Doctors Lounge - Cardiology Answers
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Forum Name: Cardiology Symptoms
|robert uk - Tue Jul 25, 2006 9:58 am|
I just wanted any advice you can give please. I started with a pain grabbing sensation under my left arm at around 11:00 PM last night. It was quite bad but bated off and on again all night. Today the feeling is not as bad but it still keeps coming back now and again then easing off again.
I can only describe it as a gnawing dull but painful feeling yet it also feels as if you were to open your hand and close it again it feels like that sensation sometimes more painful than others. Last night the pain went down part of the same arm and I had pain in my finger throbbing sensation which eased after a while.
The thing that is worrying me is that it is still here today much less than last night but if I exert to much it seems to come on more.
Do you think I need it checking out or should i give it another day or so. I have taken some pain tablets but not helping much when it does come on.
|robert uk - Wed Jul 26, 2006 3:34 pm|
Just an update. Today it is no where near the same as two days ago but it still comes on slightly throbbing grabbing feeling under my left arm still. The only other thing different is I have had hiccups now since this afternoon and it is now evening and still can't get rid of them.
|John Kenyon, CNA - Sun Mar 25, 2007 12:41 am|
Hello Robert - I apologize for the long delay in responding to your post, but I wasn't a part of the team here when it was posted. At any rate, I hope the problem has resolved by now, but would like to follow up.
You didn't mention your age or any health history, so I am assuming you are a generally healthy male. The sort of pain you describe would normally be highly unlikely, at least in a male subject, to be cardiac related. The character is spasmodic, which sounds more like muscle or even primary nerve pain. The fact that it has radiated down your arm and into a finger makes it only slightly more suspicious to me. However, the fact that is was worsened by exertion and the development, subsequently, of hiccups, does lead me to feel a certain concern and I hope that if the problem didn't go away promptly you were seen by a physician. Sometimes a problem in the lower part of the heart, near the diaphragm, has been known to trigger hiccups in the occasional patient (inferior myocardial infarct). With the limited information I could only, in good conscience, recommend you be seen at once by a physician to rule out any heart problem. However, it has been a long while since your question was posted, so hopefully the matter passed without further incident. Even if it did I would still recommend you schedule a regular physical exam including 12-lead EKG, to rule out any cardiac involvement. Better to err on the side of caution.
Hope this finds you well and if you're still checking in here, please do update us on what, if anything, became of the problem.
|robert uk - Sun Mar 25, 2007 10:03 am|
Just got your reply today. I had forgot all about it but thanks very much for replying to the problem i had at the time.
I will explain a little more now with a little past history.
I am now age 39.
For some years i have had problems at times with my heart rate in it being tachycardia as they always say that to me. They did at one stage give me cardicor i think the name is and another blood pressure tablet both which i no longer take.
Once my heart rate went back to normal they then let me home which sometimes up to a few days or longer.
I have had done some different heart tests but the last one they were going to do was angiogram but with other things going on at the time i never go around to having it done.
Other medical conditions i have is anemia which i am on at the moment 2 iron tablets per day along with folic acid.
I have an ulcer problem to so am on Lanzoprazol for some years now since i had bleeding ulcers but they fixed those by injecting the ulcers in my stomach with something that must stop the bleeding via endoscopy which i have had 5 or 6 in past years.
I do try to keep a way from the doctors if i can but this last Thursday, first time in over a year i have been to see my GP i left it most of the day then decided it was best to go and see if anything was wrong because i had been feeling dizzy for a few days prior and Thursday was much worse because i felt at times as if i was just blank i could not think straight and felt just not with things and dizzy.
He checked my blood pressure which has been high in the past and also did and ECG. The ECG he said was fine and he then checked my blood pressure again which must of also been fine and did a few other basic test..looking in my eyes, ear mouth, and sounded my chest and back.
He just said it may of been just be a one off but could not put his finger on anything specific so told me to just go home and rest a few days.
I did mention the one thing i have had now for quite some years which is pain going up my neck around the back of my ear, chest at times and sometimes into my head. I can't describe it but it is just a very deep feeling sickly pain. They did mention one time i came out of hospital have you got your angina medicine with you at home yet i was never told anything about having angina so i let that go and just said i don't have angina as far as i know.
I do have this quite frequent and up to a few times or more daily at times but with getting used to it now i just go take a glass of water and sit until it lessons for me.
I dare not take to many pain medicines because of upsetting my ulcers so try not to of possible.
The only other thing i can tell you is 2 years ago when i had bleeding ulcers and they fixed that for me is that i was just resting in hospital because i was hoping to be out before the weekend now they had stopped the bleeding.
