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What Causes Chest Discomfort While On Propranolol?

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Posted on Fri, 16 Jun 2017
Question: Hi
I have chest discomfort in the middle of the chest, I did before stress test , EKG and echo . the result is normal the cardiology also want do CT conory ango but i didn't do it because concern about radiation . the doctor gave proponolol 20 mg 3 times a day for the chest discomfort . it helps but he just increased the dose to 40 mg twice a day. do you recommend me take 20 mg only when i need it or daily because stop it and the discomfort came back again and i don't want used to it . i also take amaldopine 5 mg for blood pressure daily
doctor
Answered by Dr. Ilir Sharka (51 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

Your symptoms are not typical of coronary artery disease. The fact that the chest discomfort is relieved by propranolol, indicates possible anxiety underlying your complaints.

You should know that propranolol besides reducing heart rate, acts also in the central nervous system by reducing anxiety.

For this reason I would recommend trying alprazolam 0.5 mg or 0.25 mg.

If your symptoms are relieved by this drug, you should consult with a specialist of anxiety ( psychologist or psychotherapist) to help you manage anxiety.

But you should also know that propranolol does not relieve chest pain in case of coronary artery disease.

So, in my opinion, considering your symptoms and your performed tests, I would not recommend performing a coronary angio CT scan, because I don't think it is necessary.

Hope to have been helpful!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you
yes, i tried alprazolam 0.5 before and can help but the doctor told me not to take it for long term and better use propranolol 20 mg.propranolol 20 can reduce the chest discomfort but not completely . the doctor told me to increase the dose to propranolol 40 mg twice a day but i don't take it because prevent me to do physical activity and make me feel tired . But can I still do coronary angio CT scan for only to rule out any cardiac issue so when the result come normal i won't worry any more when i have chest discomfort in future and i will go see anxiety doctor but i want first rule out any cardic issue. And for radiation i will stop doing any CT scan for long time so i don't think would be a problem
another doctor here said "As we discussed earlier, though your age and investigation like(ECG and ECHO)doesn't support heart disease but we can't ignore symptoms in resting stage.

You may need proper and complete investigations.
I advise both MRI thorax and CT angiography. You may also need upper GI endoscopy.
We can't take chance and in such conditions and all related investigations are advised.

We are mainly concerned about radiation exposure.
CT angiography causes far less exposure than maximum allowable safe dose.So,it may be advised for diagnostic purpose."
what do you think
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

I understand your concern, but do not agree with my colleague. Sometimes doctors tend to recommend a lot of tests in order to be sure that everything is OK. But perhaps he didn't know all your story.

The fact that your symptoms are relieved by alprazolam and propranolol is a strong argument in favor of anxiety.

You should know that propranolol does not relieve chest pain in coronary artery disease patients.

Regarding alprazolam, I agree on the fact that it should not be used as a long term treatment for anxiety because it can lead to addiction and tolerance. But the same is for propranolol. Because at your age, it can cause chronic fatigue, a low physical performance and can interfere with your daily activity.

Antidepressants and Yoga are more helpful and recommendable as long term treatment for anxiety.

Anyway, if a coronary angio CT scan will definitely help calm your anxiety and push away your fears, I would recommend performing this test, despite its risks of radiation.

You should discuss with your doctor about this and about the fact that you have stopped taking propranolol.

I remain at your disposal whenever you have any other questions!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you for your respond
The cardiology told me to take propnolol 20 mg only when i need it but the general doctor increase the dose to 40 mg and told me to take it regularly. I took propnolol 20 mg because i had discomfort but it takes few hours to relieve but don't relieve completely . Do you recommend to take it regularly or only when i need it and do you recommend to take dose 40 mg or 20 ? And for coronary angio CT scan i think will help a lot to clear any doubt about the heart disease . And do you think the radiation will do a big damage for DNA or won't hurt as i heard it can cause cancer for long term that's why i was concern about it because i already did two CT chest scan few month ago in ER . And is stress test has radiation the one that i already did or only works with EKG?
doctor
Answered by Dr. Ilir Sharka (25 minutes later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

Coming to this point, I would recommend only use propranolol for a short time, especially before performing the angio CT scan, because it is necessary to have a low heart rate during this exam, so the results can be interpreted properly.

