What Do Persistent Pain And Pressure Sensation In The Chest Area Indicate?

Posted on Mon, 5 Dec 2016

Question: My wife is 65 and has the following symptoms: perpetual chest pains between her breasts and sometimes to the left, which she describes as pressure/tightness.

Answered by Dr. Ilir Sharka (1 minute later)

Better to consult your doctor there is a need to do ECG. Hope this helps you, if so hit thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (3 minutes later)

My wife is 65 and has the following symptoms: perpetual chest pains between her breasts and sometimes to the left, which she describes as chest tightness or pressure, sometimes sharp pains, occasional swelling of ankles and feet, and suddenly experiencing low level of energy. One hour naps daily and to bed by 8:00. Unusual for this high energy woman. No known health issues prior to this in the last few months. EKG and ECG, pulmonary CT scan looking for blood clots (negative), 24/7 heart monitoring for seven days, and stress test all show no apparent heart issues. Never smoked, low/normal blood pressure, low cholesterol. A family member (chief radiologist at a California hospital) feels she has coronary artery blockage even though it did not show up in stress test. Her cardiologist has been out of the US for two months so she has not met with him -- only with his PA, who says she has no heart issues. I feel they came up one test short; angiogram. The pain is worsening by the day, and she can't walk a block, even slowly. Nine months ago she could fast walk at least two miles, play an hour of pickle ball, and an hour of Zumba. She appears, to me, to be dying a little more each day. What are your thoughts?

Answered by Dr. Ilir Sharka (31 minutes later)

Brief Answer:
A careful differential diagnosis should be scheduled:

Detailed Answer:
Hello XXXX!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that her symptoms are not typical of any cardiac disorders (besides chest tightness or pressure, she sometimes complains of sharp pain, which is not specific for cardiac ischemia).

In addition, occasional swelling of ankles and feet (while the cardiac function from the cardiac ultrasound is normal) should be further investigated to exclude any possible liver or renal dysfunctions. In this regard, some lab tests are necessary to be performed:

- AST & ALT,
- bilirubin,
- total blood proteins and albumin,
- INR,
- BUN & creatinine,
- blood electrolytes level,
- arterial blood gas analysis

Anyway, considering her performed cardiac tests, before going to the angiogram (which is an invasive test), I would recommend performing one of the tests below, to investigate for coronary artery disease:

- a cardiac stress echo with dobutamine
- a nuclear stress test (CARDIOLITE)
- a coronary angio CT scan.

These tests are more sensitive and specific for coronary artery disease investigation compared to cardiac stress test and are less invasive.

I would also recommend performing some other tests:

- respiratory function tests for a lung disorder
- NT pro BNP levels for heart failure
- cortisol plasma levels for possible adrenal gland dysfunction
- inflammation tests (PCR, sedimentation rate) for an inflammatory disorder
- vitamin D plasma levels for possible insufficiency.

You should discuss with her doctor on the above issues.

Hope to have been helpful!

Kind regards,

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar