Pain on the chest

[kriswillems]

Every night, I wake up around 5AM having a heavy feeling on my chest and a light pain.

The feeling I have is like in am in a room with closed doors and windows and there's not enough oxygen.

Sometimes I get a numb feeling in my left arm.

The pain sometimes goes to the back.

Getting up and walk around always makes the pain go away.

Sleeping on my side/belly while strongly hugging the side pillow beside make the pain softer. Sleeping on my back makes it worse.

 

One year ago I went to Payathai to get my heart checked. They did a stress test and I failed that test (1 to 2mm horizontal ST depression).

So, I had a coronary angiogram in my home country and it was perfectly normal.

So, I had a gastroscopy which revealed I had a slight infection of the gullet (around the place of my heart).

My blood test were normal (1 year ago).

 

I got medicines Patomed 40mg, but if I take them or not doesn't make any difference.

 

I have the problem now for almost 1 year, and because the doctors couldn't find anything (1 year ago),

I started to think it was some kind of imaginary problem, maybe related to working too much, or becoming older (41 now).

But, I don't have a history of imaginary problems - I go to the doctor only once per 3 years or so.

 

I've tried to change my lifestyle - different food - take vitamins - don't take vitamins - don't eat in the evening - always eat in the evening - don't drink any acid (coke, fruitjuice) - it all doesn't change anything.

 

The pain does not occur more when I do heavy labor or exercise a lot. I never feel any pain after eating too little or too much. I never feel any stomach pain.

 

The only thing that makes the problem worse is being tired, work long hours, sleep little, for a long time (several weeks).

 

The problem has been bearable for the last year, but I feel like it's getting worse lately.

 

Does anyone have an idea what it could be?

I more or less accepted it's an imaginary problem, so if you think it's that it's ok to tell that too.

 

 

 

 

[Mrjlh]

Sounds like a mild heart attack...go see a Doctor ASAP.  Don't take any risks...not worth it.  The numb feeling is a big warning sign. 

 

And sitting at the computer complaining to people isn't worth it either.  Go now.

Edited July 21, 2014 by Mrjlh

[kriswillems]

I had my heart checked 1 year ago with an angiogram.

It's like the best heart check you get get.

You can clearly see the arteries. 

They found nothing. But my EKG during stress test (running on a belt) is not good.

1 year ago I was feeling worse than today, and I also felt pain during daytime.

 

After the stress test the doctor advised me to take aspirin. After the angiogram I could stop with it. 

Edited July 21, 2014 by kriswillems

[Mrjlh]

That was a year ago!....what do you think now?  You asked...was answered...your life.  All they can say is you are fine...not harm no foul...but what if you are not?

[kriswillems]

I don't know what to think. 1 year ago my arteries were perfectly normal,

I've a low/normal cholesterol, it's highly unlikely my arteries change in 1 year.

 

Maybe the problem is not related to my heart or gullet? Or not to the coronary arteries? Maybe I am seeing the wrong kind of doctor?

Edited July 21, 2014 by kriswillems

[FBN]

The failed stress test can not be denied even in the presence of a "normal" angio. 

Search "unstable angina" or: 

http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Unstable-Angina_UCM_437513_Article.jsp

 

It should definitely be regarded as an emergency; please see a cardiologist asap and, if needed, repeat the tests listed in the referred article.

[meatboy]

2007 I had a replacement valve and a double by-pass,after 6yrs of more or less going through what you are experiencing till it got worse.it all started by the tightness or that heavy feeling chest and left arm,i used to hold my arm with my right hand to get some comfort in bed every night.you need to go and have an echo-gram and a angio-gram these will check your heart and your arteries.do you find that after a meal you cant do any walking at all or if like me in the early stages short distances before giving up.one thing if you are not having pain don't think you don't have a heart problem,because I thought that.

[kriswillems]

I had the cardiac catheterization /angiogram described in that article (and an echogram). They couldn't find any blockage, so it was not necessary to do any other step.

 

I feel nothing after eating, well not different from before, I can walk as normal.

Also, heavy work doesn't make me feel worse.

 

What makes me feel bad is heavy work, for several days or weeks, with not enough sleep.

Sleeping 10 hours per day makes me feel better. Before I used to sleep only 8 hours per day.

 

Meatboy, during the 6 years that you felt bad, did you have an angiogram?

 

Edited July 21, 2014 by kriswillems

[Shurup]

Never hurts to get a second opinion from another doc.

I'm not a doc and can't advise anything except maybe getting a complete blood check?

If you have a feeling like there's not enough oxygen, maybe your hemoglobin is very low or some other weird blood condition? Or maybe the air in your room isn't clean (is there a car shop below you??) if the CO concentration in your room air is high, it might give you this feeling, not high enough to kill you but high to make you feel uneasy?? Dunno.

 

Do you feel any better when you travel and stay away from your room for a while?