I was sitting having a snack around dinner time and started all of a sudden getting chest pains, thought nothing of it at first but gradually got worse and worse then i just felt my heart racing that fast that it seemed to be coming out of my chest so i beckoned over to a nurse who came and started doing things ECG etc and called a few doctors who came around to see what was going on..
The ECG they must of done 3 or 4 and it made me much worse i think seeing the ECG has it was coming out of the machine because the lines you see were just so high and all over the place.
They put me on oxygen because my level they said was in the 70s at the time.
Broke a bottle of something for the pain in my chest and injected that which seemed to help a little...the thing is the pains that i have now daily going into my neck and ear are almost the same type but not in intensity as i had when i was in hospital.
They found out what caused the chest pain and my heart rate which seemed to be my potassium level was very low and they just kept giving me potassium drinks for a few more days.
The scary thing is i only found out after why relatives all of a sudden appeared was that the hospital rang them to come so i guess i must of been in a bad way for a time which i knew myself i was how i was feeling but came through it at least.
Anyway that basically tells you little history.
Just a note since last Thursday when i visited my GP i am still feeling dizzy at times with the pains up my neck and palpitations which is why i went up last Thursday.
Only one other difference now for over a year is i sometimes wake up with the pains going up my neck from my chest and sometimes into my ear and head when i am just sleeping and it wakes me up. I again just go get a glass of water and sit up until it lessons.
I think i must be a bit of a mystery but it would be nice to live life without the pain i have so regular and how i have been feeling on and off for years now.
Thank you for your time
|John Kenyon, CNA - Sun Mar 25, 2007 12:14 pm|
Hello Robert - I'm so glad you have been checking in here! I'm glad you responded so promptly and so thoroughly, and you definitely have supplied some very important information that may at least in part help explain what's been going on, since the problem seems to still be occurring.
First of all, now that we know you've had sclerotic therapy for bleeding ulcers (and that you've had ulcers at all) we can consider another possibility. At the same time, the pain pathway you describe is suggestive of something more likely non-cardiac in nature despite your strange experience in the hospital. Also, you are on iron replacement therapy,which also could figure into all this.
Let's start with the primary symptom of the pain you describe. This sounds very much like retrograde pain being referred up from the diaphragm, which essentially, on the left side, divides not only the thoracic cavity from the abdominal, but also the heart from the stomach. Because of your distinct history of gastric ulceration it seems more likely that the pain is travelling up the phrenic nerve and may be residual due to disturbance caused by the procedure used to cauterize the bleeding ulcers. There still remains a possibility that the pain could be cardiac in nature, but it now seems less likely when compared with direct irritation of the phrenic nerve.
Another nerve which could have been irritated or otherwise disturbed during the procedure is the vagus nerve,which controls not only motility of the stomach and intestines,but also has the job of slowing the heart rate. Vagal stimulation can cause premature ventricular contractions (PVCs), and failure to function appropriately can permit the heart rate to pick up speed for no good reason. Having had work done inside your stomach such as you had, both nerves could have been disturbed or irritated and this might well explain the strange episode in the hospital.
It would definitely be in order to rule out the possibility of heart-related disease via angiogram or at least nuclear scan stress test. Ruling out ischemia one could safely assume the symptoms you're having are, for the most part, related to nerve involvement resulting from the semi-invasive stomach procedure.
Additionally, you were given oral potassium in the hospital following treatment for bleeding ulcers. Oral postassium can reallly irritate the stomach lining. Just an observation. And along those same lines, iron replacement therapy requires monitoring of the blood levels of iron, as too much can cause heart injury.
There is no accounting for the comment about the "angina medicine", but this is an error that seems to be fairly common, the assumption that someone who has had chest pains must have nitroglycerine on hand. It is an assumption often made due to inadequate or inaccurate charting. It also adds weight to the idea of ruling out cardiac disease altogether, so that a sound differential diagnosis can be made and the appropriate treatment for your symptoms can be given. Pain is pain and at the bottom the goal is to relieve it, but only after being certain of its cause.
I am strongly suspicious of a GI/nerve relationship rather than heart, but there is enough overlap of symptoms to warrant ruling out the heart problems first.
As fior your recent dizziness and feelings of mental cloudiness, I suspect that was a random, inconvenient added symptom which may have been related to a medication or may have been just what your doctor called it, a "one off" distraction. I do think your pain is very likely non-cardiac in nature, especially since it has continued, ocurring at rest as well as when in motion, hasn't progressed to anything more severe, and due to the new information regarding your ulcer problems and their treatment.
It would be good to lay this all out in front of your doctor, along with your concerns, so as to feel more comfortable and maybe even find an acceptable way to reduce or eliminate the now-chronic pain.
