What could be the cause of chest pain during deep breathing?

Question

Hi doctor,

I am a 68-year-old male. My height is 5.4 feet, and I weigh 142 pounds. I stopped smoking at the age of 38. I drink an average of half a bottle of beer a day at most. I do prepare my own food, which is mostly organic.

I eat meat, eggs, little dairy, vegetables, a fair amount of raw food, seeds, nuts, fruit, practically no sugar, and very little flour. I am passing regular stools twice or thrice a day. I am doing about 10,000 to 15,000 steps per day.

Six days ago, I got stabbing chest pain on the left side just under the nipple. It was internal and not external. It has happened occasionally all my life, but very briefly and not often. This has persisted for six days. It seems to kick in with exertion and goes away entirely at night.

I am mostly free of it all day today, but a very little exertion brought it back, even though I walked a couple of miles with no problem. It comes and goes. It does not really hurt unless I breathe deeply. I can cough and sneeze without making it worse. And, there is no external sensitivity.

I went to my dentist this week, and my BP was 137/82 mmHg, and my pulse was 79 beats per minute. That was fairly consistent with what I was getting at several weeks ago. My highest BP was about 150/89 mmHg, and my pulse was 89 bpm. I am not on any regular medication.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

As your chest pain and heaviness are related to exertion (walking), the possibility that it is of cardiac origin cannot be neglected. A very important feature of stable angina is angina on exertion. The stabbing pain and dull nature, which can better be termed as chest heaviness, start on exertion like walking or climbing upstairs and go away on taking rest.

Your blood pressure is mostly in a prehypertensive state, but your maximum systolic (upper) BP is grade 1 systolic hypertension. Your body mass index is high. Also, you were a smoker till the age of 38. Smoking is the sole risk factor for all sorts of cardiac ailments, especially coronary artery disease.

As you have never checked your lipid profile, we cannot comment on your cholesterol and triglyceride levels. Your age is in the late 60s, and the natural presentation of coronary artery disease starts after the age of 55 in males.

In short, your case can be summed up as risk-based on the facts of increased BMI, ex-smoker, non-vegetarian, and mild hypertension. I would consider it angina on exertion and associated with on-and-off dyspnea (breathing problem) on exertion.

As you have not mentioned any history of gastritis, heartburn, peptic ulcer, anxiety, lack of sleep, disturbed sleep cycle, or muscular sprain (as all of them can mimic the cardiac pain), my suggestion is to get an ECG, 2D echo, and treadmill test done.

A 2D echocardiogram will reveal any motion abnormality of the walls of the heart. If any part of the heart receives less blood supply, then it will get injured and there will be some motion abnormality in that part. During the treadmill test, continuous ECG will be taken as the patient walks on a treadmill.

As your symptoms are present mostly during walking, any ischemia to heart muscles during this test will be reflected in the ECG. Echo and TMT are more than 80 percent sensitive to any cardiac disease.

Also, get a complete lipid profile to know the status of your cholesterol and triglycerides. Stop taking the yolk (yellow part) of eggs and red meat in your diet until these tests are done. Do strenuous exercise for 45 minutes a day for at least six days a week. Try to replace beer with red wine, which is cardioprotective in nature. Use three different types of oil in your food, alternatively, every month.

As of now, till your tests are done, I would suggest you keep a tablet of Sorbitrate 5 mg (Isosorbide dinitrate) with you and take it sublingually the next time when the pain starts. If pain settles down in 10 minutes, it is very likely to be of cardiac origin. Consult your specialist doctor and take the above medicine.

Once it gets confirmed as cardiac origin, then discuss it with your doctor and take the medicines mentioned below with consent. Take the following medicines:

1. Tablet Ecosprin 75 mg (Aspirin) once at night.

2. Tablet Atorvastatin 5 mg once at night.

3. Tablet Metolar-XR 12.5 mg (Metoprolol) twice daily.

4. Take tablet Esomeprazole 40 mg before breakfast in the morning if there is a gastritis or heartburn problem.

Your target BP should be less than 130/80 mmHg.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.