More Chest Pain In The Cold Weather...

[summer]

Does anyone else find they have more chest pain in the cold weather? I find I have two different types of chest pain. One kind is definitely chest wall, it's in my ribs and sternum, and feels like someone beat me up. Costochondritis, I think.

The other is different... like a tightness in the center of my chest, sometimes I feel it in the center of my back next to my left scapula. This is the one that has increased with the cold weather. I also feel it when I stand too long. Anyone else?

Summer

[janiedelite]

Yes, definitely. One of my first POTS symptoms was pernio or chronic frostbite. I hate this disease because if I get too warm, my skin burns and I get tachy and fatigued. But if I get too cold, I overly vasoconstrict, get purple toes and chilblains, and my skin still burns even more. I do best in neutral temperatures. I recently tried mestinon and it might have contributed to my recent trip to the hospital for chest pain because it can vasoconstrict. My troponin was elevated, so I was experiencing coronary vasoconstriction. I stayed overnight and took nitro tablets and paste which totally eliminated my chest pain and reduced my troponin level. I told my cardiologist that I'm probably the only patient whose regimen includes compression hose, salt and fluid loading, and nitroglycerin.

I've found that I have the chest wall pain like you describe, and the nitro doesn't seem to help that. I have chronic back/rib pain and which I believe contributes to this type of pain. But I do have the other pain like you described which radiates like a burning ache through my left chest. Nitro does relieve that pain for me, which leads me to believe that in addition to inappropriate vasoconstriction of my peripheral vasculature (frostbite) I experience inappropriate coronary constriction.

I've also found that abrupt change from warm to cold (like getting out of bed when the room is chilly) also makes me feel horrible. So we have high heating bills in the winter just because having a constant environmental temperature seems to help a bit. Warm drinks throughout the day also help. I also sometimes wrap a warmed rice pack around my shoulders and upper back.

This is just my recent experience. I remember reading other threads on this topic last year, so at least we are not alone in this!

[summer]

I've also found that abrupt change from warm to cold (like getting out of bed when the room is chilly) also makes me feel horrible.

Hi! Thanks for your reply. I have read some on the board recently about what you've been going through, but I must admit that I have been finding it too difficult to keep up with the board lately and may have missed some of your posts.

Forgive me if you've already posted about this, but did you also have ECG changes along with the elavated troponin? Where you still having CP when you were tested at the hospital. Have you received a diagnosis?....like coronary artery spasm, or variant angina?

I also have Raynaud's, chillblains, and migraines. Do you have migraines as well?

Interesting that you mentioned going from warm to cold being the worst. I find this too. Like when I leave my house and go out to a cold car. I often get CP if I sit in my car to warm it up (wish Santa would bring me a remote car starter). I live in Canada, so it's going to get much worse than this by the end of January.

I was feeling (relatively) great in October after a very sluggish, sickening summer. So I started imagining what I would be able to do this winter! My husband said, "you always feel better in the fall. See how you feel in a couple of months." Hmm.... not so great. It's almost like a whole new set of winter symptoms.

[potsgirl]

Hi Summer,

Yes, I've found that I have more chest pain in the winter, too, especially the second type of pain you wrote about - it almost feels like a band around my chest. I'm with you guys on going from warm to cold, too (or vice-versa). It makes me feel horrible. I run out and start my car to warm it up if I have to leave the house in the morning if the temps are in the 30s and 40s. If I get too cold, I can't seem to warm up. I also have the migraines. Blah.

Cheers,

Jana

[janiedelite]

Hi Summer,

No ECG or echo abnormalities. My troponin in the ER was 0.13 and went up to 0.35 7 hours later, then back down to 0.10. I was given 2 liters oxygen by nasal cannula in the ER which helped my pain, but it was the nitro I received later that night that really helped.

Yes, I get migraines (never got them prior to POTS). My cardiologist thinks that perhaps the mestinon I'd been taking for about 6 weeks vasoconstricted too much. I did have a bit more energy on the mestinon at first, then began having more chest pain which I just attributed to the recent onset of cool weather. The chest pain that drove me to the ER was different though, because lying down didn't relieve it and my BP was 185/105 and lying down didn't help that either. And this episode occured when I was reclining and resting. This episode lasted about 2 hours. I stayed on mestinon for 4 more days, then had another similar episode while going to sleep (BP skyrocketed again, burning chest pain that radiated into my left arm and jaw) which was halted by nitro. I stopped taking mestinon after the second episode and it's been 2 weeks now with no further episodes. I still have chest pain brought on by orthostatic or emotional stress, but that's normal for me and is helped by lying down or nitro.

Nitroglycerin is contraindicated in most POTS, so I'm certainly not advocating this type of treatment. In my case it actually makes me feel more energized at times, and I feel like I can finally take deep breaths.

I was also told by Mayo to try midodrine, but it worsened my frostbite. I just don't do well on any type of vasoconstrictor, although I must wear my compression hose every day.

Canada in the winter would be rough! I really don't know which is worse for us POTSies, being too warm or being too cold. I live in the Pacific NW which has fairly stable temperatures compared to most other regions, but I still have a hard time especially during temperature extremes.

