I have been having chest pain and palpitations. Can it be coronary artery disease?

Hello,

Welcome to icliniq.com.

It is unlikely to be a coronary artery disease. Firstly, considering your age, it is very unlikely. Next thing, your stress test is normal, and you did not have any pain during the stress test. Pain should be uniform of cardiac blockages, and you should have got it while testing as well. So the first possibility is a gastroesophageal reflux disease, which can explain all your symptoms. You also have epigastric pain, right? Do you also have nausea, vomiting, bloating, burping, throat, or chest burning? These may be the associated symptoms. So you should have a trial of antacids like Pantoprazole or Lansoprazole. Does this pain increase on applying pressure over the chest area? If yes, then it is likely musculoskeletal pain and unlikely to be heart-related. Also, if your pain is persistent even after antacids as well, I would also like to rule out a myocardial bridge in you, which can cause exertional pain. However, we would expect some changes in the stress test. Did you undergo your treadmill test or just stress ECHO (echocardiography)? So, go through it and let me know the necessary details.

Revert in case of queries.

Regards.

Hi,

Welcome back to icliniq.com.

I saw the attached reports (attachments are hidden to protect the patient's identity).

I think a trial of antacids should be given for a week. You mentioned about ache below the ribs, which can very well be gastritis. You should avoid a fatty, oily, and spicy diet. Have some walks after having food instead of taking a rest. I guess you do not smoke. Avoid alcohol if any. You should get a prescribed tablet of Pan DSR 40 mg (Pantoprazole and Domperidone) or Esomeprazole Domperidone combination before breakfast once a day for a week. So overall, the possibility of cardiac illness is very remote. However, if this exertional chest pain continues in the future, we should consider for chest CT (computed tomography) scan or MRI (magnetic resonance imaging) in order to look for a myocardial bridge and rule out other pathologies.

Revert in case of queries.

Regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

No, it is unlikely. In fact, stress-induced gastritis and reflux become a likely possibility. Also, this may be muscular pain due to muscular spasms. Exercising and running are also a stress to the body and increase heart rate and myocardial oxygen consumption, so it should precipitate angina if there is a blockage. With the stress test being negative, the angina possibility is still low. What is your age? Cold-induced bronchospasm is a likely cause that can cause aches rather than cold-induced heart problems. Cold air directly affects the lungs and may lead to pain and ache.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Beta-blockers basically will not let the heart rate rise, but in your case, the adequate heart rate must have been achieved during the stress test, so they have concluded negatively. Coronary artery disease is very rare in this age group. What kind of stress precipitates angina, and how long does this persist? Is there any sweating or radiation to the arm? This is just to review the symptoms once more. But truly speaking, this does not fit into cardiac disease either clinically or even if investigations support it. I guess you do not smoke or drink during stressful periods.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

The basic reason is increased myocardial oxygen demand. Stress tests occur due to multiple reasons, like increased heart rate, BP (blood pressure), and contractility of the heart, due to hormones. Similarly, during stress, there may or may not be a heart rate, but there may be increased contractility and maybe a slightly increased BP. So, these may be factors that may increase the myocardial oxygen demand. And coronary artery disease pain never lasts for seconds. Pain lasting for seconds means it is likely pain due to spasms of either esophagus due to acid reflux (which may occur only during stress) or chest muscle spasm.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, you should get it during exercise as well. On beta blockers, the test is inadequate and inconclusive usually, so that would not be the case. Collaterals will not provide cent percent adequate blood. There will be a deficit which will be shown on the stress test. So the possibility is collateral is unlikely.

Hope this addresses your concern.

Kind regards.

Hi,

Welcome back to icliniq.com.

Most welcome.

Revert in case of queries.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

You should get that during exercise as well. And also, whatever you are having is not anginal pain. It is atypical chest pain.

Hope this cleared your query.

Kind regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

There is no such specified temperature limit. It is based on individuals and exercise intensity. Commonly, any degree of cold cause chest heaviness due to spasms of respiratory muscles (15 degree Celsius can cause spasms of respiratory muscles). As it can also cause spasms of skin arteries, it may raise BP and increase myocardial oxygen demand. So this sometimes can cause anginal pain in patients with coronary artery disease, but your pain is unlikely to be anginal due to multiple factors being against it.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

No, these are not dangerous since the possibility of ischemia is already ruled out. So these are likely benign. Were there extra beats and pauses present?

Revert with answers.

Regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

So these are likely ectopics may be atrial or ventricular. These are benign. Nothing to worry about it. These are linked with stress, gastritis, anxiety, excessive caffeine, and sometimes thyroid problems. So you might not have these while the Holter was put on, so was not picked up.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

So these do not seem significant then. Just may be increased awareness of the heartbeat, which may occur otherwise, especially whenever we are calm. I do not think there is anything to worry about it.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

No, it does not. After exercising, there are a lot of sympathetic hormones released, which may cause these. So can be seen post-exercise.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

Commonly, these are associated. Other arrhythmias like VPC (ventricular premature complexes), atrial flutter, which is similar to A-fib (atrial fibrillation), and sometimes AVNRT (atrioventricular nodal reentrant tachycardia) are rare. Others are brady arrhythmias like AV (atrioventricular) blocks, CHB (complete heart block), etc.

Hope this clears your query.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your query.

Yes, they are benign.

Revert in case of queries.

Regards.

Hi,

Welcome back to icliniq.com.

I read your query and understand your concern.

No, these are not exercise-induced if occurring hours after exercising. They are rest palpitations. I think it is just an increased awareness of heartbeat, which is the commonest cause for palpitations, commonly referred to as psychological causes or anxiety. However, the possibility of ectopics still remains, as you mentioned, you just had mild palpitations while Holter was on.

Hope this helps.

Kind regards.

Hi,

Welcome back to icliniq.com.

I understand your concern.

I would repeat overall the picture is not fitting in coronary artery disease. Also, you are young, so you cannot have it. However, if you want to get it, then you may go for CT (computed tomography) coronary angiography, which can also be used for the screening test.

Hope this helps.

Kind regards.