How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. German Your Own Question

Dr. German
Dr. German, Doctor (MD)
Category: Health
Satisfied Customers: 3814
Experience:  MD
3310972
Type Your Health Question Here...
Dr. German is online now
A new question is answered every 9 seconds

Ive been experiencing right sided chest pain

Resolved Question:

I've been experiencing right sided chest pain for months now. Seems to radiate from around the breastbone to the right side of breastbone and up the chest. Also, pain can radiate to the right neck and sometimes the right and front teeth, right jaw. Never any pain on left side. First occurred in Jan, trip to ER included full cardiac workup-- EKG, heart enzymes, clotting all fine. Chest X-ray clear. Cardiac stress test clear, reached advanced level. Dx: "Atypical chest pain, possibly pluracy" No further problems noted until Mid-March. Same chest pain, again always right sided, two trips to ER in same week. Again, all heart (EKG, enzymes, bloodwork, chest X-ray, clotting factors, all fine). DX: from the second and third ER visits, again chest pain, no cardiac issues noted, one doc thought it was a GERD attack and maybe esophageal spasm and gave Protonix, Zofran and Reglan. My doctor sent me for HIDA-scan as I'd also had gastro issues (bloating, gas) over past two years and my results were 37% functioning gallbladder. Surgery 4/5, no stones but very inflamed galllbladder. Pain resumed when I slowly got off Norco over several days post surgery. Surgeon sent to pain specialist, who thought it could be costochondritis, chest shot full of steriods, 30 days of NSAIDS. Went to GI again and was upped to 2X's daily on Protonix to see if this helps. Still having pain episodes, at a loss of what to do next, doctor is lost. Help! ME: 44, male, 225lbs but down from 270 throught diet and exercise. Have asthma but well-controlled and well-monitored, hypertension is well-controlled and monitored. Pain is not continuous but comes and goes. Episodes can be short, or long. Meaning, a few minutes to most of the night.

Submitted: 1 year ago.
Category: Health
Expert:  Dr. German replied 1 year ago.

Welcome and thanks for your question I am Dr. German I would be here to help you and give you assistance until you are satisfied, I am really sorry to hear what you have being going through , with all these tests and procedures without receiving a successful treatment .

 

I would tell you with this medical history , You should consult a Cardiologist Specialist to evaluate you .

 

 

You could have a condition called Prinzmetal Angina. In this condition ,the patient experiences a sudden vasospasm in the coronary arteries , they suddenly constrict narrowing down the intravascular space . As consequence , a specific area of your heart becomes affected and does not receive enough oxygen during that short period of time , producing this sudden chest pain .

 

 

The problem with this condition is that most cardiology or heart tests will be completely normal ( the EKG ,the blood tests ,the heart enzymes and the chest X-rays ) and it is necessary to perform a specific test called a coronary angiography with a stimulative substance like ergonovine.

 

 

With this test, your doctor will visualize the coronary artery and the exacerbated response and contraction of the coronary arteries will confirm you have Coronary Artery Vasospasm .

 

 

If the cardiologist confirms you have Prinzmetal's Angina ,he/she could give you medications to control the vasospasm alleviating your symptoms , usually a nitrate , a calcium channel blocker or a combination of both.

 

 

 

If you need any additional information I will be happy to continue further and assist you until you are completely satisfied . Good luck to you and have a good day !

 

 

 

When we finish our conversation if you like the answer ,please click accept so I can get credit for my work.

Customer: replied 1 year ago.


Hi Dr. German,


 


Thank you for the reply. Interestingly enough, before about an hour and a half before the stress test, they gave me 3 doses of nitro but it did not seem to provide any relief of the pain. This leads me to two questions:


 


1. if the nitroglycerine tablets did not relieve the pain, would it likely rule out cardio?


 


2. Would three nitro tablets given about 1.5 hrs prior to a stress test reduce the reliability of that test in provoking an angina attack?


 



Thank you.

Expert:  Dr. German replied 1 year ago.
1. Receiving nitroglycerin without relief does not rule out Prinzmetal Angina , in many cases , you need to give the patient additional medications to alleviate the pain including a calcium channel blocker or an alpha blocker .

2. Giving nitroglycerin before will definitely reduce the reliability of the stress test ,with the stress there is an increased response of the coronary arteries that will suddenly constrict ,if you give nitroglycerin ,these blood vessels will not constrict and the results could be false negative.


If you need any additional information I will be happy to continue further and assist you until you are completely satisfied . Good luck to you and have a good day !



When we finish our conversation if you like the answer ,please click accept so I can get credit for my work.
Dr. German, Doctor (MD)
Category: Health
Satisfied Customers: 3814
Experience: MD
Dr. German and 2 other Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery