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Dr. German
Dr. German, Doctor (MD)
Category: Health
Satisfied Customers: 3834
Experience:  MD
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Ive been experiencing right sided chest pain

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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.

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 3 years 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.

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.
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