Heart & Cardiology/Chest Pain

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QUESTION: Dear Dr. Ahmed,

For the past 24 hours I've had a lingering chest pain.  It's on and off.  It's localized and it "feels" like it's just off center, to the right side edge of my sternum area.  When it comes on it can throb (wax and wane).  Then it may disappear for hours.

I've done exercise since.  It doesn't get worse with exercise---seems to be unrelated to my activity level.  Never any other symptoms either, i.e. no radiating pain, no short of breath, no accelerated heart rate, etc.  

Is it likely NOT cardiac related?  And could just being active (lifting weight, playing tennis) cause bone pain like this?  It's a sensation that is new to me.  Scary due to it's proximity to the heart!

Thanks,
James

ANSWER: Hi James, here is a link to some reading on chest pain http://blog.myheart.net/2013/06/18/angina-or-some-other-chest-pain/.

I'm hesitant to give direct medical management advice for things as acute as chest pain in this forum setting.  Such decisions require a far more detailed presentation than available over a few paragraphs. It is almost impossible to say without examining you and taking a full history how serious it is. For example if you are 21 years old, have been doing a chest work out, and generally fit and well, its almost certainly non-cardiac in nature and often no investigation required. But if you are a 45 year old male, or a smoker, with risk factors for disease and a typical pain the odds of a heart related problem increase significantly and tests should be conducted.

Chest pain is one of those things that i feel if you are concerned enough about to seek help for i.e. the fact you are even asking this question, that you should certainly see a physician of some sort to settle the issue. It may be overkill but its irresponsible to tell you otherwise. Even though most of the time the pain may be nothing, the stakes are high and critical things should be ruled out.

The facts that the pain is intermittent and localized over a 24 hour period, not associated with symptoms such as shortness of breath, unrelated to activity level, and that you are able to exercise through, are all reassuring, however my advice to you is to get it checked out. It will take a qualified practitioner a matter of minutes to tell you how serious it is and what needs doing.

Hope that was helpful,


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

QUESTION: Thank you very much for answering my question Dr. Ahmed.  

What kind of evaluation would the medical professional administer?  I have had an echo and stress test, but it was 4 years ago.  The cardiologist said I was fine/normal.  I emailed him with regards to retesting (stress test) but he felt like since I exercise daily I'm in a sense giving myself a stress test daily, and because I do not have any problems with exertion he feels that there is little to worry about.  

I'd like a second opinion, however.  Do you feel that is fair or decent advice?  

Thank you once again,
James

Answer
Hi James, i've written about stress tests here http://blog.myheart.net/2014/03/17/do-i-need-a-stress-test/. A stress test four years ago doesn't really have any bearing on the development of new symptoms.

Your cardiologist has the benefit of knowing your case well. In general from a medical standpoint people are cautious and so if he's comfortable to give you that advice despite being aware of the situation, that is reassuring. The facts that the pain is intermittent and localized, over a 24 hour period, not associated with symptoms such as shortness of breath, unrelated to activity level, and that you are able to exercise through, are all reassuring.

The exception is that If you have a history of heart disease or are someone considered at high risk (diabetic, smoker etc.) In that case the symptoms should be investigated and you should at least see a physician. If you have a good relationship with your cardiologist and he/she knows your case well then i'm sure their opinion is reasonable. If more typical symptoms develop, or they persist you can always revisit the issue. If you are entirely uncomfortable then you are always within your rights to seek s second opinion.

Hope that was helpful,  

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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