Having Chest Pains, Towards Breast Muscle And Feel Throbbing Pulse. BP Is Elevated. EKG, ECHO Normal. Cause?

Posted on Sun, 22 Sep 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 22 Sep 2013 Answered on

Mon, 14 Oct 2013 Last reviewed on

Question : I've been having chest pains in my left chest, towards the breast muscle, for weeks. Usually constant throbbing. I can press in that area and feel my pulse throbbing. My BP isnt elevated, my pulse is under 60 (i'm a runner). I've had EKG, echocardiogram, Chest CT, and everything turns up normal. I still worry but the dr's say i wouldnt be able to run 150 miles a month at competition speeds if i had a blockage or narrowing of the arteries. The pain is worse with stress. I'd feel better if they would run the XXXXXXX and check but that doesnt seem to be an option. The pain even goes into my ribs.

Answered by Dr. Anantharamakrishnan (6 hours later)

Brief Answer:
Need follow up

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

     Your symptoms do not suggest Coronary Artery Disease (CAD). However, it is better to have a Treadmill Exercise Electrocardiogram (TMT), preferably with thallium isotope. It is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle.
     We can also look at the ANATOMY (structure) – CT angio is non-invasive study for the anatomy.
     Catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is the gold standard for this, but it is invasive, has a definite but minimum risk and should not be done unless there are strong indications .
     The pain is probably muscular... / MRI of thoracic spine may detect irritation of nerve root
Over The Counter (OTC) Non Steroidal Anti Inflammatory Drugs (NSAID) / muscle relaxants / anxiolytics will be useful in the meanwhile...
     Antidepressant drugs (SSRI, SNRI) and anti-epileptic drugs (like gabapentin) raise the threshold of pain perception, irrespective of the cause. / and may be helpful
Prognosis is generally excellent - as indicated by the long duration and no negative effects

Take care
Wishing all well
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (1 hour later)

Thank you! I had a treadmill stress test 5 years ago without the injection, would have anything worsened that much in that amount of time?

Answered by Dr. Anantharamakrishnan (1 hour later)

Brief Answer:
Very likely

Detailed Answer:
Hi

Yes, for sure.
5 years is too long a time!
Much water must have flown under the bridge in this interval...
Stress EKG with radio-isotope is the best option - to convince the patient and physician... both parties can breath a XXXXXXX of relief!

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar