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I Have A History Of Dull Left Sided Chest Ache
Question: I have a history of dull left sided chest ache for atleast about 1 year now. It is more like a dull pulling/persistent ache on the left side. It does not change when I push down on it or by movement. There isnt any correlation to activity and food. I also have history of severe heart palpitations. I have been checked out by a cardiologist having done TMT, ECHO and 2D ECHO that all came out normal except for frequent ectopics/premature ventricular complex. I have also been to gastroenterologist and had upper GI endoscopy done that came out normal
I have been advised to take Inderal 10mg on an SOS basis for palpitations and performance related anxiety. This has been working without any side effects for a long time now.
My main problem now - when I take inderal the pain subsides in the chest for that day? Why would this be? Could inderal be helping any underlying cardiac issues?
Also - when inderal wears off the next day (after 16- 24 hrs) - i seem to have worsening chest pains. The pain on withdrawal seems worse than actual pain.
Please advise if this response to Inderal warrants any additional cardiac evaluation and also if I can continue to take this drug on need basis. I am dependant on this medication to help me cope with social anxiety and other medications like Xanax dont provide relief from physical symptoms of anxiety. Could high BP manifest these kind of symptoms and cause chest pains?
Please assist. Thank you.
I have been advised to take Inderal 10mg on an SOS basis for palpitations and performance related anxiety. This has been working without any side effects for a long time now.
My main problem now - when I take inderal the pain subsides in the chest for that day? Why would this be? Could inderal be helping any underlying cardiac issues?
Also - when inderal wears off the next day (after 16- 24 hrs) - i seem to have worsening chest pains. The pain on withdrawal seems worse than actual pain.
Please advise if this response to Inderal warrants any additional cardiac evaluation and also if I can continue to take this drug on need basis. I am dependant on this medication to help me cope with social anxiety and other medications like Xanax dont provide relief from physical symptoms of anxiety. Could high BP manifest these kind of symptoms and cause chest pains?
Please assist. Thank you.
Brief Answer:
Pain likely due to ectopics
Detailed Answer:
Hello and welcome to Ask A Doctor service.
I have reviewed your query and here is my advice.
Pain is likely due to ectopics. This pain is unlikely due to any blockages as it has no relationship to exercises and your evaluation is negative.
Considering your evaluation is negative, the best possible explanation is reduction in ectopics which occurs due to inderal. So this kind of pain frequently occurs with ectopics and their suppression with inderal gives you relief. Pain due to any other causes would have shown on tests.
So, it doesn't require any further evaluation, however you may undergo some other form of test to be further sure like CT coronary angiography which is 99% sure in ruling out disease.
You may continue inderal on long term basis as well. Also, get your vitD levels tested once. High bp is rare cause for this as it would also lead to other symptoms like dizziness, headache sweating etc, anyway you should get your bp checked frequently for a week period say three times a day and especially when you are having pain, to rule out this possibility.
Hope this helps you and get back if you have any doubts.
Pain likely due to ectopics
Detailed Answer:
Hello and welcome to Ask A Doctor service.
I have reviewed your query and here is my advice.
Pain is likely due to ectopics. This pain is unlikely due to any blockages as it has no relationship to exercises and your evaluation is negative.
Considering your evaluation is negative, the best possible explanation is reduction in ectopics which occurs due to inderal. So this kind of pain frequently occurs with ectopics and their suppression with inderal gives you relief. Pain due to any other causes would have shown on tests.
So, it doesn't require any further evaluation, however you may undergo some other form of test to be further sure like CT coronary angiography which is 99% sure in ruling out disease.
You may continue inderal on long term basis as well. Also, get your vitD levels tested once. High bp is rare cause for this as it would also lead to other symptoms like dizziness, headache sweating etc, anyway you should get your bp checked frequently for a week period say three times a day and especially when you are having pain, to rule out this possibility.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doctor - Thanks for your prompt response.
I have palpitations all the time and generally the pain does not coincide with them. I feel them at time when I don't have chest pain at all. I have learnt to live with them and have been doing so for almost a year now.
Question is my reaction to Inderal - till a couple of months back., I didnt have any withdrawal reactions. Now suddenly., when the drug wears off I seem to have worse pain than before I take it. I only take Inderal before a public speaking event for anxiety and not for palpitations by the way and only the smallest dose of 10mg.
I was wondering if this is something that you have seen in your experience. Is this a normal rebound effect of the drug? Can inderal cause cardiac complications? Is it safe to continue taking this drug when I have this reaction?
If I were to take Inderal everyday - what would the recommended dosage be?
Also - would it be necessary to do CT angiography or wait and watch for some more time? Can a cardiac MRI be a better alternative as I dont want the unnecessary radiation from a CT.
I have attached some ECG and Holter Monitor recordings in my profile. I am not sure if you can access them. Please let me know if you need this and will post them to you.
I have palpitations all the time and generally the pain does not coincide with them. I feel them at time when I don't have chest pain at all. I have learnt to live with them and have been doing so for almost a year now.
Question is my reaction to Inderal - till a couple of months back., I didnt have any withdrawal reactions. Now suddenly., when the drug wears off I seem to have worse pain than before I take it. I only take Inderal before a public speaking event for anxiety and not for palpitations by the way and only the smallest dose of 10mg.
