Spine and chest pain?

[mmglobal]

I posted something about some MRI's that I had a few days ago.

http://adrsupport.org/private-cgi-bin/ultimatebb.cgi?ub...t_topic;f=2;t=000085

This discussion spawned a lot of off-line discussion about chest pain related to cervical issues. It seems that this is a very important topic that should be discussed. I'll ask the people who've PM'ed and sent email about spine related chest pain to post here... this should be interesting.

I've been worked up twice in the last 1.5 years for chest pain. I always knew that my heart is fine and that the pain is c-spine related. However, when a man in his late 40's presents with chest pain and tingling in his arm and hand... they have to respond accordingly. My big fear is that one day, I'll have a heart attack and assume it's c-spine. Just because I've got knarly osteophites and moderately severe foraminal stenosis at C5-6 and 6-7, does not mean that I'm not having a heart attack.

I frequently have pain that radiates from my mid-scapular area up into my shoulder and neck. Occasionally, I get similar chest pain. Rarely, I get absolutely crushing chest pain that lasts for a few minutes. It seems to be positional. Episodes last a few minutes and taking a deep breath makes the pain a 10. An episode will be 2 or 3 short episodes over the course of a day.

I have similar episodes with a very sharp pain that extends horizontally across my back, just below my shoulder blades. Like the crushing chest pain, this pain may be raised to a 10 by taking a deep breath. Unlike the chest pain, this seems to be brought on by a sudden movement.... like when you try to catch something you dropped or trip on your dog's toy.

I know someone who died of cancer after self-diagnosing his back pain. I don't want anyone to die of a heart attack because of self diagnosing chest pain as c-spine. There are many here who know much more than I do about heart issues... I am a newbie in that area. This should be an interesting discussion.

Mark

[annapurna]

Thanks for bringing this up Mark, could be a life-saving discussion literally.
I've got c6-c6, c6-c7 DDD with foraminal herniation and posterior bulge to the cor at c5-c6. In addition to neck pain and headaches, I get the sort of shooting pain between the shoulder-blades, down the shoulder, and down the inner-arm and armpits. I also get frequent chest-pains that increase in intensity when taking deep breaths, but, that is very likely acid-reflux-related. I too have received recent EKG's (at the Alpha Klinik pre-knee surgery) as well as excercise EKG's and stress-echo over the last couple of years with no heart problems detected.

[Mariaa]

Mark,
I have the latter pain you described occasionally- it takes me by complete surprise and takes my breath away or rather makes me feel that if I've just inhaled, not to exhale..also it's piercing pain. Occasionally have weakness on outside of arms and pinky fingers, mostly right arm (dominate), a few other fingers tho I just stop doing what I'm doing as it's always keyboarding that aggravates.

I need to have my cervical probs worked up a bit more I believe as I'm having too much neck pain, and way too many of what I believe are migraines but may be related to cervical probs...I have 3 discs involved in the cervical area (just like the lumbar area)...

[queenofhearts]

Chest pain and other symptoms that may be heart related should always be checked out, regardless of C-spine problems or acid-reflux. And women need to be especially vigilant - we don't always have the same heart-related symptoms as men and the standard tests (stress-echos and EKGs) often show normal results, even when there is a problem.

I speak from experience - after my chest pain, heartburn and abnormal EKGs were brushed aside by a cardiologist who declared the problem was "all in my head", although I was still having problems.

It took a TIA (mini-stroke), a neurologist, a new cardiologist who wouldn't give up, and proper tests to isolate the problem. Ten days from now it will be 1 year since I had open-heart surgery to remove a tumor from the left atrium of my heart.

C-spine problems and acid-reflux symptoms can mimic heart-related problems, but its still best to err on the side of caution and have it thoroughly checked out. I also had bone spurs in my neck and other DDD problems at multiple levels, and had a major heart problem anyway.

[annapurna]

Other than excercise EKG and stress-echo, what other tests can be used to diagnose these problems for women short of angiogram? Are there other "non-invasive" tests that can be run?

[Harrison]

I apologize to the regular visitors for repeating this, but it is def. relevant. I went through months of confusion and pain attributed to an injury to my brachial plexus (both weightlifting and repetitive stress from swimming). Though not diagnosed yet, I am sure it's thoracic outlet syndrome.I'll find out more next week when I see the sports doc.

For me, it was bad. I had very cold hands, severe neck and shoulder pain, and my arms would fall asleep at night. Take a look at the sea of nerves and vessels flowing through your brachial plexus, and you'll appreciate how complicated this area of your anatomy is!

