Can symptoms of coronary heart disease come and go?

[tereck]

I've recently had a number of bouts of 2 to 3 days where a chest discomfort persists. Sometimes quite intense, lasting hours, to the point where I've been thinking 'is this when one should call an ambulance?' Over the next few days, it subsides and becomes a mild hum which can often been ignored. Then pretty much goes. Though, I have to say, I'm an anxious type so I cannot eliminate that as a cause.

I'm bradycardic, and on mild blood pressure meds. My cholesterol is borderline, tmk always has been, and unmedicated but monitored.

Last year, I was referred to a cardiologist by my doc and did an EKG and echo. The results indicated an issue of some kind BUT, as I found it unlikely, I got a 2nd opinion. A 2nd EKG, echo and stress test found no cause for concern. I put the first lot of results down to 'whatever', perhaps even a reaction to covid vaccines which I'd had around the same time, and forgot about it.

As mentioned in another thread, I have periodontitis. Being a bacterial infection, that can cause other complications. I'm wondering if I have some form of coronary heart disease - but could its symptoms fluctuate?

[yoav]

Firstly, I would be wary of making any diagnosis over the internet.
Secondly, I don't know your age and medical history

Having said that, your pain history does not sound like pain from coronary heart disease. Angina eases with rest and will be related to physical activity. It also doesn’t sound like you are having multiple heart attacks!

A resting ECG and echo don’t always show heart disease but as stress test should.

My guess, and it is a guess, is that this pain  is not due to coronary heart disease. A possibility would be percarditis but more likely, it not pain of cardiac origin

(DOI retired doctor)

[chrisbainbridge]

Very much echo YOAV’s comments. I wondered about reflux but I have even less relevant knowledge than YOAV.

[tereck]

A possibility would be percarditis but more likely, it not pain of cardiac origin

Thanks for the reply. Just reading about pericarditis, it does seem more likely. Both in terms of causes and relief.

Just web searching 'pain of cardiac origin' was most informative...

In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause.

I honestly didn't think it was CHD but, not being a doc, just wanted to run it past the panel. I'll not panic now (which in itself just makes matters worse) and will report it to my doc next time I go for my repeat prescription of blood pressure meds.

Thanks again 

[yoav]

Reflux: doesn't sound like that either but you can always take an antacid as a test to see if it makes any difference.
I mentioned pericarditis but I would have thought that falls within the realms of a cardiologist and they would have thought of that. It can produce funny ECG's.
Question: did any of your tests take place when you had the pain?
Another question: do you have any chest wall tenderness when you have the pain?

[tereck]

No, pretty certain it's not reflux.

Question: did any of your tests take place when you had the pain?
Another question: do you have any chest wall tenderness when you have the pain?

No* and no.

It's an intense pain (if pain is the right word, more of a discomfort) It starts as a sharpish pain in the high centre of my rib cage and slowly (over hours/days) spreads. It's like someone's inflating a balloon behind my ribs, it's like an interior pressure. I can feel nauseous but without feeling like I'm going to vomit.

Tbh, I'm not sure it's pericarditis, not from my reading of it anyway, but I wouldn't say it's definitely not. I can get my heartrate up ok (and easily pass my theoretical max even) without feeling any ill after effects. I don't think that'd be the case if it were pericarditis.

*I deliberately went for a ride before the first cardiologist appointment - if there was a problem then I wanted him to find it! His post echo remarks have now been drawn a veil over.  He did hear something, and see something, that concerned him - I've no idea what specifically. He prescribed blood thinners, 40g statins, beta-blockers (being bradycardic, those made me feel decidedly ill!) and an angina spray purely on the basis of that echo. He told me to take it easy, no cycling. It seemed to me that he thought there was a concern.

The second cardiologist told me to forget about the 1st without offering further explanation. I was happy to do that because I preferred a clean bill of health.

[yoav]

Ok, thanks for letting me know. To probably exclude cardiac pathology completely, they may be able to lend you a 24hr ecg monitor to take home and place on yourself when the pain starts. But I feel that would probably be normal.