I was wondering if this is something that you have seen in your experience. Is this a normal rebound effect of the drug? Can inderal cause cardiac complications? Is it safe to continue taking this drug when I have this reaction?
If I were to take Inderal everyday - what would the recommended dosage be?
Also - would it be necessary to do CT angiography or wait and watch for some more time? Can a cardiac MRI be a better alternative as I dont want the unnecessary radiation from a CT.
I have attached some ECG and Holter Monitor recordings in my profile. I am not sure if you can access them. Please let me know if you need this and will post them to you.
Brief Answer:
It's usually safe to continue
Detailed Answer:
Hi again
Firstly, it's not necessary for pain and palpitations to coincide and may occur at different times. Inderal is usually a safe medicines with no significant cardiac complications, and may continue long term with 10 mg dosing. These rebound effects usually subside within few days to weeks after tapering medicines.
It's common for inderal to have such rebound increase in pain after it is stopped or effect is wean off. And it's not necessarily indicative of any underlying cardiac disease. However, stopping may worsen pain in patients with underlying coronary artery disease, but CAD is unlikely in you considering symptoms and negative evaluation.
You may wait for CT as nothing is suggestive of coronary artery disease, and MRI will not be usefull in this case.
I have gone through your blood reports and Ecg while holter is not available. Ecg is showing ectopics only.
Your VitD, folic acid is low and you ll need supplements for those and I guess you must be receiving those. For Vit D you need to be on Tab Uprise D3 60,000 units once a week for eight weeks and then once a month for next six months. For folic acid, you need to have green leafy vegetables and Tab Folate5 mg once a day for eight weeks.
It's usually safe to continue
Detailed Answer:
Hi again
Firstly, it's not necessary for pain and palpitations to coincide and may occur at different times. Inderal is usually a safe medicines with no significant cardiac complications, and may continue long term with 10 mg dosing. These rebound effects usually subside within few days to weeks after tapering medicines.
It's common for inderal to have such rebound increase in pain after it is stopped or effect is wean off. And it's not necessarily indicative of any underlying cardiac disease. However, stopping may worsen pain in patients with underlying coronary artery disease, but CAD is unlikely in you considering symptoms and negative evaluation.
You may wait for CT as nothing is suggestive of coronary artery disease, and MRI will not be usefull in this case.
I have gone through your blood reports and Ecg while holter is not available. Ecg is showing ectopics only.
Your VitD, folic acid is low and you ll need supplements for those and I guess you must be receiving those. For Vit D you need to be on Tab Uprise D3 60,000 units once a week for eight weeks and then once a month for next six months. For folic acid, you need to have green leafy vegetables and Tab Folate5 mg once a day for eight weeks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks again doctor.
Just 2 more things that I forgot to mention -
1. At rest sometimes I note that resting heartbeat is very low - around 55-60BPM. While sleeping at night this drops to 44-45BPM. Active heart rate is normal between 65 - 120BPM. This is as per fitbit that seems fairly accurate with heart rate monitoring. I exercise with a chest strap device and both report heart rate accurately. This resting heart beat seems rather low - is this a concern with taking inderal?
2. I also have excessive burping but NO other related digestive issues. No heartburn, indigestion or any other symptoms. Weight also has been steady between 66- 68kgs for the past one year.
I am constantly fatigued and tired. While climbing stairs etc. have muscle pains and overall exercise capacity also seems low. Do you see anything from the blood report that could cause these issues? It feels like I am sick all the time - although I try to eat healthy and stay active as much as possible.
Thanks for your patience!!
Just 2 more things that I forgot to mention -
1. At rest sometimes I note that resting heartbeat is very low - around 55-60BPM. While sleeping at night this drops to 44-45BPM. Active heart rate is normal between 65 - 120BPM. This is as per fitbit that seems fairly accurate with heart rate monitoring. I exercise with a chest strap device and both report heart rate accurately. This resting heart beat seems rather low - is this a concern with taking inderal?
2. I also have excessive burping but NO other related digestive issues. No heartburn, indigestion or any other symptoms. Weight also has been steady between 66- 68kgs for the past one year.
I am constantly fatigued and tired. While climbing stairs etc. have muscle pains and overall exercise capacity also seems low. Do you see anything from the blood report that could cause these issues? It feels like I am sick all the time - although I try to eat healthy and stay active as much as possible.
Thanks for your patience!!
Brief Answer:
Pulse rate is acceptable
Detailed Answer:
Pulse rate is fine, and it's acceptable. Also, in individuals who exercises frequently, pulse rate tend to remain on lower side and inderal decreases it further. So the mentioned level is fine to have.
Regarding, generalised weakness, it may be due to low Vit D and inderal to some extent responsible for it. However, since it's in a very low dose, I am keeping it as a second possibility. So, get your vitamins deficiencies corrected.
Pulse rate is acceptable
Detailed Answer:
Pulse rate is fine, and it's acceptable. Also, in individuals who exercises frequently, pulse rate tend to remain on lower side and inderal decreases it further. So the mentioned level is fine to have.
Regarding, generalised weakness, it may be due to low Vit D and inderal to some extent responsible for it. However, since it's in a very low dose, I am keeping it as a second possibility. So, get your vitamins deficiencies corrected.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you doctor!
Brief Answer:
Welcome
Detailed Answer:
You are welcome and all the best.
Welcome
Detailed Answer:
You are welcome and all the best.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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