Constant Chest/neck/back pressure/angina

Posted by bozoian @bozoian, Dec 22, 2018

I am a 37yo male who has been experiencing persistent chest pain and pressure for the past 4 months. Here is my personal and medical background: 37 years old, 5’11” 195lbs. I’m very active. Played college and Pro hockey, and still play 3 times per week. 2 years ago, after some really bad hand and feet pain, my rheumatologist said I have an autoimmune disease because of a HLA B27 chromosomal mutation which produces a very arthritic response to bacteria. Since then I have been on a Paleo diet (meat, fish, veggies, fruits, nuts, eggs, and butter only) and that seemed to have rectified everything. Randomly I would fall off the “diet” to enjoy a few of my favorite foods or a few beers, but would get right back to healthy eating. Additionally, I’ve have heartburn for 20 years which I take a daily omezaprome for. Also, I have been smoking marijuana daily as an alleviation from the joint pain as well as past injuries/surgeries from my profession. 5 months ago, I began noticing shortness of breath (not being able to take a deep satisfying breath) that coincided with one of the “off the diet” spans. It began very mild and got worse for 3 weeks. It really started worrying me, and because of it, I developed anxiety that peaked with a full blown panic attack that I thought was a heart attack. In the ER, I had a D-dime test for a PE, chest X-ray, CT with contrast, all which came back fine. I also did a lung test, stress echo, and wore a monitor for 2 weeks. All test showed no issues. My general practitioner attributed it to anxiety, and gave me Xanax which I have used only when I get really tachycardic. My feeling is that I developed the anxiety BECAUSE of the symptoms, and not that the anxiety CAUSED the symptoms. 8 weeks ago i completely stopped using marijuana and I took a round of prednisone, thinking my autoimmune disease caused costochondritis. It helped my breathing to the point where now, 80% of my breaths are “satisfying”. But I’m still experiencing chest tightness (mostly left side, sometimes right side too), pain between my shoulder blades, left side neck pain, and increased head pressure constantly on a daily basis. When I’m working out or skating, I don’t notice my symptoms. When I’m sitting around, driving, or being inactive, it really bothers me and can never get comfortable. Hopefully I didn’t make this too long of a post, but really hope someone might have some insight or has been able to figure out their own similar issues

@bozoian You dont mention if you,ve had an EKG or treadmill test ,heart catheterization .Have you had your heart checked out since you have symptoms of a heart problem .I say this as my symptoms where the same I ended up with a by pass .

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@bozoian Certainly you should explore if any of your symptoms are heart related with a workup with a heart specialist and not just emergency room testing. Beyond that, my question is do your lungs work properly? Since you were able to improve your lung function with stopping smoking and prednisone, is there a reaction to smoke particulate adding to the problem? Smoke might be increasing phlegm production in your lungs and if you don't clear that well, you can feel chest discomfort from that. My next question would be, why your lungs are not clearing the phlegm. Do you have asthma or allergies? Have you had an injury that might be causing the pain between your shoulder blades, the left sided neck pain, and the head pressure? Also this is different for you when you are driving or sitting as opposed to skating, so there is a postural difference in your symptoms.

I have some similar experience with symptoms that may help, but only a specialist can confirm your diagnosis. This should give you a direction to take to your doctors in figuring out what is going on. I do have asthma and allergies. I also have thoracic outlet syndrome, and yes, that causes more symptoms when driving because of the raised arm position, and usually less than optimal body mechanics in a car seat that isn't made for good posture. My TOS is worse on the left side and causes left sided neck tightness than is worse than the right side. The tightness pulls from my neck into my chest and sometimes is enough to twist my ribs or cause a click in my sternum when I lean forward. It causes tightness through the chest wall so the left side doesn't expand as well as the right. It causes my breathing to be incorrect when I use my neck and chest muscles to do the work of breathing instead of the diaphragm, and all of that increases my heart rate if i"m doing it wrong. If it's bad enough, it does cause anxiety when I'm struggling for air.

