Re: Pounding Chest - Help Please.

From: Andrew B. Chung, MD/PhD (andrew_at_heartmdphd.com)
Date: 02/08/05 

Date: Tue, 08 Feb 2005 04:16:05 -0500

leraconteur2002@yahoo.com wrote:
>
> I am a 43 year old man, 6'3", 220lbs, healthy, run 10k's, hike at
> extreme altitude, hike mountains for exercise.

You might still be 45 pounds heavier than "ideal" despite the exercise.

> No disease at all.

Not according to what you write below.
 
> I had an LAD eluting stent inserted in October after an episode of
> Cardiac symptoms and a 180 pulse and loss of consciousness one morning.
> I had 50% blockage of my LAD w/dye test, 85% after IVUS (or so my
> Cardiologist has said...).
>
> I have become a vegan, eat no cholesterol, and low fat. No meat, eggs,
> dairy, butter, trans fat, cheese, etc...
>
> My cardiologist prescribed Lipitor 80mg, Toprol XL 50mg and Plavix 75
> mg. I began to have pain in my left arm within a week, and by week 8 I
> could not put on a shirt without blinding pain in my left bicep. I
> have also lost motion in my left arm; I cannot lay it flat against my
> bed when I lay down. It sticks up off the bed 35 degrees. To put it
> down flat causes excruciating pain. I mentioned this to my MD, he took
> me off the statin 3 weeks ago. The pain is slightly less, but I still
> don't have my range of motion back in my left arm.
>
> Putting on a shirt, jacket or suit is painful. Putting on a backpack
> also hurts.
>
> I still have pounding episodes in my chest. I went back to the
> hospital, and 2nd angiogram Oct 19 showed no cardiac blockage.

... not in the larger coronary arteries but there may still be some in
the smaller branch arteries that may be too small to be adequately
visualized.
 
> But 3 times a week I lose sleep with a pounding chest. I have no idea
> what is causing this. I consider myself a very healthy man, youthful
> in outlook. I mean, I climbed up Mt. St. Helens last year, and up to
> 10,800 ft to Camp Muir on Rainier the year before, so this just doesn't
> make any sense that I should have chest discomfort all of the time.
>
> I wake up, chest pounding, for no reason. No amount of calming music,
> meditation, relaxation or medication will calm it down. I have no
> control over this at all.
>
> I cannot eat more than 500 calories at one meal or I get chest pains
> and palpitations. Anything with any fat or meat causes discomfort.
> What is going on here?

Might be endothelial dysfunction leading to coronary spasm which is not
uncommon when there is coronary disease.
 
> I am tired of living in fear with this sensation. Prior to Oct I had
> never had this symptom, and now I live with it everyday. I lose sleep
> from it, I wake up afraid from it. I find myself afraid to go to
> sleep.
>
> Any with experience dealing with this, please share.

You have it. You should inform your doctor(s) about your continued
symptoms. If you have metabolic syndrome (MetS), this should be
aggressively addressed with permanent weight loss otherwise the
endothelial dysfunction is unlikely to improve.
 
> Thanks,
> Lee.

You are welcome.
 
At His service,

Andrew 

--
Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
**
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