Recurrent Chest pain

Question:

Hello Dr T

My name is Ray and I live in the UK. I suffered 2 heart attacks last March within about 5 days of each other (the first one wasn’t picked up on by the Paramedics). I had a stent in my right coronary artery.

I am 78.5 KG and 5’10 ½” tall (Ed: BMI=24.78 – normal weight)

My current medications are:

Asprin 75 mg
Clipidogrel Teva 75 mg
Bisoprolol Fumarate 1.25 mg
Isosorbide mononitrate 30 mg
Astorvastatin 80 mg

About 3 – 4 weeks ago I started getting pains in my chest which didn’t seem similar to the original pain I had when having my heart attack which was at the top of my left shoulder going down part of back and the top of my arm. This “new” pain is very often just slightly to my right of centre of the rib cage. Sometimes it moves to different parts: across the lower front of my ribcage and also more over to my middle right. However, when it is really painful it is usually in the first area – slightly to my right of centre of the rib cage. It also feels as those it’s just below the skin i.e. in the rib / sternum and, therefore, not deeper within the chest.

I went and saw my GP and the first one said she didn’t know what it was and said to see how it goes. The pain persisted, albeit “on and off, sometimes intense, sometimes less so. Sometimes it isn’t there for maybe a day, but is often there even if it’s somewhat milder. I returned to the GPs’ surgery just over a week later. A different GP saw me and indicated that this type of pain can be difficult to diagnose. She went down a route of making sure everything was OK in other areas by a process of elimination. So I had an X-Ray and 2 blood tests. I can only assume these haven’t shown anything as I haven’t heard anything, however I am due to revisit the surgery again this Thursday. The 2nd GP “dropped out” briefly that it might be a reaction to the statin (Astorvastatin) I’m on.

I read the article on this website about Costochondritis and there does appear to be some similarities although there are no swellings.

Have you any observations on this, please? It just seems strange that this has suddenly started to happen, although I could accept that it might be due to reaction to one of the medications.

P.S. I stumbled across your website when “Googling”. I saw you video about how long a stent lasts and found it extremely informative. Thank you.

Answer

Hi Ray,

I couldn’t disagree more with the advice you have gotten thus far! There is no blood test to diagnose another coronary blockage unless it is associated with damage to your heart muscle.
For starters, you need to have a cardiac stress test to exclude coronary artery disease – not to be delayed, because your pain is angina unless proven otherwise, not the other way around!

Exercise Stress Test

Other tests may need to follow.
Hope this helps,
Dr T