I would prefer the lower dose 20mg. But, it is necessary to closely monitor your heart rate, because higher doses can cause a low heart rate (bradycardia).

As a coronary angio CT scan, would help calm your anxiety, I would recommend performing this test.

The risk of radiation is cumulative, but I do not think that such amount of radiation would impose a higher risk for cancer.

Anyway, I would recommend avoid unnecessary tests, which impose you to risk of radiation in the future.

Regarding the cardiac stress test, you shouldn't worry about it. It does not have an increased risk of radiation.

Hope to have clarified some of your uncertainties!

Wishing a nice weekend,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (38 hours later)
Hi

I have discomfort in the chest that pain comes and goes at rest , I did stress test, EKG, Echo, CT chest two times all were normal . The cardiology want do CT cornoary ango test, Do you recommend me to do it ?

I am also concern about the radiation from this test

I take amaldopine 5mg for blood pressure and probonolol 20 mg only when i need it. probonolol can help some time for the pain but i don't take it daily.
Thank you

Can i try this magnsum powder in the link to see if can help for anxiety and chest discomfort
https://www XXXXXXX com/Natural-Vitality-Stress-Raspberry-flavor/dp/B001MJT6IA/ref=sr_1_9_a_it?ie=UTF8&qid=0000&sr=8-9&keywords=calm

because is more natural than probonolol and don't slow the heart rate. and can i take it with amaldopine 5 mg.
As the pain comes and goes i am hesitate it about doing CT ango as some time i feel the pain is strong and some time is little
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Yes, you can try this magnesium powder. It is safe to take concomitantly with amlodipine. It may help against anxiety.

Regarding the coronary angio CT scan, I do not think that it is necessary.

But, if it helps relive your anxiety and push away all the doubts about any coronary angio CT scan, I would recommend performing it, despite the risk of radiation.

Hope to have been helpful!

Feel free to ask me again whenever you need!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (3 hours later)
thank you
Do you think this supplement can help for the chest pain Turmeric Curcumin with Bioperine (Black Pepper). because some people said can help for heart burn and back pain but not sure if can help with chest pain
https://www XXXXXXX com/Bioperine-Antioxidant-Supplement-Anti-Inflammatory-Cardiovascular/dp/B01J8CR49K/ref=sr_1_1_a_it?ie=UTF8&qid=0000&sr=8-1&keywords=chest+pain+relief
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I understand your concern, but I do not think that this supplement will help in your clinical situation.

It has anti-inflammatory effects, like ibuprofen.

But as ibuprofen didn't help, I do not think that this supplement will help either.

Hope to have clarified some of your uncertainties!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (18 hours later)
Thank you
Sorry for asking many questions, just to clear any doubt
you mentioned before that CT cornary ango won't exposed to high radiation that cause cancer, but i already did two ct scan for the chest and stress test while they let me run on treadmill than they injected me with XXXXXXX and did scan to me on machine like two time maybe they did sestamibi stress test or other imaging and this also expose me to alot of radiation because lie down on a table, and a special camera or scanner that can detect the XXXXXXX in bloodstream will take pictures of your heart. is this has a lot of radiation ?

. if i do CT cornary ango are going to increase my risk to have cancer in the future ?
and can i take thus supplement with other medicine to help for chest pain
Coq-10 Cardiovascular
https://www XXXXXXX com/Omegaboost-Coq-10-Cardiovascular-Support-Capsules/dp/yyyyyyyyyy/ref=sr_1_1_s_it?s=hpc&ie=yyyyyyyyy=0000&sr=1-1&keywords=chest+pain

and can i take this supplement with other medicine because not stimulant and regulated from FDA
https://www XXXXXXX com/yyyyyyyyyy-Function-Attention-Concentration-Non-Stimulant/dp/yyyyyyyyyyyy/ref=sr_1_14_a_it?ie=UTF8&qid=0000&sr=8-14&keywords=focus+factor

doctor
Answered by Dr. Ilir Sharka (38 minutes later)
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again dear,

Yes, this kind of stress test (also called CARDIOLITE), has a lot of radiation. In fact its radiation is compared to the Coronary angio CT scan.

