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What Causes Intermittent Chest Discomfort?
Question: Hi
i have chest discomfort comes and goes , i did stress test , echo , EKG and CT chest and all were normal, the cardiology want do CT coronary ango but i am concern about the radiation because has alot of amount of radiation as i did many test. Do i do this test?
i also take blood pressure daily amaldopine 5 mg
i have chest discomfort comes and goes , i did stress test , echo , EKG and CT chest and all were normal, the cardiology want do CT coronary ango but i am concern about the radiation because has alot of amount of radiation as i did many test. Do i do this test?
i also take blood pressure daily amaldopine 5 mg
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I understand your concern and agree with you on the fact that a coronary angio CT scan imposes you to a considerable amount of radiation.
But, it should be performed only if your clinical symptoms coupled with other cardiac tests (ECG, cardiac stress test or cardiac enzymes) are suggestive of coronary artery disease.
But, as you refer all your previous performed cardiac tests have resulted normal.
Coming to this point, I do not think that you need to perform a coronary angio CT scan, because it is not necessary.
Another option is to perform a new cardiac stress test after 6 months. This would be a rational follow up and would not expose you to an unnecessary amount of radiation (by performing a coronary angio CT scan).
You should discuss with your doctor on the above issues.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I understand your concern and agree with you on the fact that a coronary angio CT scan imposes you to a considerable amount of radiation.
But, it should be performed only if your clinical symptoms coupled with other cardiac tests (ECG, cardiac stress test or cardiac enzymes) are suggestive of coronary artery disease.
But, as you refer all your previous performed cardiac tests have resulted normal.
Coming to this point, I do not think that you need to perform a coronary angio CT scan, because it is not necessary.
Another option is to perform a new cardiac stress test after 6 months. This would be a rational follow up and would not expose you to an unnecessary amount of radiation (by performing a coronary angio CT scan).
You should discuss with your doctor on the above issues.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
Do you recommend me to discuss this issue with general doctor or i make appointment directly with cardiology to make CT coronary ango because the hospital called me last week to schedule an appointment but i wasn't feeling discomfort so i didn't schedule but for this week i see the discomfort back again ?
i also posted the lab work that i did last week because the doctor said the result is confusion and the blood cell , i don't know if this related to the chest pain
I would like to mention that i did stress test few month ago but i still have the issue
Some doctors here told me to do this test to rule out any cardiac issue , what do you think of that ?
Do you recommend me to discuss this issue with general doctor or i make appointment directly with cardiology to make CT coronary ango because the hospital called me last week to schedule an appointment but i wasn't feeling discomfort so i didn't schedule but for this week i see the discomfort back again ?
i also posted the lab work that i did last week because the doctor said the result is confusion and the blood cell , i don't know if this related to the chest pain
I would like to mention that i did stress test few month ago but i still have the issue
Some doctors here told me to do this test to rule out any cardiac issue , what do you think of that ?
Brief Answer:
My opinon as follows:
Detailed Answer:
Hello again!
I carefully reviewed all your uploaded test reports and would explain as follows:
- You have had a low white cell count, with predominance of lymphocytes and monocites, which goes in favor of a viral infection, which could explain the chest pain.
- Your Hemoglobin levels are normal, but you have a higher number of red blood cells and a small MCV, which means that your red blood cells are a little small. This could be in case of iron deficiency or Thalassemia minor. But, according your your Hemoglobin electrophoresis, Thalassemia minor has been excluded. From the other hand as your Hemoglobin levels are normal, there is no need to make any treatment. These red blood cell changes could also be related to a viral infection.
- Other tests for HIV or C Hepatitis have excluded these possible infections.
Coming to this point, I would just recommend repeating your complete blood count after a month for any possible changes. If this is really a viral infection, your blood cell count will be normalized after such period of time.
Regarding your chest pain, does deep breathing or body movement trigger the chest pain? Have you tried taking ibuprofen for the pain? Did it relieve the pain? This would go in favor of a possible musculo-skeletal issue.
