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Q. What are the causes for continuous chest pain?

Answered by
Dr. Rishu
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 10, 2016 and last reviewed on: Oct 09, 2018

Hello doctor,

I am suffering from chest pain since last three years. About two weeks back, I felt uneasiness, shortness of breath and mild chest pain. The ECG was abnormal. I was admitted to the hospital and was on Lomo injections. They advised me for an angiography and the reports were normal. But, CPK-MB was 35 and creatine level was 1.08. After angiography, my doctor discharged me and prescribed Met XL 25 and Mactor ASP 75 for one month. I am still not convinced that they got the actual issue as I am still facing mild chest pain. They told that I have MVP (mitral valve prolapse) as shown six months back in my 2D echo. But, I am not sure why CPK-MB was affected by that. Please clarify.

Dr. Rishu

Cardiology
#

Hi,

Welcome to icliniq.com.

  • Creatine phosphokinase-MB (CKP-MB) is an indicator of the cardiac event, but it is not very specific. There are a number of conditions in which CPK-MB could be raised apart from cardiac issues.
  • Troponin I is a better indicator. Troponin I has very high sensitivity level and is much superior to CPK-MB in detecting a cardiac event.
  • The doctor prescribed you Mactor ASP 75 (combination of Atorvastatin and Aspirin) after angiography, which means that there is a blockage in one of the arteries though it can be less than 75%, so stents were not placed. But in case, if your angiography is normal as you have written, then no drugs would have been given.
  • Suppose if angiography shows that blockage is less than 75%, in that case, chest pain can also be because of an entity called Prinzmetal angina (pain due to spasm in heart vessels) and for which the treatment totally differ.
  • You said 2D echo showed mitral valve prolapse. To comment on the severity, I need to see the 2D echo report and the level of regurgitation (blood backflow).
  • MVP can also cause breathlessness and shortness of breath as described by you.
  • You said that the ECG was abnormal, but an ECG can have a number of abnormalities ranging from T-wave inversion to ST segment depression in case of ischemia. The ECG abnormality can also be because of mitral valve prolapse.
  • I would like to know a few more details regarding your personal history:
  1.  Are you a smoker or alcoholic?
  2. Do you feel pain on walking fast and does it relieves on resting?

Revert back with the reports and a detailed history to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist      


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Thank you doctor,

I am attaching all my reports. I do not have the 2D echo report. I was in the hospital for six days. They discharged me once the angiography reports were normal. I have quit smoking since last four years. I drink rarely, like once in a month. I have continuous mild chest pain. I feel uneasy for 20 to 30 minutes at night. I feel little sweaty and anxious for some time. Sometimes, there will be no pain, but I do feel some tingling sensation. I also feel little shortness of breath in the morning.

Dr. Rishu

Cardiology
#

Hi,

Welcome back to icliniq.com.

I have gone through all your reports (attachment removed to protect patient identity).

  • Your angiogram and echocardiogram findings are normal. Your left ventricular ejection fraction (LVEF) is perfectly normal. The mild mitral valve incompetency should not be a case of concern.
  • Your echocardiogram showed apical mild hypokinesia, which is not a thing to worry about.
  • CPK-MB is a highly unspecific enzyme. A mild elevation of this enzyme can be seen in a number of disorders.
  • Your ECG shows right bundle branch block and all the ST-T changes are because of this. In presence of a right bundle branch block, ST-T changes are insignificant.
  • The right bundle branch block is normal in 90% of the cases. If your echocardiogram and angiogram are normal, then right bundle branch block is not a problem to be worried about. As of now, mostly your pain is not of cardiac origin.
  • I suggest you tablet Clonotril 0.5 mg (Clonazepam) once a day at bedtime along with tablet Pexep CR 12.5 mg (Paroxetine) once a day in the morning and Pan DSR capsule (combination of Pantoprazole and Domperidone) once a day in empty stomach.
  • As your anxiety levels are high, anxiety can often mimic the symptoms of cardiac pain. I think it is either anxiety related or is because of acid peptic disorders.
  • Start exercising 45 minutes a day. Eat less fat. Start the medicines.
  • Please discuss my opinion with your doctor and stop taking Aspirin and Metoprolol for the time being.

Revert back after 10 days to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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Thank you doctor,

Why do I feel uneasy time to time? I have mild chest pain almost all the time. It feels like something is happening inside. How to avoid it? I do not have much stress at work since last one year. Do you advise any more tests?

Dr. Rishu

Cardiology
#

Hi,

Welcome back to icliniq.com.

  • The uneasiness can be because of palpitation, in which the heart rate increases for a few seconds and after that it becomes normal.
  • As of now, the most important cause for all your problems can be anxiety. Anxiety can be a hidden also.
  • A very important test, which I would like to suggest you, is 24-hour Holter monitoring. It is a small machine which will be attached to your body for 24 hours and will record your 24-hour heartbeats. Anything wrong with your rate and rhythm in the next 24 hours will be recorded.
  • You can even note the time in your logbook and we can see the rhythm of your heart till the time Holter is done. Please follow the medications suggested by me.

Revert back after 10 days to a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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