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Is my chest pain due to vitamin D3 deficiency?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At November 22, 2017
Reviewed AtJune 13, 2023

Patient's Query

Hello doctor,

Four months ago, I consulted you on this platform for premature complexes which I was having without any other symptoms. Below is my query and your answer - I am a male of 48 years of age. I have a lean build and do regular exercise. Since childhood, I had a tendency for heart palpitations and premature beats. After a few tests, anxiety was found to be the main cause. You had said that most probably these premature complexes are originating from ventricles which are leading to the symptoms. These are usually benign and not life threatening. The only concern remains is that of coronary artery disease, which is also less likely as these are occurring from a long time and you are not having any other symptoms. Lack of sleep, stress, alcohol, smoking, caffeinated beverages are known triggering factors for these due to sympathetic overactivity. You should also get thyroid test done. I think, just be on a safer side, you should get one treadmill test done to rule out coronary artery disease and echo should be repeated. Afterwards, I met a cardiologist and got an ECG and echo tests done. The tests were normal. The cardiologist said that there is no need for TMT test since I do running and other exercises daily and there is no known risk factor for CAD. But the VPCs continued for a month. Then, I realized that I was taking a weight gainer supplement from the last one year which contained creatinine. Two months back, I was not doing any exercise due to a small fracture in my elbow but continued to take this supplement. The doctor advised me to stop the supplement immediately since this could be the cause of missed beats. Then I read in the internet and found out that there have been cases of irregular heart beats due to creatinine supplementation. I stopped taking the supplement although it was from a reputed firm and did not contain any steroids. The missed beats reduced after stopping the supplement and from the last two months, it has come to a normal level of one or two in a day. But somehow my mind started getting preoccupied with the thoughts of heart disease and I started reading about it from the internet and even textbooks. I have been thin and slim since my childhood, have been quite active physically, no family history of heart disease, no diabetes, no hypertension, non-smoker, rarely eat fried foods. My lipid profile is normal with HDL being about 55 whenever tested, CRP is around 0.5. But in spite of this, I was not able to free my mind from worries of CAD. A month back, I did quite a lot of pushups after a gap of four to five months. After three to four days, I started having pain in my chest here and there mostly at rest. After a week I got an ECG done which was normal. The pain subsided slowly but whenever I did some exercise which put a strain on the chest muscle I started having pain and with pain, more worries. Then I met a psychiatrist. He said that I have got into an obsessive loop, which is part of health anxiety disorder which is causing these psychosomatic symptoms of chest pain. He advised me to take some antidepressants for three months, do Yoga and meditation and take some sessions of cognitive behavior therapy. I am reluctant to take antidepressants but have already started doing some meditation and Yoga. He also prescribed Alprazolam .25 mg on SOS basis. Now the pain is subsiding slowly and obsessive thoughts are also reducing. I have stopped doing any exercise that would put a strain on the chest. I do not know how long it will take to resume it. In a recent blood test, two months back my vitamin D3 was at 28 ng/mL. Could it be the cause of the chest pain? Secondly, I stopped the supplement but continued some strenuous exercises without taking a proper diet. Could it be the cause of it? Please guide me. How to get rid of this unwanted health anxiety which I have got into?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Looking at the overall picture, the problem appears to be a minor one and not worrisome. The likely cause of the pain is chest muscle strain. It is less likely to be related to vitamin D as it is just borderline, not very low and also not related to supplements. Once a muscle strain has happened, then it takes around a week or two for complete resolution. This basically occurs due to sudden unaccustomed heavy activities. So, once the pain has settled completely, you can gradually resume your exercises and you need to start with low intensity and then increase these activities gradually so that there is no excessive strain. The possibility of cardiac pain is less. Now, VPCs (ventricular premature contractions) are probably benign. So, no need to worry about it. For this problem, you should have anti-inflammatory medicine like tablet Naproxen 250 mg twice a day for five days along with tablet Pantoprazole 40 mg before breakfast once a day for five days. For local application, you can use Diclofenac gel whenever pain is more. Overall, I do not think there is any need to worry about it. Yoga and meditation, you can continue. Alprazolam you can skip. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thanks for the reply. My psychiatrist strongly insisted that this pain is of a psychosomatic nature and recommended treatment with anti-depressants as the solution. However, I personally believed that the pain is connected to the sudden strenuous exercise I had performed. Additionally, excessive worry can worsen it due to the focus of attention, as I have read. I will be following your advice and starting medication as suggested by you, and I will provide you with an update soon.

Hello,

Welcome back to icliniq.com.

Yes, I agree with you that there seems to be a specific event that triggered this pain. Psychosomatic pains are typically unexplained and long-lasting, and we usually reach a diagnosis after carefully eliminating other potential causes through investigations. I am greatly thankful for trusting me for your queries and for giving me the chance to take care of you.

Thank you.