What about an antiacid? Gastro-esophageal reflux can mimic this clinical situation. I recommend trying omeprazole. If it helps relieve the pain, it would indicate possible gastro-esophageal reflux, underlying your complaints.
I would recommend you to make these small trials, before deciding to go on with the coronary angio CT scan.
If you decide to perform the angio CT scan, you should discuss with your cardiologist about this.
Hope you will find this answer helpful!
Let me know about everything!
Wishing good health,
Dr. Iliri
My opinon as follows:
Detailed Answer:
Hello again!
I carefully reviewed all your uploaded test reports and would explain as follows:
- You have had a low white cell count, with predominance of lymphocytes and monocites, which goes in favor of a viral infection, which could explain the chest pain.
- Your Hemoglobin levels are normal, but you have a higher number of red blood cells and a small MCV, which means that your red blood cells are a little small. This could be in case of iron deficiency or Thalassemia minor. But, according your your Hemoglobin electrophoresis, Thalassemia minor has been excluded. From the other hand as your Hemoglobin levels are normal, there is no need to make any treatment. These red blood cell changes could also be related to a viral infection.
- Other tests for HIV or C Hepatitis have excluded these possible infections.
Coming to this point, I would just recommend repeating your complete blood count after a month for any possible changes. If this is really a viral infection, your blood cell count will be normalized after such period of time.
Regarding your chest pain, does deep breathing or body movement trigger the chest pain? Have you tried taking ibuprofen for the pain? Did it relieve the pain? This would go in favor of a possible musculo-skeletal issue.
What about an antiacid? Gastro-esophageal reflux can mimic this clinical situation. I recommend trying omeprazole. If it helps relieve the pain, it would indicate possible gastro-esophageal reflux, underlying your complaints.
I would recommend you to make these small trials, before deciding to go on with the coronary angio CT scan.
If you decide to perform the angio CT scan, you should discuss with your cardiologist about this.
Hope you will find this answer helpful!
Let me know about everything!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
I took omeprazole 20 mg but doesn't help so i stopped it. i did blood test last week but the result will be after one week. i tried take ibuprofen but doesn't help . i went to the general doctor today and he want me to take propranolol 20 mg three time a day. and he said if doesn't help he want send me to cardiology to do angio CT scan. but he said if propranolol help he will take it off slowly. what do you think of this because i think propranolol 20 mg three time a day is alot.
I took omeprazole 20 mg but doesn't help so i stopped it. i did blood test last week but the result will be after one week. i tried take ibuprofen but doesn't help . i went to the general doctor today and he want me to take propranolol 20 mg three time a day. and he said if doesn't help he want send me to cardiology to do angio CT scan. but he said if propranolol help he will take it off slowly. what do you think of this because i think propranolol 20 mg three time a day is alot.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I agree with your doctor on the prescription of propranolol. You should know that this is not a high dose, but a normal one.
It will help avoid possible artifacts from tachycardia during the coronary angio CT scan.
So, I would strongly recommend continue taking propranolol 20mg three times daily before the coronary angio CT scan.
Hope you will find this answer helpful!
Let me know about everything!
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I agree with your doctor on the prescription of propranolol. You should know that this is not a high dose, but a normal one.
It will help avoid possible artifacts from tachycardia during the coronary angio CT scan.
So, I would strongly recommend continue taking propranolol 20mg three times daily before the coronary angio CT scan.
Hope you will find this answer helpful!
Let me know about everything!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi
The doctor want increase proponolol 40 mg two time a day. Can i stopped take it two days and i see the discomfort back again. do you recommend me to continue taking propnolol or i stop because i don't want used to it
I mean i stopped taking proponolol 20 mg for 2 days now . because proponolol make me sleepy and tired during the day
The doctor want increase proponolol 40 mg two time a day. Can i stopped take it two days and i see the discomfort back again. do you recommend me to continue taking propnolol or i stop because i don't want used to it
I mean i stopped taking proponolol 20 mg for 2 days now . because proponolol make me sleepy and tired during the day
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
As long as propranolol is causing these adverse effects (sleepiness and tiredness), it would be reasonable to stop taking it.
But, you should not stop taking it cold turkey, because it should be stopped gradually (to avoid possible adverse effects from stopping it abruptly).
