Heart is only one cause of chest pain

Cape Breton Post - - LIFESTYLES -

DEAR DR. DONO­HUE: I of­ten have this strange chest pain. It’s usu­ally on the left side. I feel my heart beat­ing pretty fast at times, but it speeds up and slows down. Some­times the pain is se­vere, but most of the time it is just an­noy­ing. I thought it might be poor blood cir­cu­la­tion, anx­i­ety or heart dis­ease. When I go to the hospi­tal, they check my heart and blood pres­sure, and they are nor­mal. I ex­er­cise reg­u­larly and eat healthy. I am a 25-year-old male. Can you sug­gest any­thing? — A.J.

AN­SWER: Chest pain puts doc­tors and pa­tients on high alert. The doc­tor doesn’t want to over­re­act and make a well per­son feel he is sick, and he doesn’t want to un­der­re­act and have a dead pa­tient. Heart con­di­tions are the most danger­ous cause of chest pain. You are quite young and heart dis­ease doesn’t usu­ally strike at your age. In­suf­fi­cient blood get­ting to the heart causes angina pain — pain that comes on with ex­er­tion and leaves with rest. This doesn’t sound like your pain. A heart at­tack doesn’t hap­pen the way you de­scribe your pain, ei­ther. I don’t know what the speed-up and slow­down of your heart means. When you went to the hospi­tal, was an EKG taken? That would pro­vide valu­able in­for­ma­tion.

Other se­ri­ous con­di­tions caus­ing heart pain are things like blood clots that have trav­elled to the lungs. Again, what you de­scribe isn’t typ­i­cal of pul­monary em­bo­lus — clots to the lung.

If move­ment of the chest brings on the pain or makes it worse, it could be mus­cu­loskele­tal pain — pain orig­i­nat­ing from the chest mus­cles or from the ribs or back­bones. This kind of pain al­most al­ways sub­sides on its own.

I can’t be of much help to you. You have to es­tab­lish your­self with a doc­tor who can fol­low you and can or­der tests to pin­point the cause of your pain.

You men­tion anx­i­ety. That’s an­other cause of chest pain. Are you un­der a great deal of stress right now?

DEAR DR. DONO­HUE: I am a 49-year-old, sin­gle male. I have many med­i­cal prob­lems, in­clud­ing Paget’s dis­ease. In the past few years, I have been di­ag­nosed with es­sen­tial tremor. Why isn’t In­deral be­ing mar­keted any­more? I tried pro­pra­nolol, but my stom­ach couldn’t han­dle it. Can you sug­gest any­thing over the counter? — T.H.

AN­SWER: Es­sen­tial tremor, also called fa­mil­ial tremor, is the kind of shak­ing hands that make it dif­fi­cult to bring a spoon­ful of soup to the mouth, write leg­i­bly or do any kind of metic­u­lous work with the hands. Ob­servers mis­tak­enly in­fer that the af­fected per­son is ner­vous. That’s not the case.

In­deral is no longer be­ing made, I sup­pose be­cause it’s not prof­itable to pro­duce it with so many other less-ex­pen­sive generic equiv­a­lents to In­deral on the mar­ket. The generic equiv­a­lent is pro­pra­nolol. Per­haps the man­u­fac­turer of the pro­pra­nolol you took has some in­gre­di­ent in the drug that up­sets your stom­ach. There are other man­u­fac­tur­ers, and their filler in­gre­di­ents dif­fer. You might be able to tol­er­ate one of those prod­ucts. I don’t know of an over-the-counter medicine that can still the shak­i­ness of es­sen­tial tremor. Caf­feine and other stim­u­lants make it worse. Prim­i­done (Myso­line) is a pre­scrip­tion medicine that does a good job of con­trol­ling es­sen­tial tremor.

DEAR DR. DONO­HUE: I have a ques­tion about tak­ing thy­roid hor­mone af­ter a blood test that showed an el­e­vated level. I thought you’d take the hor­mone only if you were mak­ing too lit­tle of it. What is your opin­ion? I feel un­com­fort­able tak­ing this medicine. —C.C.

AN­SWER: The thy­roid test you re­fer to is not a test for thy­roid hor­mone. It’s a test of thy­roid­stim­u­lat­ing hor­mone, a hor­mone that comes from the pi­tu­itary gland and that prods the thy­roid gland to make its hor­mone. A high value for thy­roid­stim­u­lat­ing hor­mone in­di­cates that the thy­roid gland is slug­gish and needs more thy­roid­stim­u­lat­ing hor­mone than nor­mal to keep up the pro­duc­tion of thy­roid hor­mone. If you have no symp­toms of too lit­tle thy­roid hor­mone — dry skin, fa­tigue, be­ing cold when oth­ers are warm, weight gain without an in­crease in calo­ries — the con­di­tion is called sub­clin­i­cal hy­pothy­roidism. No uni­ver­sally ac­cepted guide­lines ex­ist for han­dling this sit­u­a­tion. Some doc­tors pre­scribe the hor­mone be­cause a de­creased pro­duc­tion is likely to oc­cur.

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