For me allergies have complicated this by adding phlegm to a mechanical problem of breathing wrong, and having asthma that causes my airways to swell essentially becoming smaller and making it more difficult to breathe or clear the phlegm. I had a lot of episodes of phlegm I wasn't clearing that exhausted me and would turn into chest infections in a repeating pattern. I've been to the emergency room with this and a resting heart rate over a hundred, but anxiety wasn't the cause, it was the effect of what the other issues were doing. I had been treating my allergies and found out I am allergic to my cats, and I get allergy shots for that. Apparently, cat dander is very sticky and when inhaled, it makes my phlegm sticky making this hard to clear in addition to the physical problem. I bought some high quality surgical masks and wear them when I sleep when my lungs are most vulnerable and that alone made a huge improvement in getting a "satisfying breath of air". The masks are 3M Earloop Procedure Face Masks, Blue, 50/bx 3M Model: 1820. The masks have >99% Bacterial Filtration Efficiency (BFE){1} and >95% 0.1 micron filtration efficiency which is comparable to HEPA filters.

I am a Mayo surgical patient for a spine problem in my neck 2 years ago, so I was dealing with all of these issues together. I recently went back to Mayo and consulted a Pulmonologist and have a new preventative inhaler that is helping my asthma. This makes my breathing slower and more relaxed. Treatment for TOS is physical therapy and posture is important for recovery. The TOS is enough to cause neck muscle spasms that cause headaches.

Acid reflux can cause asthma, and of course chest pain. You mentioned some skating injuries and hand pain, and it is possible they could be related to something like TOS. TOS causes compression of nerves and muscles to the arms, and my hands used to turn blue/purple and get cold because of it. My physical therapist uses regular PT in addition to myofascial release to help the TOS which is like wearing a straight jacket. It's easy to attribute those symptoms to something else. Many doctors don't understand TOS because it doesn't get covered well in medical schools. Mayo is a good place to go for that for a proper diagnosis. There is surgery for TOS and different variations, but often physical therapy is the best treatment. Injuries and surgeries will cause fascial adhesions and can limit normal movement and body mechanics. That is where a physical therapist who understands MFR work can help. If you have been falling on the ice a lot, that might be equivalent to a whiplash injury which can cause cause TOS or a spine problem. If you start looking at the physical mechanics of your body, you can find problems where limitations are stressing nerves or muscles. I think you are on the right track with your diet because you know that you cut inflammation and feel better. I too have dietary restrictions with multiple food allergies that used to cause joint pain for me too, but it doesn't happen anymore. The chest pain, shoulder blade pain, chest tightness and discomfort, and breathing problems can all be related to TOS if that is what you have. Keep track of your normal resting rate of breaths per minute, and if that increases, try to figure what is causing that.

Surgery creates fascial scar tissue which tightens everything and can increase pain. MFR work with a therapist trained in the John Barnes methods can break up that scar tissue and get things functioning more normally and reduce pain. See myofascialrelease.com for info. You can also call Therapy on the Rocks in Sedona , and ask for names of PTs who have trained there if you don't find any near you from the website. Treating the scar tissue might make a difference. FYI, a lot of doctors don't understand or accept the MFR therapy, but it works for me.

Here are some information links that might help-

Thoracic Outlet Syndrome https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
Info on myofacial release http://www.myofascialrelease.com
Shoulder pain causes https://www.mayoclinic.org/symptoms/shoulder-pain/basics/causes/sym-20050696
Headaches https://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800
https://www.mayoclinic.org/symptoms/arm-pain/basics/causes/sym-20050870
https://www.mayoclinic.org/symptoms/numbness-in-hands/basics/causes/sym-20050842
Here is a facebook post about Thoracic Outlet Syndrome from "Training and Rehabilitatioln" explaining a case

Posted by Training and rehabilitation on Saturday, December 15, 2018

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@lioness

@bozoian You dont mention if you,ve had an EKG or treadmill test ,heart catheterization .Have you had your heart checked out since you have symptoms of a heart problem .I say this as my symptoms where the same I ended up with a by pass .

Jump to this post

yes i had an Normal ECG, wore a Holter Monitor for 2 weeks, did the treadmill stress test with ecocardiogram, and all came back with no issues. i havent had a heart cath done however, and was hoping to avoid it, being only 37 years old and in good shape and athletic condition

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@bozoian

yes i had an Normal ECG, wore a Holter Monitor for 2 weeks, did the treadmill stress test with ecocardiogram, and all came back with no issues. i havent had a heart cath done however, and was hoping to avoid it, being only 37 years old and in good shape and athletic condition

Jump to this post

@bozoian I was a very active person but in 1996 I had a triple by pass due to clogged arteries I was sweating and shortness of breath I couldn't do steps without stopping to catch my breath I suggest you talk to your cardiologist if your still concerned.

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