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What Causes Aching Pain In The Chest Area And Asthma?
Question: husband with cardiac stent placement rca and circumflex 2 weeks ago. Day after felt great. 3 days after began having left sided chest pain - re XXXXXXX - stents normal - pressures in all other vessels normal . on new meds - brilinta, metoprolol 25, and lipitor.. Continues to have left chest aching ( 1/10) and yesterday with minimal exertion sob. he has asthma. any suggestions? thanks
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I passed carefully through your question and would explain that in this clinical situation, your husband chest pain could be related to two main causes:
1- During stent implantation procedure not rarely may occur occlusion of some small collateral coronary branches, which may lead to persistent chest pain and subsequent cardiac enzymes (CK-MB, Troponin) elevations.
2- Chest pain related to an extracardiac cause ( musculoskeletal pain, inflammation, lung disease, pleural inflammation, gastroesophageal reflux, etc.).
For this reason, I would recommend performing some tests to exclude the first possibility:
- a resting ECG and cardiac enzymes
- a cardiac ultrasound.
If the above mentioned tests result normal, further tests to investigate for an extra-cardiac cause are needed:
- a chest X ray study
- respiratory function tests
- complete blood count and inflammation tests (PCR, sedimentation rate).
You should discuss with his doctor on the above issues.
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I passed carefully through your question and would explain that in this clinical situation, your husband chest pain could be related to two main causes:
1- During stent implantation procedure not rarely may occur occlusion of some small collateral coronary branches, which may lead to persistent chest pain and subsequent cardiac enzymes (CK-MB, Troponin) elevations.
2- Chest pain related to an extracardiac cause ( musculoskeletal pain, inflammation, lung disease, pleural inflammation, gastroesophageal reflux, etc.).
For this reason, I would recommend performing some tests to exclude the first possibility:
- a resting ECG and cardiac enzymes
- a cardiac ultrasound.
If the above mentioned tests result normal, further tests to investigate for an extra-cardiac cause are needed:
- a chest X ray study
- respiratory function tests
- complete blood count and inflammation tests (PCR, sedimentation rate).
You should discuss with his doctor on the above issues.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
cardiac enzymes normal - cxr normal - taking protonix ( not helping) - obrien's left negative - no chest wall pain on palpation - cbc normal - ef on XXXXXXX 65% - in cardiac rehab 3 x per week - I think this may be the metoprolol - do you think this is possible? thanks
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Coming to this point, cardiac ischemia or angina can be excluded (as cardiac enzymes and ECG are normal).
I do not think that these symptoms are related to metoprolol, because it is not a known adverse effect of metoprolol. It is known to reduce the physical performance, cause chronic fatigue or a low heart rate (bradycardia), but not chest pain.
I recommend trying ibuprofen for the pain. If the pain is relived by ibuprofen, this could indicate a possible extracardiac cause of chest pain (inflammation or musculo-skeletal pain).
Hope to have been helpful!
Best wishes,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Coming to this point, cardiac ischemia or angina can be excluded (as cardiac enzymes and ECG are normal).
I do not think that these symptoms are related to metoprolol, because it is not a known adverse effect of metoprolol. It is known to reduce the physical performance, cause chronic fatigue or a low heart rate (bradycardia), but not chest pain.
I recommend trying ibuprofen for the pain. If the pain is relived by ibuprofen, this could indicate a possible extracardiac cause of chest pain (inflammation or musculo-skeletal pain).
Hope to have been helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
As of today I have come to agree with you - It is musculo-skeletal and after asking multiple questions and observing I discovered that this is exacerbated with him bending over - he saw a physical therapist and now has exercises - I have been concerned about giving him ibuprofen because of the Brilinta - do you think even with the brilinta that he could take ibuprofen? I do think that the metoprolol is causing him some depression - for the time being I have reduced his dose to 12.5 mg po qd - but am watching him carefully - and he told me that last night he did feel better wrt the fatigue - thanks - I look forward to hearing from you again - ME
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I am glad that it seems to be just a musculo-skeletal pain.
Regarding Brilinta and ibuprofen, it is true that when used concomitantly they both increase the risk of bleeding.
For this reason, ibuprofen like all the other NSAID or painkillers should be used with caution.
Acetaminophen would be more safe in this clinical situation compared to ibuprofen, but it has not an antiinflammatory effect.
So, I would recommend trying acetaminophen first. If the pain persists, I would recommend trying ibuprofen in low doses (200-400mg).
I agree with your decision on reducing metoprolol dose, as it can cause fatigue and a low physical performance. I recommend also closely monitoring his heart rate (the main effects of metoprolol are on his heart rate and its dose should be adjusted based on his heart rate).
Hope to have been helpful!
Greetings!
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I am glad that it seems to be just a musculo-skeletal pain.
Regarding Brilinta and ibuprofen, it is true that when used concomitantly they both increase the risk of bleeding.
For this reason, ibuprofen like all the other NSAID or painkillers should be used with caution.
Acetaminophen would be more safe in this clinical situation compared to ibuprofen, but it has not an antiinflammatory effect.
So, I would recommend trying acetaminophen first. If the pain persists, I would recommend trying ibuprofen in low doses (200-400mg).
I agree with your decision on reducing metoprolol dose, as it can cause fatigue and a low physical performance. I recommend also closely monitoring his heart rate (the main effects of metoprolol are on his heart rate and its dose should be adjusted based on his heart rate).
Hope to have been helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much - and I hope that we won't have to keep conversing - I do find your thoughts to be helpful though - so hopefully - one last thing - he is having some episodic sob - he describes this as the energy just leaving him and feeling winded -it happened today after he had been busy - went to chiropractor and then shopping at lowes - by the time he got back to the car he was winded - lung sounds are cta b - last night he said that he had trouble singing and playing the piano because he felt winded - he does have a h/o asthma but has not felt the need for his inhaler - I really don't think that he is sob as in decreased o2 sats or hyperventilation or asthma - I think this is fatigue - he is in cardiac rehab and seems to get through this - do you think this is normal after stent placement? thanks
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that these symptoms could be partially explained with the procedure that he has gone through.
But, you should know that betablockers like metoprolol can exacerbate asthma and even cause chronic fatigue.
I recommend discussing with his attending physician on the possibility of reducing metoprolol dose further.
I would also recommend performing inflammation tests (PCR, sedimentation rate) in order to exclude possible inflammation.
Hope you will find this answer helpful!
If you have any other questions, feel free to ask me again!
Best wishes,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Regarding your concern, I would explain that these symptoms could be partially explained with the procedure that he has gone through.
But, you should know that betablockers like metoprolol can exacerbate asthma and even cause chronic fatigue.
I recommend discussing with his attending physician on the possibility of reducing metoprolol dose further.
I would also recommend performing inflammation tests (PCR, sedimentation rate) in order to exclude possible inflammation.
Hope you will find this answer helpful!
If you have any other questions, feel free to ask me again!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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