Best of luck to you and please do stay in touch.
|robert uk - Wed Mar 28, 2007 10:39 am|
Thanks for explaining that to me it makes a lot of sense.
Could i just ask you a question regarding myself and how i am feeling since last evening.
The reason i thought i would ask here is because i hate to make trips to a doctor when there is no real need and although last Thursday was my first time seeing my GP in over year i would feel a bit stupid if i have no reason to go.
What happened last night was that i was sitting and started with a pain on my right chest area...just below the breast bone area and right side. What happened is when i took a breath in i got the pain in that spot and in intensity i would say out of 10 it got to 6 or 7 a few times. no problem when i exhaled but just when i inhaled i got the pain.
Thinking it might be trapped wind i went and got a drink of tonic water thinking it being fizzy it would help.
It did not help and so i just went and lay down and was up this morning around 7:30.
The pain had lessoned and seemed to have gone. Now this afternoon for about 2 hours now i keep getting the same pain in the same place but much less frequent yet very aware it is there.
The only other difference is that the area under my left armpit to the side of my chest feels like a pulsating sensation like as if you got a soft ball and squashed it in your hand and opened it again. that is how i can describe it.
It seems to come on a few times within a matter of minutes then dies down again. Very uncomfortable feeling as i know it won't help but i kind of hold the area when the sensation and pain comes thinking it will lesson.
It's quite bad as i am writing this. The only other difference is the pain on my right side i explained also seems to go through to my back at times..like the pain shoots from the front and into my back on the right side.
Still feeling dizzy at times things seem to spin for a little but then returns to normal. Tiny bit sickly feeling but that is about all.
Any advice if your about would be appreciated.
|John Kenyon, CNA - Wed Mar 28, 2007 12:01 pm|
Hello robert uk - The two things you describe in this post would seem to be unrelated, but given the history they may not be. At any rate, I will give you some rationale for going to a doctor and not feeling silly about it, not that you should ever feel silly, really, in addressing symptoms that have even a remote potential for threat to life or limb. Here goes:
The pain you describe on the left side, in your armpit, could very well be referred phrenic nerve pain from something related to the treatment of the bleeding ulcers. However, the description has now evolved to the point where I would have it evaluated at once, as it also could describe a rare type of arterial aneurism involving the brachial artery or perhaps a branching off point nearer the aorta. It's probably not, statistically, but if it should be, then it needs to be addressed at once. No advantage in waitng for it to go away, as it has persisted for quite a while and even seems a little more severe now. The description is just too close to what sounds like a vascular accident waiting to happen, even though the actual likelihood is small. (it is a rare location for such a lesion to develop, but they can, especially in people with certain connective tissue diseases which often otherwise go undiagnosed).
As for the pain in the lower right chest, while it could in some way be related to the other pain (especially if they are both the result of an irritation of the phrenic nerve), it first of all does not sound like cardiac pain at all, as it is worsened on inhalation, a good indication that it is not heart related. That being said, if you were to have some fairly obscure connective tissue disease involving the blood vessels, this could also be related to the armpit pain in a far more serious way. It is essential, in my view, to rule out any potential vascular lesions right away, and then work down from there. The goal, absent anything truly serious, would be to at least manage the pain. This, in itself, is certainly sufficient reason to be seen promptly.
Please bear in mind how difficult it is to evaluate in this medium what is really going on in any given patient. We must go with what we do know, and what you have described concerns me enough to urge you to get to a doctor or medical facility promptly to have both complaints evaluated. Odds are they are separate, benign issues, but even a small chance of them being something far more serious makes it a high priority, and pain itself, as I have said already, is reason enough to be seen and to get these things managed.
Please consider my advice in this matter and do stay in touch.
|robert uk - Wed Mar 28, 2007 1:42 pm|
Thank you John.
I have not gone to my GP today anyway as it is after 7:00 pm and also it has lessoned from what it was but just seems to flare up.
See i am not exactly sure what to explain to my GP would me printing out the topics i wrote here and the replies you made help him understand better what might be going on but hopefully not.
I was also going to have a look for someone in the UK and try and contact them and explain everything and go from there. I mean if things could be sorted out ruling one thing or another out at least i would understand better why i get all theses strange symptoms.
I also forgot to mention my stomach also seems quite bloated at times lately feeling very full yet feeling that way before i have eaten anything and also stomach pains which i put down to ulcers playing up but nothing very painful just the grinding sore like pain in my right lower stomach area when i get it.
Maybe that may also have something to play in all this but i will indeed let you know how i get on with things once i have decided which is the best way to approach my GP or other about it.
Thanks again John
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