Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am 64 years old. I am a heavy drinker for 30 years and had SCA two years ago. I also had an AICD implant and on Dytor 10, Flavidon, Cordarone 200, Xeralto 15, and Xtor 10. My HR is 60, EF is 45, and LV grade 2 dysfunction with LV hypertrophy. I do cardiac exercise biking 8 km per day in 40 minutes. For the last 1.5 years, I have had left sided chest pain radiating to the back below the shoulder blade. It comes and goes off suddenly, and I do not get any relief from Ultracet. I do not have any other symptoms. My renal function and other parameters are normal, with no episodes of arrhythmia. I consulted two cardiologists, and they said it is noncardiac. I feel very uncomfortable when the pain starts. My HR after exercise is 95 and comes down to 75 after one minute. Please advise.
Hello,
Welcome to icliniq.com.
Did you ever undergo angiography or CT coronary angiography to look for the status of the vessel? Was your sudden cardiac arrest attributed to hypertrophic cardiomyopathy? Please share your echo report as well. Now regarding your pain, it does not show the characteristics of cardiac pain. Cardiac chest pain classically occurs on exercises and relieves with rest. Such intermittent rest pain are usually noncardiac. Also, cardiac pain usually does not persist for 12 hours unless it is a heart attack, which would be very evident on echo or ECG (electrocardiography). Also, one cannot have a heart attack so frequently. Now regarding the probable cause, two likely possibilities are gastric reflux and spinal pain. Do you have any other gastric symptoms like bloating, burping, heartburn, or epigastric pain? If yes, then it supports reflux. Even otherwise, it can be acid reflux. You should have the trial of antacids like Pantoprazole, Domperidone, and also topical antacids like Sucral-O whenever symptomatic. Now another possibility is spinal pain. Now, does this pain increase on movements? Or is there any tingling numbness or band-like sensation over the chest? If yes, then it supports the possibility of spinal pain. Can you recall any precipitating factor like weight lifting, prolonged standing, or abnormal sleep posture? However, the possibility of cardiac pain still should also be ruled out on investigations like CT (coronary tomography) or stress test if not had recently. I hope this helps.
Patient's Query
Thank you doctor,
Angio done befroe two years showed 30 percent block in one vein. I have taken a spinal x-ray with no obnormilties. I do not have gas or acid reflux and also had 2D echo done before six months. Contractual uth has improved and ef increase from.35 to .45. SCA occurred due to V fib.was having AF since 2017 and was on regular medicines. I am bothered about spot chest and spot back pain as it is very uncomfortable . Cardiologist consulted. Rahul Gupta hod Apollo hospital
Hello,
Welcome back to icliniq.com.
As I mentioned earlier, it is unlikely to be cardiac pain. The probability of missing cardiac pain with an in-person consultation with two cardiologists is very low. It is probably musculoskeletal pain like spinal pain. X-ray is not always reliable. If you have an MRI (magnetic resonance imaging) compatible AICD (automated implantable cardioverter-defibrillator), then MRI or else CT scan may be able to diagnose and localize nerve compression. CT scan will also help to rule out other rarer causes for chest pain. Orthopedic consultation may be helpful in this regard. You should also give the trial of antacids even in the absence of other gastric symptoms.
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Cardiology
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