So, it is true that all these tests can lead to a lot of accumulated radiation in your body. But, this amount of radiation is not so high as to lead to Cancer.

So, relax and don't worry about it!

Regarding the supplements that you refer:

1-Omegaboost-Coq-10-Cardiovascular-Support-Capsules contain Conzime Q, which is necessary for our heart and body muscles. It helps have healthy muscles and increase the physical performance. But, I do not think that they will help relieve your chest pain.

2-Neutropix-Function-Attention-Concentration-Non-Stimulant. This supplements contains a lot of vitamins and proteins helpful for a normal memory and brain function. They just increase the concentration and your mental performance. But, they have no effects on the chest pain.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 hours later)
Thank you
do you mean that when i do Coronary angio CT with previous test won't expose me to radiation that cause cancer?
because i calculated the radiation for each and with Coronary angio CT and maximum dose would be 108mSv and they mention that we should expose to 100 mSv in life time so this number is exceed the number they mention in life time . that's why i am concern about doing this test.
And do you think i have epigastric or chest wall, And if i don't want do this test is there another option i can do . I heard these herbs can help but not sure "Garlic. ...
Ginger. ...
Curcumin. ...
Alfalfa."
Pomegranate juice
Omega-3 fatty acids
doctor
Answered by Dr. Ilir Sharka (13 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Yes, in fact it is a considerable dose of radiation.

But, in everyday life patients make a lot of these tests without being conscious about the radiation. That is because sometimes the disease (coronary artery disease) is much more serious compared to a hypothetical risk for cancer in the future.

Considering your age, your previous performed tests and your symptoms, I would not recommend performing a coronary angio CT scan, because I think it is unnecessary. It will probably result normal.

Regarding these supplements, they can help, but I can not say that they will totally relieve your chest pain. They act mainly by regulating the cells function.

I would also recommend taking some valerian supplements for a short period of time. They act like alprazolam and propranolol.

But you can take both these supplements. They have a lot of benefits, restoring the body natural balance.

Hope to have clarified some of your uncertainties!

If you have any other questions, please don't hesitate to ask me again!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you
I will try valerian supplements but i remembered before when i moved heavy thing i have short of breathing for like few minute. is this sign of coronary issue but i wasn't have any chest pain that time and didn't happened again .
but i see like 4 doctor here advise me to do that test two cardiology and one is Pulmonologist
and one mention to do invasive ango , let me post their respond . what do you think of their answer

"I never said that am 100 % sure that you don't have any heart issue. I rather told you that to be 100 % sure you should undergo Angiogram. But again you don't want that. I told to see Gastroenterologist only after your cardiologist rules out any kind of cardiac issue. Primary importance is to cardiologist only.
"
"i will recommend you to go for invasive one, because if the CT Angio shows some blockage than to exactly quantify the blockage you have to go for invasive angio. So why not directly go for it. If such thing was done than it was CT Angio & if not done you should get it done or the invasive coronary angiography which i told you earlier.
"
"IN my experience in patients like your pain we preceded for sure with CT angio.

Or another step before doing it is fibrogastroscopy for excluding gastric problems.
Sometimes stomach problems may cause pain like you prescribe

If this examination come negative than you MUST do CT angio to evaluate heart and its vessels.

When clinical picture is clear for heart diseases its not so important the radiation compare to the secure life of the patient
"and they mention also"In my personal opinion from my clinical view and if we should follow the guidelines for chest pain the last test to exclude the cardiac origin of the pain is CT angio.
"do you think dimethylglycine and B15 will help
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again dear,

I understand that discussing with a lot of doctor and facing different opinions has brought a lot of confusion in your mind.

It is true that we doctors tend to make all the tests to exclude all the possible causes. But, we don't think too much about radiation risks. It is true that coronary angio CT scan is a more accurate test for the diagnosis of coronary artery disease.

From the other hand all your previous performed tests have resulted normal. This indicates that there is a high probability that the angio CT scan will result normal too.

So, if I were your cardiologist, I would not strongly recommend this test, because I don't think it is necessary.

In my opinion anxiety is playing an important role in all your complaints. Other arguments in favor of this cause are the fact that propranolol and alprazolam both help improve your situation.

