Heart & Cardiology/Chest discomfort

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QUESTION: Hi Doctor,
For about 3 years I have been getting chest pain and discomfort. I have had a nuclear stress test, echo  and ct thorax in nov 2009 and a ct angiogram on 256 slice scanner in Nov 2010. All tests were negative.i am a male 54 years and weigh 205lbs.
Mostly I get pain when I drive or just sitting. It is a dull achy pain about a 2 or 3 on a 10 scale. But the pain is daily and can last for an hour or so. Lately slight activity causes mild pain after I stop the activity.
This lasts only a few seconds. MRI showed cervical spondylitis and doctors attribute my pain to this. I have hiatal hernia and hypothroidism.
These episodes cause a lot of anxiety and have effected the quality of life. My cardiologist does not recommend a heart cath and says I do not have a heart problem.
I would appreciate your opinion. I have contacted your service earlier.
Many thanks for your help.
Rick

ANSWER: Hello Rick,

Chest pain is usually cramping of muscles in the chest wall.  If pushing on the painful area modifies the pain (makes it better or worse), or if the pain is relieved or worsenedby bending the body away from the painful area, that proves the pain is from chest  wall.  Even if these maneuvers donít affect the pain, itís still probably chest wall.  Pain caused by narrowing of the coronary arteries that supply blood to the heart usually comes with exercise and is relieved in 5 minutes by rest.  I agree with your cardiologist that you don't have a heart problem.  The tests prove that your heart is normal.  Chest wall pain is no threat to life or health, just a big nuisance.  Safest management is just to ignore the pain, though Tylenol, aspirin or ibuprofren usually help.

Please write back if this doesnít answer all your questions.

David Richardson

---------- FOLLOW-UP ----------

QUESTION: Doctor
Thanks for your encouraging response. I have a follow up question.
My Ultr Sens crp went from 0.6 to 2.4 in about 18 months. Should that be a concern and how long are the results of a nuclear stress test and ct angiogram good for.
Thanks for your help
Rick

Answer
Rick, CRP increases with any inflammation.  Elevated CRP is of some concern, but I'd wait six months and then repeat it.  If still elevated, repeat the CT angiogram.

Negative nuclear stress test promises 95% freedom from heart attack or cardiac death for at least 7 years.  You're at more danger on a highway than from your heart.

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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