As I already explained above, this would be a temporary treatment before the coronary angio CT scan, in order to reduce the heart rate during this exam.
But, considering your age, I would not recommend it as long term treatment, because it is known to reduce the physical performance, thus leading to chronic fatigue.
I recommend you to discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
As long as propranolol is causing these adverse effects (sleepiness and tiredness), it would be reasonable to stop taking it.
But, you should not stop taking it cold turkey, because it should be stopped gradually (to avoid possible adverse effects from stopping it abruptly).
As I already explained above, this would be a temporary treatment before the coronary angio CT scan, in order to reduce the heart rate during this exam.
But, considering your age, I would not recommend it as long term treatment, because it is known to reduce the physical performance, thus leading to chronic fatigue.
I recommend you to discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for quick replay,
my doctor told me to take it without any date to stop it. and he didn't told me to do CT cornory ango But i will try call the hospital next week and see if i can make the appointment for CT cornory ango because i want make sure that my heart is fine as the pain is getting worse . proponolol 20 mg can help but i don't want take it for long term like you mentioned. do you think i have Unstable angina that cause chest pain and lead to a heart attack ?
because another doctor here told me to do CT cornory ango to rule out any cardic issue.
I did many test before like stress test , echo, EKG, all were normal but there is no conclusion i got from there test and another doctor here said even if these test were normal i will still get a heart attack
my doctor told me to take it without any date to stop it. and he didn't told me to do CT cornory ango But i will try call the hospital next week and see if i can make the appointment for CT cornory ango because i want make sure that my heart is fine as the pain is getting worse . proponolol 20 mg can help but i don't want take it for long term like you mentioned. do you think i have Unstable angina that cause chest pain and lead to a heart attack ?
because another doctor here told me to do CT cornory ango to rule out any cardic issue.
I did many test before like stress test , echo, EKG, all were normal but there is no conclusion i got from there test and another doctor here said even if these test were normal i will still get a heart attack
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
As a cardiologist, I don't think that you have any unstable angina.
It would show up in your previous tests, if it was present.
But all your tests have resulted normal.
I know that even though tests result normal, sometimes they do not exclude coronary artery disease, but your symptoms are even not suggestive of this disorder. I would not agree with my colleague (the other doctor who has encouraged you to perform the coronary angio CT scan) on this point.
From the other hand, the propranolol helps relive your chest discomfort, does not indicate coronary artery disease. You should know that propranolol does not have this effect in angina. But it just helps reduce your heart rate. Besides, it acts also on the central nervous system, leading to relaxation and elimination of anxiety.
So, this raises high suspicions that anxiety is playing an important role on all this clinical scenario.
But, if coronary angio CT scan will help calm your anxiety and reassure you that you do not have coronary artery disease or unstable angina, then you should go on with this test, despite its radiation risks.
You should discuss about all this with your cardiologist. You should tell him that you have stopped taking propranolol too.
Hope to have clarified some of your uncertainties!
Let me know about everything!
Wishing good health,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
As a cardiologist, I don't think that you have any unstable angina.
It would show up in your previous tests, if it was present.
But all your tests have resulted normal.
I know that even though tests result normal, sometimes they do not exclude coronary artery disease, but your symptoms are even not suggestive of this disorder. I would not agree with my colleague (the other doctor who has encouraged you to perform the coronary angio CT scan) on this point.
From the other hand, the propranolol helps relive your chest discomfort, does not indicate coronary artery disease. You should know that propranolol does not have this effect in angina. But it just helps reduce your heart rate. Besides, it acts also on the central nervous system, leading to relaxation and elimination of anxiety.
So, this raises high suspicions that anxiety is playing an important role on all this clinical scenario.
But, if coronary angio CT scan will help calm your anxiety and reassure you that you do not have coronary artery disease or unstable angina, then you should go on with this test, despite its radiation risks.
You should discuss about all this with your cardiologist. You should tell him that you have stopped taking propranolol too.
Hope to have clarified some of your uncertainties!
Let me know about everything!
Wishing good health,
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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