chest pain

It has been just over 4 months since my AF ablation. The first month was fine. After that I started getting chest pain and shortness of breath in increasing duration and severity on a daily basis. In September I went to the ER with chest pain and was admitted with high Troponin. I was only kept overnight for observation. Last week I went back to the ER again with chest pain unrelieved with nitro and was admitted again with high Troponin. All other blood work was normal. I have had about 6 or 7 echoes, 2 treadmill tests with stress echoes, a barium swallow test, an angiogram, and a repeat CT angio. During both treadmill tests, my heartrate response was abnormal and the physician called in chronotropic incompetence. Everything else has come back negative. I also just completed a 3 week monitor to check for AFib after the 3 month post op period. The good news is that everything was negative and there was no AFib on the 3 weeks monitor, just PACs. All of the big "suspects" such as MI, Pulmonary Vein Stenosis, Esophageal Fistula, have been ruled out. What is continuing to cause the chest pain? I have been out of work for over a month already and now I can't even go for a walk. The chest pain comes and goes with no precipitating factor. Thanks for all of your input.

Tim

Could be anxiety since everything else was OK.

Tim,

Here is a long shot, since you've tested clean on everything else -myofascial trigger points referring pain. In this article, Dr. Simons describes a bit of Dr. Travell's work [www.ncbi.nlm.nih.gov] "As fully described in chapters 42 and 43 of The Trigger Point Manual, 12 the pain patterns of the pectoralis major and pectoralis minor muscles mimic the pain referral patterns of cardiac ischemia. The early studies by Dr. Travell and colleagues provided convincing experimental evidence that the referred pain of cardiac ischemia and the referred pain of active myofascial MTrPs can be eliminated, or decreased remarkably, by application of vapocoolant spray to the skin over the painful area. Clinical studies showed that the 2 sources of pain are easily mistaken for each other 7,8,13,14 and that persistence of pain for some time after the ischemia of a myocardial infarction should have resolved is likely to be caused by MTrPs. 15 Symptoms of angina in the absence of demonstrable cardiac disease should be considered as likely due to MTrPs."

Previous posts of mine on trigger points:
<[www.afibbers.org];

Without talking to you, here are some potential muscles:

[www.triggerpoints.net]
[www.triggerpoints.net]
[www.triggerpoints.net]

I've solved many pain issues for family and friends with this approach. I can discuss this further if you want.

George

Mike, that has been mentioned before. I am going to set up an appt. with my internist to discuss it. Although, outside of the heart issue, I really don't feel very stressed or anxious.

George, That would be great if you could give me further information and discuss it with me.

Tim

Tim,

I'm off to a busy day, however I'll put some more info together in the next day or so.

To start:

Read the links & linked links here <[www.afibbers.org];

Looking generally in the area of the black X's, but don't limit yourself, palpate the muscles (in the pictures on the triggerpoints.net links above). In this area I'd press pretty hard - 15 to 20 pounds of pressure from your finger on the muscles in question. Use a bathroom scale to judge this. Trigger (tender) points are 4 or more times more tender than the surrounding tissue, with the same pressure.

There are a number of ways to get the trigger points to release, however here is one approach [saveyourself.ca].

George

Tim - If you haven't read the report, The Strategy, you may find some useful info there for post-ablation cellular energy care.
[www.afibbers.org]

I agree with George that some mode of physical therapy may be in order in case you have a pinched nerve affecting muscle function or some blocked energy that need to be cleared.

Jackie

Tim,

Elevated troponin levels are routinely observed after catheter ablations and are are sign of cardiac inflammation. Perhaps you have a lingering inflammation which is causing the pain. Might be a good idea to have your CRP level checked as well.

Hans

Hans,

All my bloodwork has been normal. My CrP and CK-MB levels have been checked numerous times and continue to come back normal.

If it was inflammation, would the pain then be constant vs. the intermittent pain that I am having?

Tim,

From the "Bible" Myofascial Pain and Disfunction: The Trigger Point Manual
[tinyurl.com] continue reading down to p 822.

This book is the best lay person reference and I'd suggest getting it from the library or purchasing it:
[www.triggerpointbook.com]


A key concept is that of "referred pain." That is where you feel the pain, may not be where the trigger point that is causing it is located. [www.triggerpointbook.com] An example is that the scalenes muscles, located in the neck, can cause referred pain all the way down the arm, including the thumb [www.triggerpoints.net]. This is why the referred pain maps, such as those here [www.triggerpoints.net] and in the books linked above, are so important. These are the outcome of years of clinical experience of Dr. Travell (President John Kennedy's physician when he was in office).

George

Tim - on the CRP... you should be as close to zero as possible. What was your number? Normal on the lab scale may not be low enough esp. in an ablated and recovering heart. And the CRP should be the 'cardiac' or High Sensitivity measure for CRP.

Jackie

Jackie,

My CrP was zero every time I have had blood drawn.