Patient's Query

Hello doctor,

Thank you for the prompt response. As per your advice, I took Naproxen for five days. The pain significantly reduced during that time, but unfortunately, I caught an infection causing a cough and cold, resulting in mild pain persisting for a few more days. However, the pain has now almost disappeared. I am still avoiding exercises that strain my chest muscles. I also want to inform you that last year, I underwent a lipid profile test which showed a total cholesterol level of 193 mg/dL, LDL level of 114 mg/dL, HDL level of 56 mg/dL, and triglyceride level of 111 mg/dL. Three months ago this year, I repeated the test, and the results indicated a total cholesterol level of 206 mg/dL, LDL level of 120 mg/dL, HDL level of 50 mg/dL, and triglyceride level of 157 mg/dL. During that time, I was taking a weight gainer supplement, which led to a slight increase in my weight, reaching around 163 pounds. However, I have stopped taking the supplement, and my weight has since reduced to 154 pounds. Yesterday, I decided to conduct the lipid profile test again to observe the effects of discontinuing the supplement. Unfortunately, the results did not meet my expectations. The values showed a total cholesterol level of 221 mg/dL, LDL level of 138 mg/dL, HDL level of 65 mg/dL, and triglyceride level of 114 mg/dL. Although there was an increase in HDL and a decrease in triglycerides, both LDL and total cholesterol levels have shown an upward trend. I must mention that I had a heavy meal with some extra ghee the night before the test, and I have been consuming butter or ghee daily for the past month. Additionally, I have been having one or two whole eggs in the morning. Could these factors have contributed to the results? But my daily intake of fruits and vegetables is quite high. I would appreciate your advice on how to reverse this process and achieve desirable levels of LDL and total cholesterol.

Kindly help.

Hello,

Welcome back to icliniq.com. Let me start answering your primary health concerns. Yes, it is highly likely that the increasing cholesterol levels are due to your diet. As you mentioned, the daily consumption of butter can certainly contribute to elevated cholesterol. It is also important to review your overall diet for foods that are high in fat, oil, and fried items, as well as fast food. However, having a heavy meal before bedtime is not likely to have a significant impact on cholesterol levels. Additionally, it would be helpful to review your family history regarding similar cholesterol issues, as genetics can also play a role in cholesterol levels. For the next three months, I suggest you focus on making lifestyle modifications and then retest your cholesterol. It is crucial to adopt a healthy lifestyle, which includes avoiding fatty, oily, fried, and high-calorie foods. Limit the consumption of egg yolks and focus on consuming only the egg whites since egg yolks are rich in cholesterol. If you are aiming for weight gain, opt for a high-protein diet rather than a high-fat or high-calorie diet, as the latter can increase fat levels in the blood. Regular exercise is important, such as brisk walking or jogging according to your capacity, for at least 30 minutes a day, five days a week. Include plenty of green leafy vegetables, fruits, and incorporate fish into your diet once or twice a week, while avoiding meat. It is advisable to refrain from smoking and limit alcohol consumption if applicable. After two to three months, I suggest you repeat your cholesterol test. If the levels are under control, I suggest you continue with the same lifestyle modifications. However, if the levels remain elevated, medication may be necessary for a short period. Wishing you all the best in achieving your goals. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor,

I do not smoke, but occasionally I consume beer. I already engage in regular exercise and incorporate daily walks into my routine. Although my mother had slightly elevated cholesterol levels, there is no history of cardiac disease in our family. Could you please suggest me the desirable levels of lipids for me? And also, please inform is it beneficial to have high HDL (high-density lipoprotein) levels?

Kindly help.

Hello,

Welcome back to icliniq.com.

You just modify your diet and we will see its effect on you cholesterol levels. Occasional consumption of beer is acceptable. And yes, High HDL (high-density lipoprotein) is good. I suggest you maintain your total cholesterol level below 160 to 180 mg/dL. However, a level below 200 mg/dL is also considered acceptable. As for LDL (low-density lipoprotein) cholesterol, it is preferable to keep it below 100 mg/dL, although a level below 130 mg/dL is also acceptable. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Feeling unconvinced by the previous test results, I decided to have the test done again, this time at a different laboratory. This morning, I provided a blood sample there. The only difference was my dinner last night, which consisted of only one chapatti without butter or ghee. Additionally, I did not drink milk before going to sleep, as I usually have one glass of full-fat milk in the morning and another in the evening. The new test results arrived in the evening and showed some variations compared to the previous results from the other laboratory. The current results are as follows: total cholesterol of 196 mg/dL, LDL of 125 mg/dL, HDL of 61 mg/dL, and triglycerides of 109 mg/dL. There is a difference of 25 points in total cholesterol compared to the previous result of 221 mg/dL, and a difference of 13 points in LDL compared to the previous result of 138 mg/dL. However, there are no significant differences in the values of triglycerides and HDL. Could these variations be due to differences in the pre-meal routine or the laboratories themselves? I think the new results are more reliable. In any case, I am following the diet plan suggested by you. And also I wanted to ask, should I switch to toned milk instead of full-fat buffalo milk?

Kindly suggest.

Hello,

I appreciate you for being a health-enthusiast and posting this query at icliniq.com.

I will help you to understand this issue better. It is possible that the difference in the test results is due to variations between the two laboratories. Generally, food intake has minimal impact on cholesterol levels, while triglyceride levels tend to remain elevated for eight to 12 hours after a meal. However, in your case, since the triglyceride levels are similar in both samples, the difference in cholesterol levels is likely due to lab variation. However, your current cholesterol value is borderline, and I suggest you keep it within a controlled range. And yes, switching to toned milk is a better option as it contains significantly lower amounts of fat compared to full-fat buffalo milk. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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