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Forum Name: Chest symptoms

Question: Right chest pain / radiates up neck and face


 sunnyhawaii - Fri Apr 11, 2008 12:04 pm

Over the past two weeks this pain becomes very intense and blood pressure rises. Ended up in the ER and was hospitalized for 3 days. After numerous testing( Ecco gram, stress test, blood test and EKG's and last a cardio cath the doctor said there was mild inferoacpical hypokinesis and mild focal hypokinesis. (What does that mean?) Then sent back to PCP who referred me to have a ultrasound of abdomen. This showed only that I have "fatty liver". This still does not explain the pain that comes on and is sever. What else could this be. I'm affraid still I'm having a heart attack. I have been put on lipitor, niacin, zanex, baby asprin, pain killers. What to do from here?

Please help....
 John Kenyon, CNA - Sat Jul 12, 2008 9:40 pm

User avatar Hello sunnyhawaii -

First of all, I hate to say this, but your doctor may as well have not told you anything at all rather than simply give you some extremely technical information that means virtually nothing but leaves you wondering and concerned. What the inferoapical hypokinesis means is that there is a slight sluggishness of the muscle lying at the base of one or both of the upper chambers of your heart, as well as some mild focal (localized) sluggishness somewhere, either in the same place or somewhere else, but it is non-specific and certainly wouldn't account for the pain you experience, nor is it, by itself and out of context, diagnostically important.

Fatty liver is a generally benign condition as well, and means that more than 10 per cent of your total liver weight is made up of fat. It may cause no problems whatsoever or, over time, it could cause inflammatory liver disease. It is something worth following during annual physicals and if there are any GI or other symptoms suggestive of a liver problem. So far you haven't reported anything like that here.

Which leaves the question of the pain you experience. You were undoubtedly referred for the abdominal ultrasound to rule out a possible abdominal aortic aneurism, which could have been responsible for the type of pain you describe (although that would usually sound more like an ascending or thoracic aneurism, which would have been discovered during your cardiac workups). All you came away with, thankfully, is a fatty liver. You did good.

So what about that pain? Right chest pain can actually invovle the sympathetic nervous system and could even be as remote as some sort of trauma or irritation of the C-8, T-2 section of the spine. There are nerves which serve the diaphragm as well, and these can be irritated by various anatomical or postural abnormalities and which can cause really severe and unsettling pain in the left or right chest, radiating up into the neck, throat, head, or armpit on the affected side. These are almost never associated with heart problems, although it is wise to rule that out, which you have now done.

Sometimes, if this is the problem (nerve irritation) the solution is as simple as taking up the practice of yoga, or as complex (if the discomfort warrants it) surgery to release the affected nerve or remove pressure.

The first line of therapy, however, is always pain medication. Non-steroidal anti-inflammatory agents usually work well, but sometimes, if the problem originates in the GI tract and is due to pressure on the diaphragm from below, then this may actually aggravate the problem. Even that would be telling, however, so it is a good idea to try this approach first, even if it only serves to prove the problem is gastric rather than an irritated nerve.

The pain can be truly severe and sometimes momentarily disabling. It almost never is accompanied by any other symptom than elevated blood pressure (in some patients) due to the sympathetic response to pain. (High BP is often a confirming corollary of reported severe pain anywhere in the body, and makes serves to make the finding more convincing). Not everyone is "wired" to respond with elevated BP, but it is not unusual at all.

I hope all this helps to ease your mind some, since you've been through quite an ordeal of ruling out things. Please do keep in touch here.

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