Chest Pain And Doctors?

[mkoven]

I've posted here a fair amount recently about a new type of ongoing chest pain thatno one has been able to explain. Here is the scenario. It's always in the middle of the night. I wake up with no pain to go to the bathroom. No pain, but I"m sure my heart is racing from the transitions from lying to standing-- even if I get up slowly. I go to the bathroom. No problem. I lie back down to go back to sleep. No problem yet. Then, shortly after, the pain starts on the left side of my chest, often going down my left arm, with nausea, and often shortness of breath. (Yes, I"ve been to the ER FIVE times for this.) The big question is whether this is dangerous--maybe some sort of prinzmetal angina--but I took nitroglycerin the other night, upon my doctor's suggestion, and it actually made it worse. It gets better if I give up and get out of bed, and decide to be awake. There's something about the transition from sleep-half-wake-sleep that triggers is. The other thing I"ve noticed is that right when I lie back down, it seems like my heart rate is confused--like it can't decide whether to speed up or slow down. The pain starts right after it's slowed down--maybe too much? I do have an event recorder, and have been hitting record everytime this happens. When I call it in, the people on the phone can't tell you anything specific, but they do let you know if there's anything to "notify the doctor about." And there never is.

Anyone else ever have this? I don't know what to think or who to go to anymore. Some of my docs are saying i still have to go in EVERY time, but this is a nightly occurrence at this point, sometimes better or worse. Other docs are saying that it can't be my heart. And if nitro didn't help or even made it worse, it can't be a spasm/prinzmetal. I'd be thrilled for it to be benign. But no one can say what it actually is. (It seems that docs are often better at ruling stuff out, ratehr than explaining some weird phenomenon.)

the last er doc told me to start taking prilosec, in case it's gerd. I've done that for two nights. It may be too early, but no difference.

Intuitively it feels like something about my heart racing and then slowing down triggers whatever this is-- but then wouldn't one expect it to show up on an event recorder?

Doctorwise, I don't know anymore who to turn to. I get the 2 extremes of "it's nothing," to "it could be a spasm that could trigger a heart attack." It makes going to bed an unpleasant event.

Any ideas? anyone else ever have this? Any ideas about how to manage this?

[pat57]

Frankly what I should do is write a long reply- but I'm such a #$%^& typist. So in poor choppy style- here goes.

I'm not comfortable replying re chest pain- for obvious reasons. There is only one safe reply- IE (as you posted) "Some of my docs are saying i still have to go in EVERY time"

I have gotten the 2 extremes and go with my EPs eval. Not the PCP.

I have experienced similar going up stairs. There's a delay about 5 seconds, the palps, I lay down, one little gasp for air and then its over. No pain for me tho.

I would describe it like you do the heart "is confused--like it can't decide whether to speed up or slow down. " And "Intuitively it feels like something about my heart racing and then slowing down".

Have you ruled out costochronditis? Its a reach ,but I know it can hurt bad, the important question is can costoconhdritis be triggered be the tension that

the experience creates.

I think you need to know if ANYTHING showed up on the recorder. Is it what the DR called a spasm?????? If you knew it was a safe jump and decline in BP, then you could at least know a partial cause. Stress pains could result from a fear of physical harm .

[bjt22]

I have had so many different types of chest pain that I have pretty much given up on totally understanding what's happening with each and every kind. The variant angina, well, from what I've read, it isn't particularly dangerous if one doesn't have a lot of plaque built up in the arteries. You've recently had an angiogram that determined this was not a problem, so I wouldn't be overly worried.

Now, this doesn't mean that you don't deserve relief. Keep working on getting your other symptoms under better control...that has helped with me. If I keep my heart rate down and keep my blood pressure at as steady a level as possible, I have less chess pain. I don't know which drugs you have tried, but beta blockers work well for me, as does Catapres and a couple of other medications in combination.

[jbrian00]

You say this chest pain is occurring in the middle of the night...do you know what your heart rate is doing at the time? Sometimes I'll have some chest pain in relation to a low heart rate (below 60bpm for me) if I'm lying down. I have come up with 2 tricks to try and avoid this chest pain:

1. Get up out of bed really slowly. I first prop the upper half of my body up by my elbows for about 30 secs...this seems to get your body into thinking you're about ready to get up, so you don't suddenly shock your body by jumping right up too quickly. Then I sit up on my bed for about a min, and by then I can usually get up with no problem. I do the same thing getting into bed...I prop myself up on my shoulders or pillows for about a min then I lay myself down. If I simply lay down right away, my heart will feel wierd as if it hasn't caught up to the fact I'm lying down, and will become confused.

2. I also sleep with the upper half of my body propped up on 3 pillows. Lying down flat seems to trigger chest pain for me, particularly with a low heart rate. Propping up or raising the head of the bed appears to help.

Hope you find something to help with these attacks, cause I know chest pain can be a *****. Also, there are some supplements you could try out if you feel comfortable with it. Omega 3 fish oil might help along with the herb hawthorne. I'd first try the fish oil though before trying hawthorne. It's always best to ask your doc, but I've found the typical doc knows nothing about natural supplements/herbs.