some cardiac risk factors and you are taking a gamble waiting for your insurance.

2. A baby aspirin a day and good diet and exercise is great. Keep doing it.

3. You may have a gall bladder problem causing many of your symptoms. If the sharp pain you get is pain that comes particularly after eating then I am even more suspicious of this. Click on this sentence to learn about the symptoms of gall bladder disease and see if you agree. Now here you are really going to run into a money problem and there's nothing you can do, if you have gallstones, to reverse the process apart from having your gall bladder out. Be aware though, that if I am correct about your gall bladder, that you run the risk of developing Cholecystitis

I am going to make room for my colleagues here. Do not put of a primary care visit for the sake of 'waiting on your insurance'. The cost is less than you think for a one time 'howdy do' and some medication prescriptions. The doc could also get an idea about your gall bladder and could form a plan of action with you were it to become worse suddenly.

Thanks so much for your question!

MD STAT ER DOC 1
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1) YOUR BLOOD PRESSURES : The range you describe is not good. (should be around 130/80). The wrist blood press. cuffs are often inaccurate. You can google mayo clinic wrist blood pressure monitors to see if you are doing measurements correctly. Very likely the family history of hi b.p. is partly responsible for your pressures.

2) RAPID HEART RATE (tachycardia) can be related to hi thyroid levels in the blood &/or some changes in the conduction system of the heart.

3) RIGHT SIDED PAIN UNDER RIBS GOING TO RT. SHOULDER BLADE. Could be gall bladder or liver problems.

4) "HEARTBURN". ( Unrelated to the heart). Stomach and esophageal reflux of acid. Tums or over the counter Omeprazole can help.

5) DIET. Low fat intake and avoiding acidic foods might help gall bladder and heartburn

6) SUMMARY:(a) Bl.Press. needs to controlled!! probably with medication since your weight,exercise and eating habits seem good.
(b) Need heart evaluation! (ekg etc} to check out heart rate & rhythm
(c) Need gall bladder evaluation (ultra sound etc.)
(d) One of our docs has a lot of emergency room experience and maybe he can help out on where to get things done that won't cost you an arm and a leg. I would be quite hesitant to continue on without getting these things checked out.

Good Luck---don't wait too long!!

Space Doc

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