In my case, the inflammation produced impingement on the nerves and vessels, and it really scared me. Oddly, this can produce angina-like symptoms, and it did for me. Scary stuff -- and documented (in another thread I posted I think).

I learned much more about the criticality of "proper" blood flow as it relates to inflammation and BP; much more. Feel free to email if you can relate.

[queenofhearts]

I'll be seeing my cardiologist for my 1 year check up and ask him what non-invasive testing he recommends, or what he does different for female anatomy.

Although more studies are being done specific for females (smaller coronary arteries for one), the standards and norms for cardiac testing are still based on studies done on men.

[Poncho]

Well, where to begin here.......

Basically, with anyone over the age of 35 with a chief complaint of chest pain, regardless of their past history, they need a cardiac workup first to rule in or out cardiovascular disease such as "heart attack" (myocardial infarction - MI) FIRST - because this is most critical to sustain life. Then, from there rule in or out other causes that can "mimic" symptoms of an MI.

Not all cases that present to the ER are "textbook". I have had some that complain of chest pain / arm pain and the symptoms are coming from a cervical disc issue. In other cases, I have had someone come in only complaining of left pinki finger numbness and be in full cardiogenic shock from a MI.

Most commonly are patients that complain of chest pain and have either acid reflux disease commonly known as GERD or gall bladder issues. Nonetheless, cardiac issues need to be ruled out first before exploring other causes.

In my humble opinion, if a patient is having symptoms as such mentioned above and they feel as if they are being "blown off" by their provider and not being followed upon.... I strongly encourage them to go for a second opinion. Even if it means going to a different ER the same day/night. Any suspicion of symptoms coming from cardiac in origin are not to be take lightly.

[Mariaa]

One thing that should be noted is that when one complains of chest pain on an office visit, a good physical exam should be done at this point and listening for heart sounds. This can often be the first point where the astute physician decides there is something that should be checked further.
Labwork for cardiac enzymes can be ordered,plus general labwork of pertinence, a baseline EKG can be done and further workup recommended as needed with echocardiogram, halter monitor, stress testing (active or passive) and angiogram.

The most common thing that is heard when a patient misconstues cardiac pain for another type of pain is "I didn't know if it was gas.." causing the pain or pressure.

Complete GI workup should be done if warrented. Pocketed gas can cause pain in the chest wall and pressure that can be confused with true chest pain. GERD- gastroesophageal reflux disease, can also cause pressure and pain tho often will cause some amount of burning pain that goes from the sternum to the throat. There are a host of other conditions, hiatal hernia, diverticultius, ulcer...that can cause pain, pressure, discomfort in upper thorax area.
Endoscopy can be done to rule out much of the above and it's good to have a colonscopy done if there is any report of rectal bleeding.


Further GI pain can often be relieved by something that reduces acid or gas. True chest pain cannot.
Breathing is not usually labored and pain doesn't radiate to jaw, throat, teeth, shoulder, arm, altho a very upset stomach and some of the GI conditions can make it feel like breathing is difficult.

In the moment of having a heart attack or one doesn't really know tho and probably the best action to take is to call 911. Driving to the ER one can lose time and possibly suffer a heart attack behind the wheel. Know the symptoms of heart attack, esp. if you have an early family history of cardiac problems, heart attack or stroke and also if you are 50 or older.

Doreen mentioned TIA, transient ischemic attacks which can happen and one can not fully be aware anything has happened but maybe feels faint and has to lie down, can't function, can't think, loses consciousness ..

Angina, stable or unstable- usually causes chest pain that can be mild to severe, radiating to jaw, shoulder, arm and can be medicated with nitroglycerin tablets to relieve pain.

There's really a lot here to rule out, including gallbladder probs. however, a good Internist should be able to get on all this and rule out what is GI and what is cardiac.

If you do not feel like your problems/complaints are being fully addressed, make sure you either make the doctor you're seeing understand your concerns or go to another doctor that does.
Know signs and symptoms of chest pain vs. GI pain/probs.

***costochrondritis*** if you have pain in the chest wall/rib area, and have done some sort of heavy lifting, this condition can mimic chest
pain.

One last note: having had back pain for over 20 years, I've blamed it for everything including being the cause of my knee pain that ended up needing surgery for patella tendon release and other things that if I hadn't been so focused on my spinal problems, I may have realized something else was the cause a tad earlier...

Again, a good internist can rule out GI/cardiac, and most likely ortho/neuro symptoms and make appropriate referrals. Find a good Internist with whom you have good rapport and when you have something that bothers you, see your doctor, unless it's emergent/urgent- go to appropriate facilities in timely manner.