[FBN]

With a normal angio at that time you may be suffering from a variant of angina called "Prinzmetal" angina which means the cardiac artery\ies just spasms intermittently which will not show up on an angio but is just as serious.

Your symptoms seem to fit in with what is described here:  http://emedicine.medscape.com/article/153943-overview

 

[kriswillems]

Never hurts to get a second opinion from another doc.

I'm not a doc and can't advise anything except maybe getting a complete blood check?

If you have a feeling like there's not enough oxygen, maybe your hemoglobin is very low or some other weird blood condition? Or maybe the air in your room isn't clean (is there a car shop below you??) if the CO concentration in your room air is high, it might give you this feeling, not high enough to kill you but high to make you feel uneasy?? Dunno.

 

Do you feel any better when you travel and stay away from your room for a while?

Actually, 1 year ago when I traveled back to my country to have have angiogram, I stayed there 2 months. When I arrived there I felt really bad.

But I started to feel gradually better until, after 2 months the problem was gone.

What was strange is that I felt getting better quickly, the cold weather was much easier to bear than the tropical weather.

When I came back to Thailand, it slowly came back.

The airconditioning is clean. I think it's not related to the room, because I also get it when I sleep in another room.

[FBN]

Fairly confident that you are suffering from "Prinzmetal's Angina"; please mention this to the cardiologist (as it is rare) who you really have to see asap.

[kriswillems]

Yes. FBN, that fits the symptoms I have, only the articles says:  ST-segment elevation, while I have an ST-depression, so that's completely the opposite of what you would expect.

You can clearly see on the EKG that the horizontal piece between the S and T point of the cardiogram goes down when the heartbeat increases, until about -2mm at 180 beats/min

 

2mm is actually on the edge. Only about 40% of the people with 2mm horizontal ST depression during stress test, actually have a heart problem. The angiogram seemed to confirm that I am with the 60% that doesn't have a problem.

 

Anyway, I think I better get a second opinion. Maybe i'll see a specialist in another clinic.

I am  bit worried about wasting the time and money of my family and making them worried for no reason (possible imaginary problem), so I haven't told them anything when I felt bad.

Edited July 21, 2014 by kriswillems

[meatboy]

I had the cardiac catheterization /angiogram described in that article (and an echogram). They couldn't find any blockage, so it was not necessary to do any other step.

 

I feel nothing after eating, well not different from before, I can walk as normal.

Also, heavy work doesn't make me feel worse.

 

What makes me feel bad is heavy work, for several days or weeks, with not enough sleep.

Sleeping 10 hours per day makes me feel better. Before I used to sleep only 8 hours per day.

 

Meatboy, during the 6 years that you felt bad, did you have an angiogram?

 

the no of tests that I had done and having a job to find out exactly what was wrong used to get me down.you know your own body and can always tell if something is not right.the nhs.in the uk.is or was one of the best in the world if you are prepared to wait,but if you go in the meantime its no help,i was lucky I have family that are well connected with some of the top doctors or as they are called professers and one saw me and he more or less diagnosed exactly what was wrong and he got me an appointment to see a heart specialist in a very short time[normally a long wait] even then it was 6yrs before surgery.test after test,pills pills and more pills,i remember going to see the surgeon [july] 2007 and him telling my wife it has got to be done in September,i thought why have they waited this long,even on op.day it was cancelled and once again after that.so if you are in Thailand I would sugest you go and see a cardio-olagist straight away i know Sheryl will post who is the best.test that I can remember,the jelly put on your chest and a camera rubbed over it and you could see the images on screen,then there was the test where you could hear a swishing sound of your heart,then there was the test where florescent fluid was injected near your groin and again you could see it going through your veins,then there is a lung test,and a stress test on a running machine,all of this was ok.but I hate the flipping needle it makes my toes curl up. good luck and don't delay.

[faraday]

Go to see your Doctor now..or better still go to the Emergency Department.

 

Do not postpone this, please.

[kriswillems]

Ok, thanks all for your advise. I'll go to see another heart specialist, maybe in another hospital this time.

I am not very worried, my condition hasn't changed much the last year, but the feeling is still there. 

 

I really don't know if the problem I have is related to my heart - maybe not.

 

I think I'll get a normal ECG (not a stress test) to see if something is wrong.

Last time nothing abnormal showed up during the normal ECG, but if the condition got worse something might be seen this time.

If nothing is visible on the ECG, I think I'll just leave it.

[Sheryl]

As FBN has said you urgently need to see a cardiologist and it needs to be a good one who will listen carefully to your history

[kriswillems]

Do you know a good cardiologist in Chonburi province?

Or if it's possible to make an appointment via telephone - a good cardiologist in BKK? (PS. I am uninsured here, so for anything more than 30K I would fly back to my country)

 

Suppose I get a blood check (which I can do in the local lab), which kind of things should I get checked?

 

I just to make sure that  the reason of the problem is not my heart, because last year they said it not my heart. Even my family doctor, which I know for all my life, says it's not my heart. He says it's my gullet, but I really doubt that because the problem is totally unrelated to when I eat or what I eat.

