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Dr. Sohaib
Dr. Sohaib, Doctor
Category: Medical
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Experience:  MBBS, FCPS Experienced in all Medical Specialities
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Ive been having pain in my chest (left side about 1 inch above

Resolved Question:

I've been having pain in my chest (left side about 1 inch above my nipple) for approximately 8 days now. It was only noticeable after (intense) exercise and I ignored it for the first week, but last night the pain did not subsided as it usually does and even woke me up. When I woke this morning I felt dizzy and lightheaded, especially when standing up.

I went to the hospital to have an EKG and Xray done. Both tests came back with normal results. The doctor was stumped, after ruling out muscle soreness he ordered a blood test to check for infection.

Background info: I'm 29 years old, in great shape and have no history of heart problems. I had bronchitis (or pneumonia?) six weeks ago and it resolved itself without treatment, although I still produce a good deal of thick and clear phlegm. Four weeks ago I received head trauma. After healing I noticed my heart rate started to jump rather quickly during exercise. It's still the case and I don't know why. My lymph nodes are still swollen (left: throat, ear, and back of neck). For the last two days I've been feeling generally unwell. Please help

Thank you,
Vincent
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Sohaib replied 1 year ago.

Hello and thank you for the question.
Answers given are for informational purposes only and are not meant to replace an exam by an in-person.

I am Dr. Sohaib, a practicing Internal Medicine Specialist and i will do my best to help you today.


You need to answer a few questions first which will help me assist you in a better way.

Do you still have cough?

Get palpitations along with this pain?

Did they check your blood pressure? Was it normal?

Does this pain occur at rest also?

Family history of heart disease?

Smoking?

Customer: replied 1 year ago.

The cough has subsided
Last week I thought I felt murmurs, but i honestly can't tell.
My BP was 142/70 (i'm usually in normal/lower ranges)
Normally no, but last night's workout was intense and the pain stayed with me till the next morning.

Yes, my father's side has a good deal of heart disease.

I smoked for 9 years, but have been without tobacco for the last 6 years

Expert:  Dr. Sohaib replied 1 year ago.

Thank you very much for the useful information Vincent.

Glad to hear that the chest x-ray, especially the EKG turned out to be normal thus ruling out a serious possibility like a heart problem.

Since you had cough due to bronchitis, and that too for a significant duration, this is most likely a result of localized muscles spasm (most of us experience this whenever we have a prolonged or severe cough).

Reduced oral intake, dehydration or electrolyte imbalance can also contribute to muscle spasm.

Another possibility is of costochondritis (inflammation of the costochondral joint) also known as teitz's syndrome, which can give you similar kind of sharp and localized pain.

There there are other problems we should consider. You have been under stress, get episodic palpitations/rapid heart rate, and also had slightly high systolic blood pressure ---- if all these symptoms are not due to your heart then what else it can be?

The answer is that it can be due to anxiety or panic attacks.

Yes this is very common condition, even my closest friend had this problem some time ago. He used to get all the symptoms related to heart but the investigations (in detail) were normal, so he was put on anti-anxiety treatment and it worked.

In your case there is a remote possibility of transient cardiac arrhythmia which might give you these symptoms. An EKG is usually not a good investigation to determine such "transient arrhythmias" as this is only a 6 seconds strip. Holter's monitoring is more sensitive technique which is done by wearing a device for 24 hours which records any abnormalities in the heart rhythm during this period, which may be transient and the routine EKG fails to pick it up.

Once a cardiac cause has been reliably ruled out by your cardiologist, only then we can attribute this to anxiety. Therefore at this point you should have a detailed re-evaluation done by the cardiologist, while continuing with the symptomatic management.

I emphasize on cardiac re-evaluation because you have 3 risk factor for heart problem. History of smoking, family history, and male sex.

Have rest.

Try using Motrin or Aleve for the pain.

Muscle relaxants (like heat application and drugs like tizanidine) can also help.

Drink lot of water.

And discuss all the details i have mentioned to your doctor, in order to get further opinion and management plan chalked out.

I would have been worried too if I were at your place, but let me reassure you that this is a treatable condition and carries a good prognosis with appropriate management.

It was a pleasure assisting you and thank you very much for visiting us.

My goal is to provide you with Excellent Service - if satisfied with the response, Please do not forget to Rate my service.

If you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Kindest Regards.

Customer: replied 1 year ago.

Thank you for your detailed response.
A couple things


 


My cough stopped about 4 weeks ago and the pain started about one week ago. Can it still be from coughing?



About anxiety... the thing is that it (usually) only hurts after i exercise. The gym it is the most relaxing time of my day, I don't worry/think about anything. Why would the pain be so localized? It is always the same place and only on the inhale.

If it is costochondritis, what cautions should i take?




Expert:  Dr. Sohaib replied 1 year ago.

Thank you.

Honestly if the cough settled 4 weeks back then its not the cause.

But muscle spasm due to other reasons (as i mentioned earlier) can still be the underlying reason. Since this occurs with exercise (soon after it), this again suggest a muscle spasm due to high respiratory rate and laboured breathing during exercise.

Anxiety is one of the differential, but before that a cardiac problem should be ruled out with certainty.

For costochondritis, no precautions. Just Motrin or Aleve for few days, and heating pad application --- that should solve the problem.

I hope this clarifies.

It was a pleasure assisting you and thank you very much for visiting us.

My goal is to provide you with Excellent Service - if satisfied with the response, Please do not forget to Rate my service.

If you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Kindest Regards.

Dr. Sohaib, Doctor
Category: Medical
Satisfied Customers: 4708
Experience: MBBS, FCPS Experienced in all Medical Specialities
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