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Chest Pains
September 2000

Q. I suffer chest pains often. Before the pains, I usually have a crushing feeling to my chest ranging from the feeling of someone giving me a big bear hug to someone sitting on my chest. The pains vary from a tightness that is bearable, to "bites" which can only be explained as being like someone pinches you with tweezers (sharp and quick but quite deep) and "mule kicks." The "mule kicks" vary but feel like someone reaching their hand inside my chest and trying to pull my heart out while squeezing it very tightly. On some occasions, these have been followed by radiating pain up my shoulder and neck and down my arm. When I exercise at all, I get breathless and if continued will lead to a tightness then pain. As the day progresses I just get worn down. When I get the tightness, it usually stays with me until I rest for a while. If I lie down at all, I will be asleep within minutes. What could this be?

A. Chest pain is a common problem, especially as one gets older. Without more details of your history, or exam, it is difficult to say what is causing the different chest pains you are having. However, the fact that it seems worse with exertion and better with rest, along with the shortness of breath and radiation of the pain in the neck and arm, I think it would be prudent to rule out coronary artery disease (i.e. narrowing of the heart arteries). Often, the best way to do that is having your doctor order a stress test which monitors your heart rhythm and blood pressure while you walk on a treadmill. Other causes of chest pains can be muscle strains or arthritis of the chest wall, reflux of stomach acid into the food pipe (GERD), lung disease such as asthma, pericarditis (inflammation around the outer heart lining), aortic aneurysms (dilated artery in the chest), pleurisy (inflammation around the lung lining), anxiety and depressive disorders, among many others.

I would highly suggest you see your internist for a thorough history, physical exam, labs, EKG, chest xray and a stress test.

Fortunately, there are many effective treatments for the above disorders. I hope you feel better soon.

References: Harrison's Principles of Internal Med.

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