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Susan Ivy
Susan Ivy, Nurse (RN)
Category: Health
Satisfied Customers: 4058
Experience:  BSN, MSN, CNS
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very active, healthy, muscular boy with no known illnesses

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Hello, my name isXXXXX have a question about my 16 year old son. He is a very active, healthy, muscular boy with no known illnesses. He has been suffering for over a year now with strange chest pain that completely debilitates him lasting several seconds to minutes, 1-3 times daily. The attacks come on during exertion or during rest. They cause nausea, shortness of breath, heart pounding, blurred vision,chest pain that feels like it's piercing to his back, and as he describes it, a sensation that, " His blood veins in his arms and neck are going to explode." He has been seen by a heart specialist in Houston, Texas. He has had a stress test, EKG, chest x-ray, and an echocardiogram. All of which were negative and show no heart problems whatsoever. His PCP has noted that his BP was in the 147/90 range atleast 4 times during his visit. We do have a strong family history of heart disease and high blood pressure. His maternal uncle had surgery at 18 years old for Wolfe-Parkinsons disease. Is there anything that could be causing this besides the heart? There is something definitely wrong with this boy, who is otherwise very healthy. Thank you!

Hello Serril,

 

Thank you for using Justanswer for your concern.

 

First of all he should be treated for hypertension. It is now known the even BP in the 130/80's and above (prehypertension) can lead to damage in the peripheral circulatory system, and later elsewhere, including the heart (heart failure, especially at higher levels). The symptoms of pain after exertions are very concerning.

 

It is unusual, but not impossible for a child to have these issues, and even though they have not found anything on stress test etc., something must be done for the BP.

 

If you must, get a second opinion. If you have a university in your area with a medical school and pediatrics devision, and even if not - look for a pediatric cardiologist.

 

I hope this helps. Remember, sometimes it is the "squeeky wheel that gets oiled" so be assertive when calling, take notes with a list of his BP's, so that you have something in writing to show the doc; keep a diary with incidences of chest pain, but he needs to see someone soon. If his BP is elevated, especially at home, make not of what it is and take him to an Urgent care clinic. The doctor may have thought this is "white coat syndrome" (high blood pressure upon seeing a doctor - but even with this it is now recommended to treat the patient.

 

If you have questions, please reply.

 

Susan

Susan Ivy and 3 other Health Specialists are ready to help you
Customer: replied 8 years ago.

Dear XXXXX,

 

Thank you for your reply. As you have suggested, my pediatrician in the States also wants me to keep a journal and record pressures. He probably would have wanted to run more tests, but Daniel had to return to St. Lucia too soon. My son doesn't seem to have high BP at home, but I can't really trust my cuff. It records very unusually low BP readings for anyone who uses it. (?)

I guess my frustration is with all those tests being negative, what in the world is going on? He is obviously seriously suffering with SOMETHING. But how do I find out if they say he's fine. Of course he didn't have any attacks during those tests, only later that day.

When I took him to the emergency room here in St. Lucia for chest pains, the doctor asked me if I wanted something to be wrong with him. This was because I was not satisfied that he was fine after only an ekg. So, since I live in a 3rd world country, what would you suggest that I insist upon them testing? Is there anything else that could have been done if we had stayed in the States a little longer? I feel like it's useless until he has one of those attacks, then I'm back to square one - What in the world is going on?

Hello.

 

Well, sitting back and thinking about this, 1st, lets be happy that the test were okay. Although it is possible to miss angina sometimes, if he had damage to his heart or clogged vessels, that would have shown up on the tests.

 

If possible, get a good blood pressure cuff.

 

He may be having panic attacks. These can mimic heart angina and heart attack very closely.. They are a phyisiological problem that usually begins after long periods of stress and then if something else happens there is a peak in anxiety, excelerating rapid shallow breathing - that doesn't have to be noticeable (Some people are also just more prone to this genetically - anxiety is common in individuals with cardiac disease as well). Here is a short explanation of how this occurs: This (the rapid and shallow breathing) actually decreases the carbon dioxide in the system, leading to some vessel constriction and actual pain.

 

The trick is to know that this is a possibility and start learning ways to head this off. This can include whole lifestyle changes but sometimes it is more simple (more exercise, learning how to control breathing, learning how to express fears and emotions verbally and other ways, noticing the incidents {thoughts and occurence} that happen before these start). I will leave you a link that explains how the phyisiological response occurs due to the "fight or flight" stress response that causes cortisol and adrenaline to be secreted into the blood stream leading to a panic response.

 

Some people don't like to think that this (anxiety) could be causing what feels so bad. And, I don't know for sure that this is what is happening with him. But if this continues to happen and it seems likely to be anxiety related, I suggesst an evaluation with a psychiatrist or a advanced practice nurse that can prescribe medications. Whether a panic reaction or a cardiac problem, low doses of SSRI medications can help with anxiety tremendously in certain cases. Cognitive-behavioral therapy can be successful with controlling this as well, if the patient is motivated.

 

Physiology of the response: http://en.wikipedia.org/wiki/Fight-or-flight_response

 

Coping with this: http://www.anxieties.com/panic-step2.php

 

 

 

 

Customer: replied 8 years ago.
Sorry to reply so late. Thank you so much for your help in this matter. I will try to get a new cuff, and be more diligent about my journal. I talked to him about stress, anxiety and other factors that could be triggering these attacks. He agreed that certain stressful situations mike bring them on. But, he also commented that it's exactly the same when he is really happy, excited, or laughing. So, that makes me wonder if it could have anything to do with his pituitary gland. I don't know but hopefully they will go away soon.

I don't necessarily see a pituitary issue, although there could be some sort of neurological or hormonal issue that is quickly set off by certain conditions.

 

Tell me why you think pituitary? Perhaps this could be reviewed in more depth.

 

It is a puzzle, with it happening when he runs and also when he is happy. I think it is still important to work on trying to stop them when it occurs or they are coming on with deep breathing techniques, visualization -- perhaps trying to run 5 minutes shorter if he finds out it comes on after a certain amount of time.

 

Keep in touch if possible (after this post is closed, you can ask for me by putting my name in the post title such as "for susan ivy")

 

But first - hopefully he can get involved with a small pad to jot times down on, etc. to get a little more information on specifics and I'll keep you in mind incase I run across any thing else to recommned.

 

 

Customer: replied 8 years ago.

Susan,

 

When I spoke to him about what you said, he talked about it more in depth as if it happened when his body might be releasing any type of hormone, sugh as excitement, fear, joy, stress, etc. He says that it always happens immediately following any of those things, like right after he laughs, or right after he exercises, etc.

Isn't that related to the pituitary gland?

 

Thanks for your reply!