Now, I’m going to go out on a limb here and say you might have Tietze syndrome or costochondritis.

I don’t know much about it and I don’t think I’ve ever seen a case. I was first made aware of it when I was a house officer in 1984 to an elderly cardiologist who claimed to have identified it as a possible cause of  chest pain presenting to cardiology clinics (so he boasted).

Some of the symptoms you describe could fit. You’ll need to Google the condition yourself. As far as I know it’s not a sinister condition.

[tereck]

Now, I’m going to go out on a limb here and say you might have Tietze syndrome or costochondritis.

Now there's something for me to while away some hours reading up on!

Whatever it is, whilst it is uncomfortable and unsettling, I have this feeling that it isn't hugely serious, and certainly not life threatening. That's why I wasn't on the phone to the emergency services when it's happened - I feel I can just ride it out. I am going to mention it to my doctor when I next see them but I don't think it merits any more than that at this stage.

Thanks again for offering your opinion yoav, much appreciated 

[rafletcher]

Gallstones? Pain can be mild to excrutiating.

[tereck]

It's possibly something like a variant angina (not saying it is, just something like).

Exercise doesn't trigger the discomfort. It comes on at rest, I wake with it or it comes on during the evening. I find the use of a nitrospray (prescribed by the 1st cardiologist I saw) lessens the discomfort in the chest but I still feel the general unease/malaise associated. Interestingly, I think I can even induce it; alcohol seems to be a trigger.

Both Christmas & NY period saw heavier than usual alcohol consumption and whilst I was okay after Christmas, I was suffering the day after NY's day with it (wasn't a hangover btw!) Since then, a glass of whiskey the other night was followed by chest discomfort, then a glass of champagne last night (new neighbours) and I'm similarly afflicted this morning. As a rule, a single glass doesn't trigger it but maybe the Christmas/NY indulgences have built up a level, or something. Equally, as a rule, I'm not a big drinker. Indeed will go weeks without drinking any alcohol.

I can exercise with the chest discomfort without any apparent ill effects, but I am not 100%. Breathing's not an issue but I do tire more quickly and don't have my usual levels of strength on climbs etc - but that could be psychological.

[DuncanM]

When I had costochronditis, deep breathing (eg from exercise) or coughing made it much worse. Treatment was anti-inflamatories, and it went away over a couple of weeks. I think bad posture can bring on similar feelings now, but it goes away if I correct it.
NB - I am not a doctor, just someone who had it - listen to the others!

[TimC]

Some years ago (2017) I had a chest pain during exercise which landed me in hospital in the States. After several ECGs (which I regularly took for my job anyway), EKG, stress tests, Holter tests and consultations with cardiologists various, it was retrospectively diagnosed as pericarditis. Absolutely nothing was revealed by all the testing. A couple of years later (2019), I was diagnosed on a routine medical with an ectopic heart beat which (as always in my profession) got me more time off work while the whole investigation process was reprised. The senior consultant cardiologist declared himself 'spectacularly uninterested' as the symptoms (of which I was entirely unaware) were well within normality for someone of my age and previous exceptional (by normal standards) fitness. He explained that a heart that has trained significantly in younger days can go a bit dolally once it gets a bit flabby, and recommended a book 'The Haywire Heart' (purely as background information; not as a route to self-diagnosis).

I have since then kept a close eye on my heart's behaviour. Now retired, and no longer being checked by a medical system with interests beyond my health (rather that of my passengers!), I check my blood pressure weekly and have a Kardia 6L to take a 6-point ECG at the same time. I am constantly aware of how my chest feels and do occasionally get a bit nervous if I feel squeaks and gurgles which - so far - have always been some level of reflux or digestive issue. Alcohol always make that more likely! So far, I've not felt the need to consult further, and the monitoring is reassuring. I do occasionally pay for a blood test for cholesterol etc, and it always confirms what I know anyway: that it's above the recommended range, but not by much. I am determined this year to adjust my diet to tackle this.

I'm not sure if any of this helps except to show that you're not alone!