Nighttime Chest Pain and Discomfort in Older Adults

Dad has been frequently waking up in the middle of the night due to upper body pain?

Your father, who is 60 years old and has a history of smoking and alcohol use, has been experiencing pain in his upper arms that radiates to his chest during the night.
The pain feels like it originates from the bones and is accompanied by cold sweats, resembling a sensation of suffocation.
These symptoms typically resolve after half an hour to an hour.
During the day, he often feels fatigued and has difficulty concentrating.
After visiting the emergency department and undergoing evaluations by cardiology and pulmonology, he was informed that he does not have a myocardial infarction.
Blood tests and urinalysis returned normal results.
He has a history of open pulmonary tuberculosis and has been on medication for several months.
Additionally, he has degenerative bone issues due to years of heavy lifting at work, which has led to a history of lower back pain.
Family medicine has suggested a referral to cardiology or pulmonology for further diagnosis, but he has not experienced improvement with medications from both specialties.
Your father is suffering from these physical ailments, and you are seeking information on potential alternative causes for his symptoms and recommendations for other specialties or tests.
Given the symptoms described, it may be beneficial to consider the following possibilities:
1.
Musculoskeletal Issues: Given his history of heavy lifting and degenerative bone conditions, it may be worthwhile to consult an orthopedic specialist to evaluate for any musculoskeletal causes of his pain, such as rotator cuff injuries or cervical spine issues that could be causing referred pain to the chest.
2.
Anxiety or Panic Disorders: The sensation of suffocation and cold sweats could indicate anxiety or panic attacks, which can manifest with physical symptoms.
A consultation with a mental health professional may be helpful.
3.
Gastroesophageal Reflux Disease (GERD): Sometimes, chest pain can be related to gastrointestinal issues.
A gastroenterologist could evaluate for GERD or other digestive disorders that may cause similar symptoms.
4.
Pulmonary Issues: Although he has been treated for tuberculosis, it may be prudent to have a follow-up with a pulmonologist to rule out any residual effects or complications from the previous infection, such as pleuritis or lung scarring.
5.
Neurological Evaluation: If the pain is severe and persistent, a neurologist may be able to assess for any nerve-related issues that could be contributing to his symptoms.
It is important for your father to continue seeking medical advice and to advocate for further testing if his symptoms persist or worsen.

Wendy, 20~29 year old female. Ask Date: 2016/07/15

Dr. Zhang Ziyan reply Pulmonology

Hello, based on the symptom description, if a cardiologist has ruled out myocardial infarction, the next step may involve considering some sleep-related breathing issues (sleep medicine specialty).
Other conditions to exclude include obstructive pulmonary disease caused by smoking (pulmonology) and other musculoskeletal or neurological problems (orthopedic neurology).
For detailed evaluation, it is best to consult with the treating physician.
We hope this information is helpful.
Changhua Hospital cares about you.

Reply Date: 2016/07/15

More Info

Understanding nighttime chest pain and discomfort in older adults, especially in a 60-year-old male with a history of smoking and alcohol use, can be quite complex. Given the symptoms described—pain radiating from the arms to the chest, cold sweats, and a sensation of suffocation—it's essential to consider various potential causes beyond just cardiac issues, especially since initial evaluations have ruled out myocardial infarction.

Firstly, the symptoms could be indicative of musculoskeletal pain, particularly given your father's history of bone degeneration and heavy lifting. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or thoracic outlet syndrome could manifest as chest pain and discomfort, especially in someone with a history of physical labor. These conditions can cause referred pain that mimics cardiac symptoms, leading to confusion during diagnosis.

Another possibility is anxiety or panic attacks, which can present with chest pain, sweating, and feelings of suffocation. Given the stress of dealing with chronic health issues, it's plausible that anxiety could exacerbate physical symptoms. It would be beneficial to explore whether your father has experienced increased stress or anxiety, particularly related to his health concerns.

Additionally, considering your father's history of open pulmonary tuberculosis, it’s crucial to monitor for any potential complications related to his lung health. While he may be on medication, the effects of tuberculosis can linger, and lung-related issues could contribute to feelings of breathlessness and discomfort. A follow-up with a pulmonologist may be warranted to ensure that his lung function is adequately assessed and managed.

Moreover, given the symptoms of fatigue and lack of concentration during the day, it is essential to evaluate for sleep disorders, such as sleep apnea, which is common in older adults and can lead to significant daytime fatigue and cognitive impairment. A sleep study could provide insights into whether he is experiencing disrupted sleep patterns that could be contributing to his overall discomfort.

In terms of next steps, I recommend the following:
1. Consult a Pulmonologist: Given the history of tuberculosis and current respiratory symptoms, a thorough evaluation of lung function and imaging studies (like a chest X-ray or CT scan) may be necessary to rule out any complications.

2. Consider a Rheumatologist: If musculoskeletal pain is suspected, a rheumatologist can evaluate for conditions such as arthritis or fibromyalgia that may contribute to chronic pain.

3. Psychiatric Evaluation: If anxiety or depression is suspected, a mental health professional can provide support and treatment options that may alleviate some of the physical symptoms.

4. Sleep Study: If sleep apnea or other sleep disorders are suspected, a sleep study can help diagnose and treat these conditions, which may improve both nighttime symptoms and daytime fatigue.

5. Lifestyle Modifications: Encourage your father to adopt healthier lifestyle choices, including smoking cessation and moderation of alcohol consumption, which can significantly impact overall health and may alleviate some symptoms.

In conclusion, while cardiac issues have been ruled out, it is essential to consider a multidisciplinary approach to address the various potential causes of your father's symptoms. By consulting with specialists in pulmonology, rheumatology, and mental health, you can work towards a comprehensive treatment plan that addresses both the physical and emotional aspects of his health.

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