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What are the causes for continuous chest pain?

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What are the causes for continuous chest pain?

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

Answered by

Dr. Rishu Sharma

Medically reviewed by

Dr. K. Shobana

Published At December 10, 2016
Reviewed AtJune 6, 2023

Patient's Query

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 help.

Answered by Dr. Rishu Sharma

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 percent, 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 percent, in that case, chest pain can also be because of an entity called Prinzmeta angina (pain due to spasm in heart vessels) and for which the treatment totally differ. You said 2D echocardiography 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?

I hope this has helepd you.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply.

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.

Please help.

Answered by Dr. Rishu Sharma

Hi,

Welcome back to icliniq.com.

I have gone through all your reports (attachments 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 percent 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 milligrams (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.

I hope this has helped you.

Kindly consult a specialist, talk with them, and take medicines with their consent.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply.

Why do I feel uneasy sometimes? 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?

Please help.

Answered by Dr. Rishu Sharma

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 of all your problems can be anxiety. Anxiety can be 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.

I hope this has helped you.

Thanks and regards.

Patient's Query

Hello doctor,

Thank you once again for quick reply.

I have enquired about Holter monitor. But it is not available at my town. I need to join the office. I am a software engineer by profession. So not much physical work. I was never having issue with sleep. But after this recent bout, I always wake up in the midnight. Still, there is uneasiness and I still feel anxious. Also, it did not feel good when travel or in office. I have started yoga and walking. Your medicine stopped my pain but I still feel anxious.

Please help.

Answered by Dr. Rishu Sharma

Hi,

Welcome back to icliniq.com.

It is good that you are not having pain now. Anxiety will take time to settle down for atleast 21 days to show initial response. Keep on taking the three medicines as adviced by me. After seven days, increase the dose of Tablet Pexep to 25 mg. Take Tablet Clonotril 0.5 mg once before going to bed, and Capsule Pan dsr once daily (empty stomach). Take them for 14 days and review after 14 days. You can join the office. Do not over think about palpitations because anxiety in the main reason in your case. Try to divert your mind by keeping yourself busy in work. Get a holter done when ever possible, it takes one day, so you can go to nearest place with this facility for a day. Take medicines as adviced by me.

I advise follow up after 14 days.

Thanks and regards.

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

Dr. Rishu Sharma
Dr. Rishu Sharma

Cardiology

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