Chest Pain: When Walking or Climbing Stairs Becomes Difficult

The cardiac CT scan showed no issues, but I feel discomfort or even pain in my chest after brisk walking for a few minutes or climbing stairs to the fifth floor or higher?

Dr.
Zhou: Hello, I am a 57-year-old male, weighing approximately 66 kg and standing 166 cm tall.
I do not smoke or drink alcohol.
I have periodontal disease and my blood pressure is relatively low, with last year's record at 93/64 mmHg and a pulse of 76 bpm.
I experience significant discomfort and even pain in my chest after brisk walking for a few minutes or climbing more than five flights of stairs, which improves with rest.
Sometimes, I 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 2 to 3 times a week for 20 to 30 minutes each time, with no other exercise.
Last year, during a health check, my resting electrocardiogram (ECG) 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 ECG report indicated a primary diagnosis of mitral valve disorders, 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.
I was informed of valvular heart disease in 2014 and have knee osteoarthritis, which prevents me from running.
The examination report indicated inadequate heart rate response with inconclusive results.
During the second half of the exercise ECG, my chest discomfort increased, and I endured until the technician noted that my heart rate had just reached 85% of the maximum heart rate before stopping.
The doctor mentioned that I have mitral valve prolapse but did not provide further explanation.
Later, I underwent a 256-slice cardiac CT scan, and the report was as follows: Total coronary artery calcium score: 0, No abnormal findings in coronary artery lumen diameter changes, No abnormal findings in left ventricular function.
The doctor congratulated me and did not prescribe any medication, but I still experience chest pain after brisk walking for a few minutes or climbing four to five flights of stairs.
Therefore, I am seeking help from a pulmonologist.
What could be the potential issues with my chest? What further examinations should I undergo? Thank you for your response.

Lao Chen, 50~59 year old female. Ask Date: 2015/12/19

Dr. Zhou Ziguang reply Pulmonology

Hello, patients with mitral valve prolapse may sometimes experience chest discomfort.
If a cardiologist has ruled out other issues, a chest X-ray can be performed to examine the lungs (by a pulmonologist), and an endoscopy can be done to assess for gastrointestinal disorders.
It is advisable to follow up with a cardiologist to confirm the heart condition.
Wishing you good health, Dr.
Chou Tzu-Kuang.

Reply Date: 2015/12/19

More Info

Chest pain during physical activities such as walking or climbing stairs can be concerning, especially given your medical history and the results of your previous examinations. Based on the information you've provided, there are several potential causes for your symptoms, and it's important to approach this systematically.

Possible Causes of Chest Pain
1. Cardiac Issues: Given your history of mitral valve disorders and the abnormal Q waves noted in your ECG, it's essential to consider that your chest pain could be related to cardiac conditions. Mitral valve prolapse can sometimes lead to symptoms like chest pain, especially during exertion. Although your coronary artery calcium score was zero, indicating no significant coronary artery disease, the presence of abnormal ECG findings suggests that further cardiac evaluation may still be warranted.

2. Musculoskeletal Pain: Sometimes, chest pain can arise from musculoskeletal issues, particularly if you have poor posture or tension in the chest and shoulder muscles. This could be exacerbated by anxiety or stress, which you mentioned you experience frequently.
3. Pulmonary Issues: Since you are experiencing discomfort when climbing stairs, it might also be related to respiratory issues. Conditions such as asthma or chronic obstructive pulmonary disease (COPD) can cause chest discomfort during exertion.
4. Gastroesophageal Reflux Disease (GERD): Another common cause of chest pain, especially when bending or lying down, is GERD. If you experience heartburn or acid reflux, this could be a contributing factor.

Recommended Next Steps
1. Cardiology Follow-Up: Since you have a history of heart issues, it would be prudent to follow up with a cardiologist. They may recommend additional tests such as a stress echocardiogram or a Holter monitor to assess your heart's function during physical activity over a longer period.

2. Pulmonary Function Tests: Given your symptoms during exertion, it might be beneficial to evaluate your lung function. A pulmonary function test can help rule out any underlying respiratory conditions.

3. Musculoskeletal Evaluation: If cardiac and pulmonary causes are ruled out, consider consulting with a physical therapist or a musculoskeletal specialist. They can assess your posture, muscle tension, and any potential musculoskeletal causes of your chest pain.

4. Lifestyle Modifications: Incorporating regular, moderate exercise can improve cardiovascular health and reduce anxiety. However, it's crucial to start slowly and gradually increase your activity level. Techniques such as deep breathing exercises or yoga may also help manage stress and tension.

5. Dietary Considerations: Since you have elevated cholesterol levels, consider discussing dietary changes with a nutritionist. A heart-healthy diet can help manage cholesterol levels and overall cardiovascular health.

Conclusion
Your symptoms warrant a thorough evaluation to rule out any serious underlying conditions. While your previous tests have shown no significant coronary artery disease, the presence of mitral valve prolapse and abnormal ECG findings suggests that further cardiac evaluation is necessary. Additionally, consider pulmonary and musculoskeletal assessments to ensure a comprehensive approach to your symptoms. Remember to communicate openly with your healthcare providers about your symptoms and concerns, as this will help guide appropriate testing and treatment.

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