But, if the coronary angio CT scan will help calm your anxiety, you should perform it. Later, you should be careful to any other tests which impose you to radiation risks.

Regarding dimethylglycine and vitamin B15, you should know that these supplements are used to help increase the immune response.

But, I do not think that they will help.

I would just recommend taking valerian supplements, which will help against anxiety.

Vitamins can also help gain your lost body balance.

I remain at your disposal for any other questions.

Best wishes,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you
I agree with you that other test is normal there is chance CT cornory ango test will be normal too. but i feel all the time like i will have heart attack and i can't relax and all the time . and this scaring me as i feel not safe and the pain become sharp . is this all anxiety and how about the pain that i feel it ?And if i have anxiety why the doctor don't give me anxiety medication that are safe and i can use it daily
doctor
Answered by Dr. Ilir Sharka (6 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Yes, I understand how you feel.

I do not think that this is just anxiety.

Sometimes pain has different components: musculo-skeletal pain. Anxiety can also trigger gastritis and gastro-esophageal reflux.

And so anxiety amplifies the pain.

But, you should know that sharp pain that lasts for some seconds, is typical of musculo-skeletal pain and inflammation.

In my opinion, this is not related to coronary artery disease.

But, if a Coronary angio CT will help push away all your fears and doubts, than you should perform it. Try not to think too much about radiation. You will try to avoid it in the future.

But at least you will be sure that your coronary arteries are OK.

Another option would be starting an antidepressant and Yoga. After some weeks, if you are feeling again pain and anxiety, then you can go for the coronary angio CT.

The decision is yours, as it is your body and only you can decide what to do.

Our duty is to recommend what we think it is the best for you and clarify your uncertainties.

Let me know about everything!

Take care,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (11 minutes later)
Thank you
but i did take omeprazole for gastritis and gastro-esophageal reflux and didn't help so i stopped it . And i need to decide this week because next week i won't be able to do it as is the hospital is in another city . but you mention that sharp pain last for second but i always have pain but is moderate and not sure f it's sharp that consider heart pain . And do you assure that the radiation won't cause me any cancer if i do this test because i will try to avoid any test if i know that my heart is fine in the future ?and yes you right, alot of opinion confuse me so not sure which i follow. if the cardiology who treat me told me no need for more test i won't do it but he didn't say that
doctor
Answered by Dr. Ilir Sharka (17 minutes later)
Brief Answer:
My opinion as follows:

Detailed Answer:
I understand how you feel dear,

It is really reasonable to follow your doctor advice, because he knows you better.

It is also rational to discuss with other doctors, when you are uncertain about these tests.

But, you should not be afraid of radiation. A lot of patients perform repeated coronary angio CT scan or angiogram, without any consequences. From the other hand a lot of doctors work inside the angiogram room everyday and the radiation is not so high to cause cancer.

As you say, you will have no fear after this test and will avoid unnecessary tests with radiation risk in the future.

Then, go ahead and do this test. This will put an end on all your fears and anxiety.

It will clarify everything! Just do not think too much about it!

Everything will be OK!

I would be happy to review your future tests, whenever you want to upload them for another professional opinion.

You can ask me directly a question, if you wish (question for Dr. Sharka) and I will be happy to discuss with you on these issues.

Let me know about everything!

Wishing all the best,

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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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9534 Questions

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What Causes Chest Discomfort While On Propranolol?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome back on HCM! Your symptoms are not typical of coronary artery disease. The fact that the chest discomfort is relieved by propranolol, indicates possible anxiety underlying your complaints. You should know that propranolol besides reducing heart rate, acts also in the central nervous system by reducing anxiety. For this reason I would recommend trying alprazolam 0.5 mg or 0.25 mg. If your symptoms are relieved by this drug, you should consult with a specialist of anxiety ( psychologist or psychotherapist) to help you manage anxiety. But you should also know that propranolol does not relieve chest pain in case of coronary artery disease. So, in my opinion, considering your symptoms and your performed tests, I would not recommend performing a coronary angio CT scan, because I don't think it is necessary. Hope to have been helpful! Kind regards, Dr.Iliri