Chest pain and breathlessness for a year. All tests clear. What do I ask my GP for next?

[squashyhat]

I have posted about this before (under a previous username) but trying again in case any newbies or specialists can help. As it says above I have been getting chest pain and breathlessness for over a year – always on exertion but sometimes just spontaneous. I’m 56 and well past the menopause. There is very little family history of heart disease. I have been seen by both cardiac and respiratory specialists and had a chest x-ray, pulmonary scan, ECGs, echocardiogram and angiogram. All have come back clear. No blood pressure issues. Angina meds don’t help. I took early retirement 6 weeks ago so all the stress of working and commuting has gone - but I can't begin to enjoy my new life.

I’m planning to go back to my GP to review the latest consultants’ letter. But what then? Do I ask for a second opinion? Are there more tests that can be done? Nobody has assessed me after exercise when the symptoms are bad (no treadmill test or 24 hour blood pressure or heart rate monitoring) – should I ask for these?

People seem to think I should just be grateful nothing serious has been found. But this is really limiting my life – I can’t walk more than 50 yards without the pain coming on and I used to be able to do 3-4 miles quite easily. I’m becoming more and more sedentary which isn’t helping either my weight, sleep or mental health.

If anyone has any experience or ideas I would love to hear them – I’m getting a bit desperate

Have you had your haemoglobin leaves checked? Anaemia can cause breathlessness and chest pains.

Levels not leaves

Hi Pointless. I also have rheumatoid arthritis (this and the meds I take for it have also been ruled out as causes) so get regular blood tests - but I will see if my haemoglobin is being checked. Thanks

Have you had your iron levels checked?

Sorry, pp sort of already asked that!

Ferritin, folate, Hb, vitamin D, B12 should all be checked and optimised.

When you had your angiogram was the possibility of Prinzmetal's angina discussed? ie angina symptoms caused by spontaneous arterial spasm.

I'm surprised you haven't had a treadmill stress test, it would be good to have this so they can see any ECG changes whilst you're symptomatic, and if so, if they resolve with GTN spray.

What investigations have you had to explore possible RA issues? Have you had lung imaging to check for fibrosis, spirometry, left heart catheter study to check for pulmonary hypertension?

It would surprise me if the OP has undetected anaemia as she will be having FBC measured routinely.

I assume by cardiac specialist you mean you have has the works at a cath lab?

have you been investigated for reflux?
wheres the pain?

Do you take statins?

Another vote for reflux. Had a close friend with this, turned out to be problem in her oesophagus leaking acid upwards which she was breathing in. So chest pain + breathing problems. Took about 18 months to diagnose in the end.

I was just coming on to say basically what PurplewithRed did. Get an endoscopy. I have breathing problems when I lay down if reflux is bad (I don't get any burning sensation which you expect with acid) and I do get stabbing chest pain too.

I would suggest a 24 heart monitor would be useful. An ecg only shows what is happening over those 10 seconds when you are unsymptomatic so it would be helpful to see what is happening when you are getting your symptoms. Also excersise stress test, the symptoms you describe are what the majority of these tests are carried out for. Some heart arrhythmias are paroxysmal so you basically need to have some monitoring while you are experiencing your symptoms to see what, if any, changes are occurring.

Could any of it be anxiety related?

Don't mean to drip feed but it's such a long story. I have been given GTN spray but it has no effect. Spasm has been mentioned and I tried amlodipine, also with no effect (although a low dose - I could ask to try a higher one). The pain is usually in the centre of my chest - like someone is standing on me or pressing down hard. Sometimes it varies to the right and left

Interesting about the possibility of reflux - I am prone to mild heartburn and have been experiencing more recently although the pain feels different. I will ask about an endoscopy (not looking forward to that - the angiogram was bad enough).

Badders - no, I don't take statins. Is that good or bad? Highinthesky - not sure what you mean. I was referred to the cardiac clinic at my local hospital where the tests were done.

Vivienne - anxiety is certainly not helping! I don't think it's the cause but after a year it's difficult not to be depressed about it despite there being no indications of serious illness. I do have a bit of form for fearing the worst of any symptoms.

Thanks for all your help so far.

Statins can cause chest pain

Reflux can be very painful as can gastritis - are you on lots of painkillers? I got gastritis after taking painkillers after having my gallbladder out - it was agonising