 

 

 

 

 

 

Edited July 22, 2014 by kriswillems

[FBN]

Look at it this way; a "gullet" problem is highly unlikely to have a fatal outcome where a cardiac condition has a very different risk profile.  The cardiac possibility needs to be either confirmed and treated or 100% excluded.

Basic tests may include a repeat stress ECG as a normal resting ECG will be virtually useless in trying to diagnose this.  If the ECG is done when the pain is there, it will probably show an abnormality.  You can have a normal resting ECG with a very severe blockage...

The mechanism of this (Prinzmetal) is:  The coronary artery goes into spasm for whatever triggers it, the blood supply to that region of the heart muscle becomes compromised and pain results.  If this does not proceed to actual damage of the muscle through prolonged spasm (>10 - 15 min), there will be no sign of it in any test afterwards as the blood vessel relaxes and normal blood flow is restored.

The key in diagnosing this is in the detailed history and distribution of the pain, which in your case is classic for a cardiac event.

 

I will ask Shery to advise on the best cardiologist or cost from her extensive database.

Cost will be determined by the tests performed.  Likely they would want to repeat the stress ECG at minimum.

[Sheryl]

I suggest you see Dr. TAWORN  SUITHICHAIYAKUL at Bkk Christian Hospital. He is there only on Saturday mornings 10 -12 noon. No appointment needed but it is first come, first serve and if you have never been there before will have to register to get a patient number, so get there early if possible. Bring all relevant records with you, esp. results of the stress test and angio.

 

http://www.bangkokchristianhospital.org/dr-e.asp?page=fs&spid=002-Med#

[rhythmworx]

Sounds like Angina to me, ask a local lady boy if he can get some Amyl Nitrate, Liquid Gold, bear in mind its illegal.

 

Try a few sniffs of that when you get this tightness you describe if it relieves it your 1 step closer to a diagnosis.

 

You need to see a decent qualified doctor, not a 2 bit one, but someone who knows their rectum from their elbow.

[FBN]

Amyl nitrate is a potentially lethal drug in this case; I hope the poster was referring to Nitroglycerine!

Only after a cardiologists consult though.  Factors like blood pressure and other vital signs are critical before this medication can be taken.

[kriswillems]

I suggest you see Dr. TAWORN  SUITHICHAIYAKUL at Bkk Christian Hospital. He is there only on Saturday mornings 10 -12 noon. No appointment needed but it is first come, first serve and if you have never been there before will have to register to get a patient number, so get there early if possible. Bring all relevant records with you, esp. results of the stress test and angio.

 

http://www.bangkokchristianhospital.org/dr-e.asp?page=fs&spid=002-Med#

Results of angio? What is that? A video on CD/memory stick? I remember seeing my arteries on the screen when they did the angio.

 

The results of the angio are in my country. The conclusion said: normal arteries. It worth to try to find back more information?

 

I've the result of the stress test.

 

Thanks Sheryl.

[Sheryl]

Well you can try just telling him it was normal but if you can get at least the report, it would be better. (They wouldl ikely have it on disc too but that might take longer to get).

[kriswillems]

Ok, in the process of collecting information to take with me to the heart specialist, I had a chat with my family doctor (which has my whole medical file).

 

He said:

- that the old stress-test or future stress-test doesn't have any meaning because the angiogram showed my heart is healthy.

- that some people just have strange EKG, even though their heart is healthy.

- that I should not have stopped taking Pantoprazole. I stopped after two weeks because I thought it didn't help at all

- that Pantoprazole works slowly and I need to take it for a long time. He even said me I've to take it for 5 years.

- that I should stop worrying about my heart and that it was absolutely not necessary to see another heart specialist

- that problem is probably my gullet

 

Because it's so cheap (150B) I took another blood-test to take with me to the heart-specialist. All values were far away from the limits, except for HDL, which was 31, so lower than the limit (should be higher than 40, I think).

 

So, I think I will try to follow the advice of my family doctor for at least 2 months. If it still doesn't go better I'll go to see the specialist with the information I've collected.

 

Now, I've only 1 question.

Where do I get Pantoprazole?

What is the brand-name?

Is there a generic, cheap version?

 

Edited August 14, 2014 by kriswillems

[golden farang]

Have you ever tested for asthma? maybe you not get enough oxygen and you feel light pain and numbness in muscles. Could be some kind of allergy too. I take aerius 5mg once a day for allergy when needed,works well and not make tired.

[Kitsune]

10 Hours sleep needed + chest pains, + numbness could be Chronic Fatigue Syndrome (CFS).

You might want to also check

• a viral infection
• problems with the immune system
• an imbalance of hormones
• psychiatric problems, such as stress and emotional trauma

The walking making it better, seems like it's an oxygen / toxicity issue.

Try control breathing when it happens again

Edited August 17, 2014 by Kitsune