Chest Pain During Exercise: Heart Issues and Next Steps

The CT scan results are normal, but I still experience chest pain when walking quickly or climbing stairs?

Dr.
He: Hello, on July 18, 2015, I consulted you about experiencing chest pain after brisk walking for a few minutes or climbing four to five flights of stairs.
My original question was, "Am I experiencing typical angina? Do I have myocardial ischemia?" I am revising my question slightly since you have not yet responded.
I apologize for the inconvenience.
I am a 57-year-old male, weighing approximately 66 kg and standing 166 cm tall.
I do not smoke or drink alcohol, but I have periodontal disease.
My blood pressure is relatively low, with a previous record of 93/64 mmHg and a pulse of 76 bpm.
I feel very uncomfortable or even experience pain in my chest after brisk walking for a few minutes or climbing more than five flights of stairs.
Resting alleviates the discomfort.
Sometimes, I also feel discomfort in my chest for a few seconds when standing up from a seated position.
I often feel stressed and anxious, and I only walk for exercise 2 or 3 times a week for 20 to 30 minutes each time, with no other physical activity.
Last year, I underwent a health check, and the resting electrocardiogram report indicated abnormal Q waves.
In May of this year, I visited a cardiologist, and the examination results were as follows: Cholesterol = 204 mg/dL, Triglycerides = 63 mg/dL, HDL = 66 mg/dL, LDL = 128 mg/dL.
The echocardiogram report showed: Anatomy AO root: 16, LA: 30, LVS: 8, LVEDD: 40, LVPW: 8, LVESD: 27, RA: normal, RV: normal, LVEF M-mode: 61%, Mitral Valve structure MR: mild, Tricuspid valve TR: mild.
The exercise electrocardiogram report indicated a primary diagnosis of mitral valve disorders, with secondary diagnoses of chest pain and dyspnea with respiratory abnormalities.
The reason for the examination was to deny major systemic disease, but an abnormality in the ECG was noted during the physical check-up, and valvular heart disease was mentioned in 2014.
I have knee osteoarthritis and cannot run.
The examination report indicated inadequate heart rate response with inconclusive results.
The doctor mentioned that I have mitral valve prolapse but did not provide further explanation and scheduled me for a myocardial perfusion scan.
After researching, I learned that this scan involves radiation, and I am hesitant to undergo it.
I would like to ask you: 1.
During the latter part of my exercise electrocardiogram, my chest discomfort increased, and I endured until the technician said my heart rate reached 85% of the maximum heart rate before stopping.
Can my exercise electrocardiogram report be used to determine whether I am experiencing typical angina? Based on my physical condition and examination reports, do I have myocardial ischemia? Is it possible for someone with mitral valve prolapse to experience chest pain after brisk walking for a few minutes or climbing more than five flights of stairs? 2.
Since my heart rate reached 85% of the maximum heart rate, is it still necessary to perform a myocardial perfusion scan? Both the myocardial perfusion scan and the 256-slice cardiac CT scan involve high radiation exposure and potential carcinogenic risks.
Given my situation, if further examination is needed, are there alternative methods to avoid these two types of scans? 3.
If these two types of scans cannot be avoided, which one should I undergo and why? Later, I underwent a 256-slice cardiac CT scan, and the report was as follows: Total coronary artery calcium score: 0, coronary artery lumen diameter changes: no abnormalities found, left ventricular function: no abnormalities found.
The doctor congratulated me and did not prescribe any medication.
However, I still experience chest pain after brisk walking for a few minutes or climbing four to five flights of stairs.
What other potential heart issues could I have? What further examinations should I consider? Thank you for your response.
Sincerely, Mr.
Chen.

Lao Chen, 50~59 year old female. Ask Date: 2015/11/28

Dr. He Dongjin reply Cardiology

Hello, the total coronary artery calcium score is 0.
There are no abnormal findings in the coronary artery lumen diameter changes.
Left ventricular function shows no abnormalities, including cardiac vascular and systolic function.
There should be no issues.
It is advisable to consult a pulmonologist for further examination.
Changhua Hospital cares about you.

Reply Date: 2015/11/28

More Info

Chest pain during exercise can be a concerning symptom, especially for individuals with a history of heart issues or other risk factors. Based on your detailed description, it seems you have been experiencing chest discomfort during physical activities such as brisk walking or climbing stairs. Given your age, medical history, and the results of your previous tests, it is essential to approach this situation with caution and thorough evaluation.

1. Understanding Your Symptoms: The chest pain you experience during exertion could indeed be indicative of angina, which is chest pain caused by reduced blood flow to the heart muscle. This can occur due to various reasons, including coronary artery disease or valvular heart disease, such as mitral valve prolapse, which you have been diagnosed with. The abnormal Q waves noted in your electrocardiogram (ECG) could suggest previous myocardial ischemia or other cardiac issues. However, it is also important to consider non-cardiac causes of chest pain, such as musculoskeletal issues, anxiety, or gastrointestinal problems.

2. Exercise and Heart Health: The fact that your heart rate reached 85% of the maximum during the exercise stress test without significant abnormalities in the ECG is a positive sign. However, the discomfort you feel during exertion cannot be overlooked. It is crucial to differentiate whether this pain is due to cardiac issues or other factors. The symptoms you describe, such as feeling discomfort when standing up or during physical activity, warrant further investigation.

3. Need for Further Testing: The recommendation for a myocardial perfusion scan is typically made to assess blood flow to the heart muscle under stress conditions. While you express concern about the radiation exposure from this test, it is essential to weigh the risks against the potential benefits. If your symptoms persist, this test could provide valuable information regarding your heart's health. If you are hesitant about this test, discuss alternative options with your cardiologist, such as a cardiac MRI or echocardiogram, which may provide insights without significant radiation exposure.

4. Current Findings and Next Steps: Your recent coronary CT scan showing no significant abnormalities is reassuring. However, since you continue to experience chest pain, it is essential to follow up with your healthcare provider. They may consider additional tests to evaluate your heart's function and structure, such as a repeat echocardiogram or a Holter monitor to assess for any arrhythmias during your daily activities.

5. Lifestyle Modifications: In addition to medical evaluations, consider lifestyle changes that can improve your overall heart health. Regular, moderate exercise is beneficial, but it should be tailored to your tolerance level. Incorporating stress management techniques, a heart-healthy diet, and regular follow-ups with your healthcare provider can also contribute to better heart health.

6. When to Seek Immediate Care: If you experience severe chest pain, shortness of breath, or any other alarming symptoms, seek immediate medical attention. It is better to err on the side of caution when it comes to heart-related symptoms.

In summary, while your recent tests have provided some reassurance, the persistence of your symptoms during exertion necessitates further evaluation. Engaging in an open dialogue with your cardiologist about your concerns and the best course of action is crucial. They can help you navigate the necessary tests and provide guidance on managing your symptoms effectively.

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