[summer]

Hi Summer,

Yes, I've found that I have more chest pain in the winter, too, especially the second type of pain you wrote about - it almost feels like a band around my chest. I'm with you guys on going from warm to cold, too (or vice-versa). It makes me feel horrible. I run out and start my car to warm it up if I have to leave the house in the morning if the temps are in the 30s and 40s. If I get too cold, I can't seem to warm up. I also have the migraines. Blah.

Cheers,

Jana

Hi Jana,

I know what you mean about not being able to get warmed up. Sometimes, the only way I can is to get into the tub. Then I get too hot and.... well... you know .

Interesting that you also have migraines. I've even heard that the rib/chest wall pain can be caused by vasocontriction to the small vessels supplying blood to the cartilage - there's alot around the ribs. I guess we'll just have to stay bundled up until spring!! Thanks for your reply.

Take care,

Summer

[summer]

The chest pain that drove me to the ER was different though, because lying down didn't relieve it and my BP was 185/105 and lying down didn't help that either. And this episode occured when I was reclining and resting. This episode lasted about 2 hours. I stayed on mestinon for 4 more days, then had another similar episode while going to sleep (BP skyrocketed again, burning chest pain that radiated into my left arm and jaw) which was halted by nitro.

185/105!! That must have been really scarey for you! Glad to hear that the nitro helped. Have you ever been on calcium channel blockers? It's pretty frightening to think of our blood vessels constricting all over the place. It's hard to understand how it all fits in with orthostatic symptoms, low BP, etc. No wonder we find it difficult to tell other people what's going on with us. It's hard enough to try to figure it out for ourselves!

So sorry to hear about all you've been dealing with. Hope you are feeling better and can figure out a good combination of meds to help.

Yes, winter here can be pretty vicious! I bought myself an early Christmas present... a big, puffy down filled coat that goes right to my knees! My kids think it's pretty funny, but I plan on surviving this winter!! I guess I've either gotten too old or too cold to be vain!!!!

Take care,

Summer

[janiedelite]

Yes, winter here can be pretty vicious! I bought myself an early Christmas present... a big, puffy down filled coat that goes right to my knees! My kids think it's pretty funny, but I plan on surviving this winter!! I guess I've either gotten too old or too cold to be vain!!!!

That sounds like great idea! Right now I'm trying a combination alpha/beta-blocker called coreg/carvedilol. I don't think it will be the drug for me because it makes my raynaud's worse. You take care too!

[tinkerbella]

thankful,

this is what i take my chest pain is less frequent on this, but helps my raynauds. neuro says my circulation needs better control, but i'm at the highest dose.

this is the brand nane that the neuro wanted me on instead of cartia xt.

http://www.drugs.com/pdr/cardizem-cd.html

it sures beats popping nitro all the time. I had muscle dammage done that looked like i ran a marathon, luckily, my heart was not involved.

i wish you the best sweet one.

may you find something to manage your symptoms.

bellamia~

[janiedelite]

Thanks BellaMia. One vascular doc told me to take a calcium channel blocker, but then an EP cardio said it would make my OI worse and not to take it. This new cardiologist said he'd keep trying different drugs til we found one that works. I suggested a calcium channel blocker, but he said he wanted to try the coreg first. We'll see what works.

BellaMia, do you find that you have more problems with vasoconstriction when cold weather sets in?

[tinkerbella]

THANKFUL,

I don't have many options, and we know that I may have to live with being more tachy as I can't take bb tried again and failed. COLD MAKES ALL KINDS OF STUFF FLARE, this week my knees are going out on me, I roast everyone in my hospital room, my teeth all hurt off and on to chew, I think my heart works so hard to make my body warm up all the way to the tip of my nose that feels so numb when cold.

bellamia~

[erik]

The other is different... like a tightness in the center of my chest, sometimes I feel it in the center of my back next to my left scapula. This is the one that has increased with the cold weather. I also feel it when I stand too long. Anyone else?

I do ok in cold, but I get the chest/heart/lung/back discomfort as part of the last phase of standing too long (not long before I will eventually go faint).

[jump]

I have chronic chest pain in the winter, and for a long time I thought it was the cold, but now I actually think it might be due to dryness. One of my most troubling symptoms has always been excessive thirst (made better by florinef), and I always "feel" dehydrated.

My current apartment is very moist and damp, and I find when I stay at my parents' house over night (their house is VERY dry), my chest-wall pain is always much, much worse. And of course, it's much more dry in the winter than in the summer.

The other factor, though, that I can't rule out, is that in the summer I hardly work at all (about 7 or 8 hours a week), whereas in the fall, winter and spring I work much more (15-25 hours a week). So sometimes I wonder if the chest pain is related to the increase in activity. For me, work-related activity is the most "stressful" on my body (standing up, sitting down, going up stairs, talking to people in a coherent way, driving). Although I'm inclined to think the winter-chest-pain is about dryness, it could also be about increased physical stress, I don't know.

I do know I haven't found any relief for it. I think the florinef has helped some, and it has also helped me feel less thirsty all the time - but it's hard to say, because it could also be that I'm just more used to the pain now and less bothered by it. But I think the florinef did help. Other things I've tried - massage therapy, reiki, ibprofen, asprin, inhaling steam, keeping very warm, doing yoga - do not seem to help at all.