Medical question

[kitkatz]

So here I am nine years into dialysis and the past two months I have had chest pain on and off.  Well on Monday I was standing in a Carls Jr ordering my lunch and I had chest pain.  Once I got into my car and was driving back to school I popped a nitro pill and was able to wait it out.   Well this afternoon on the way home I had chest pain again.  I took a nitro while driving home and waited five/six minutes and took another one.  The pain slowly went away and I was able to go on to dialysis.,  No pain yet so far tonight.    Here are my questions:

The pain is on the right side of my chest and blossoms to my back and shoulders. Any ideas what it might be?

Should I be driving and taking nitro?

[okarol]

Kit,
Not sure if this will help but try following this symptom chart http://familydoctor.org/online/famdocen/home/tools/symptom/523.html

Pleural effusion -  A pleural effusion is fluid between the membranes covering the outside of the lungs - the pleura. Despite extensive evaluation, the causation of a pleural effusion is not established in about 20% of cases.
During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness.

The following tests may help to confirm a diagnosis:

    * Chest x-ray
    * Thoracic CT
    * Ultrasound of the chest
    * Thoracentesis
    * Pleural fluid analysis

[goofynina]

Kit?  When you have these chest pains, do YOU think it affects your way of thinking? Does it make you delusional at all?  My friend from Philly just called to tell me he had a mild heart attack, he told me had been having minor chest pains on and off BUT never went to the dr. to go get them checked out.  He said that lately he noticed he would forget things or do things he wouldnt know why he did (simple things like taking off his shoes AT WORK)  He needed some type of medication to regulate something, there was too much medical lingo for me to understand,  i just know that he is on meds now and feeling better.  But it took an accident to happen to get him the care.  While he was driving home, he said the last thing he remembered was hitting the median, they told him he had a heart condition that affected his way of thinking (it was something in his blood)  I may be way off topic here but it just made me all the more concerned for you especially if you are driving.

[KT0930]

Kit, at the very least I would mention it to a doctor or nurse next time you're at dialysis. It may be nothing, but it could be something. In this case, definately better safe than sorry!

[petey]

I'm with KT0930 -- mention it to the doctor.  I'm hoping it's nothing serious.

[qwerty]

It very well may be nothing more than a strain or chest wall pain BUT!! Keep in mind with women chest pain can be very atypical and not follow the "standard" symptoms. When I worked CCU/Open hearts I had women come in with nothing more than tingling in thier little finger and had a major MI. Best advice is if the pain continues dont play around with it. Get it evaluated by the appropriate physician and dont just take the word of the dialysis nurse (she/he is not the doctor to diagnosis) and I find half the time they really dont know.  If you were male and the pain was on the right side I'd tend to think it was chest wall but being female - dont guess, get it checked by a Cardiologist for a work up. Women for too many years have been overlooked regarding cardiac disease and it gets played off until they do have that big one.  If the NTG relieves that pain then I would tend to think it needs further evaluation. Best scenario is if they can get that EKG done during the time you are having pain but it doesnt always work out that way. Hope all goes well. There is a new test with a CT scan that is great for diagnosis of heart disease in women but the problem is most insurance companies wont pay for it as it's considered still "investigational".

[stauffenberg]

Over the course of human evolution, the position of the heart in the body has migrated over the generations, as a result of progressive adjustments to the fact that we stopped walking on all fours and began walking upright.  However, there is a so-called 'neurological memory' of the fact of the earlier positioning of the heart higher in the chest, so that when the heart is under stress, such as during a heart attack, many patients report a sense of pain above and to the left or right of the heart.  This is because the heart's migration during evolution has left a trail of heart-connected nerves extending to the areas it has vacated.

[okarol]

Kitkatz was hospitalized for this (it's in another thread) - also has been telling them for awhile, that's why they gave her nitro. But no one seems to have answers for her.

[kitkatz]

I have been evaluated in the ER three times for the chest pain.  They say there is nothing wrong. The next time they are going to throw me back in to have  an angiogram. I go to see my primary do on Monday about all of this stuff.  I just wanted to know if I should pull over to the side of the road while taking the nitro.  Sounds pretty dangerous to me to be having chest pain and popping pills while driving.  I did pull over to take the nitro. But then figured I had better get going home so I was in a safe place if anything else went down.  Besides there is no warning signs that the pan is coming.  Just blossoms out into my chest and hurts to take a deep breath.  Really kind of scared me coming home the other day in the car.  After two nitro five minutes apart, it calmed down and went away.

The ER people said: Take one, nitro, then if the pain does not go away take another in five minutes, if that does not work take another five minutes later, if that does not help call 9-1-1. I have visions of me going in an ambulance to kaiser and nothing being found again!

[qwerty]

By all means I would pull of the roadside popping Nitro or infact even having chest pain would be enough for me. Hope they can find what is causing the pain. I'm one that believes the medical field looks too lightly at our complaints when it comes to cardiac issues. Cardiac spasm can cause this also and never show up in testing unless your having one at that exact time of the test. Hang in there and be insistent but never let them blow it off as "nothing" if it's causing you worry as you know how you feel better than anyone.

[Ang]

hoping  its  nothing  serious,each  time  it  occurs  get  off  to  the  er,tell  em  you  aint  leaving  till  they  come  up  with  a  diagnosis.

[KICKSTART]

Kitkatz can i ask do you sweat alot at the time and do you get the shakes during or after?  It sounds alot like what happened to me about 3 times.I had an ECG after the first episode and was told i might have had a small heart attack, but no could confirm! I have a GTM spray and was told , if it eases the pain , chances are its heart related, if it doesnt have any effect on the pain, then chances are its not your heart. My pain is slap bang in the middle of my chest when i get it but having said that ..heart attack pain need not be in your chest. My mum had a major heart attack several years ago ..her warning sign was a pain in her shoulder for about 3 days before, she thought she had pulled a muscle.If you gert the pain again , the sooner you can have sn ECG done, the better the results ..like within a couple of hours maximum.

[kitkatz]

Yep, going to see the doc on Monday.  Got my symptoms and questions in hand and am going to get a referral to a cardiologist.  I want this looked at soon.

[Ken Shelmerdine]

Kitkatz sorry to hear about the chest pain problem. I hope you soon get an answer.

[kitkatz]

Wen to see my primary doc today. He says yep, it must be chest pain. It might be one of three things:

angina- created by stress
An occlusion that has gotten bigger.
Or another occlusion has occurred and they just do not see it on a stress test.

He also said the stress test is 80% accurate.
He put me on capsules of nitroglycerin twice a day to help if there is an occlusion.
He says if I have to take two nitro go to the ER immediately.

I am taking a huge amount of pills now.  Up to ten each morning I think.

So that is my report.  I go back in six weeks. If I have any more chest pain I am to call him and let him know when and how long it happened.

[livecam]

If they are thinking about problems I wonder why they haven't done any other diagnostic tests? It would seem that a radiologic study with a dye and perhaps an echocardiogram might be in order.  Your HMO (mine's the same) likes to do stress tests for any sign of chest pain or cardiac problems before they'll progress to other diagnostic options. 

"If you take two go to the ER" sounds like a pretty imprecise way to handle a possible problem.  I don't mean this to be a rant but if something is even suspected diagnosing it now and getting it out of the way would be preferable to leaving things up in the air.

I hope you feel better!

[kitkatz]

I agree with you. That is why I went to the doctor today and am seeking help and medical advice.