Can lower rib pain be caused by a heart problem?

Question

Hello doctor,

I have been dealing with some health issues lately. When I was 32 years old, I experienced my first atrial fibrillation, for which cardioversion was performed in the hospital. Five years later, I had a second episode, with the same outcome. I have never taken any medications, but I just started taking coenzyme Q10 and magnesium, and I have not had any problems since then. I still experience PVCs (premature ventricular contractions) and can feel those skips. I have undergone treadmill tests, a stress echocardiogram, an EP study, coronary calcium scoring, and EKGs, all of which showed that my heart is structurally normal.

Recently, I had severe pain in my right rib area, so I went to the doctor, who found a liver hemangioma and cysts on the ultrasound; these were benign. That day, my doctor advised me to place Nitroglycerin under my tongue, and the pain went away immediately. He then performed another EKG and blood tests and concluded that he did not believe the issue was related to my heart, as they found spots on my liver, and my pain was located in the upper right quadrant, where the liver is situated. However, I have reviewed three of the EKG reports, and they indicate abnormalities.

Additionally, I have been experiencing bouts of shortness of breath and central chest pain, which I attributed to anxiety regarding the liver mass and the acid reflux I have experienced in the past. My CRP levels were normal in the blood work, and my blood pressure has been stable. My cholesterol levels have always been high, but my most recent coronary calcium score was 0.

My questions are: could the pain in my lower right rib area be related to my heart? And could my heart have any connection to the multiple hemangiomas and cysts on my liver, as well as the two parapelvic cysts? I am attaching all my reports for your review.

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your reports (attachment removed to protect the patient's identity) very carefully. Your heart appears to be fine, and your blood tests are also normal, except for elevated cholesterol levels. Your ECGs (electrocardiograms) are also normal, which makes it less likely that your pain is cardiac in nature. This pain is most likely due to gastritis and reflux disease, which can also respond to Nitroglycerin. Additionally, any spasmodic pain in the abdomen can respond to Nitroglycerin, so it is not indicative of heart disease.

For gastritis and reflux disease, I suggest the following:

Avoid fatty, oily, and spicy foods.
Go for a walk after eating instead of resting.
Have multiple small meals throughout the day rather than one heavy meal.
Maintain regular sleep habits and avoid stress.
Eat plenty of green leafy vegetables and fruits.
Consider taking a combination of Pantoprazole and Domperidone before breakfast, once daily for two weeks.
You can also add Sucralfate or antacid (a combination of Aluminum and Magnesium hydroxide and Simethicone), two teaspoons three times a day for one week.

For your cholesterol, I recommend the following:

Adopt a healthy lifestyle by avoiding fatty, oily, and high-calorie foods.
Follow a low-salt diet and monitor your blood pressure regularly.
Engage in regular exercise, such as brisk walking and jogging, for at least 30 minutes a day, five days a week, based on your capacity.
Include plenty of green leafy vegetables, fruits, and fish once or twice a week in your diet, while avoiding meat.
Refrain from smoking and alcohol, if applicable.
Aim to reduce your weight.

If your cholesterol levels do not improve in three to six months, consider discussing with your specialist the possibility of taking cholesterol medication, such as Atorvastatin 10 mg at bedtime, after obtaining their consent.

For your hemangiomas, you should visit a gastroenterologist for further management. Typically, they are benign and harmless.

I hope this helps.

Thank you.