I have been advised following treadmill, echocardiograms , CT scan and MRI stress test that my occasional ( at least monthly chest discomfort) is not a blood supply issue as only mild plaque build up ( I am 62 male). They did find an ascending aortic aneurysm that I am seeing a heart surgeon about and for which I am having another CT scan and angiogram shortly. Anyway the discomfort I guess is like ( this is the only way I can describe it) like short ripple ( 1-3 seconds) like an electrical pulse. More often upper left chest but also upper right. I will get this then on or off for a couple of hours. Sometimes accompanied or preceded by what I presume is more classic hesrtburn. I have had endoscopy that revealed oesophagetis but not significant. I have tried omeprazole, estoprozal and now lanzoprisol. Anyone else have any similar issues with what is presumed non cardiac pain. By the way I am advised that unless aortic aneurysm is growing quickly ( no evidence to date it is) that it should be asymptomatic.
non cardiac chest pain?: I have been... - Atrial Fibrillati...
non cardiac chest pain?
I should have said no accompanying symptoms like jaw , arm or other pain, no feeling unwell , shortness of breath or sweating and isn’t affected by exertion. I had the MRI to rule out angina or micro vascular disease
Hello Rob, it sounds like what I have been suffering from for 50+ years now and that is "costochondritis". Feels like a heart attack and makes you feel nauseous, but it is the inflammation of the Cartlidge of your sternum and rib cage, been to the ER many, many times for it and told it is not life threatening at all but it can mimic the feeling of a heart attack. It flares up at various times, no warning and that is what was unnerving to me, but Drs. told me if you can press on the area and it hurts or is sore to the touch it is not a heart attack. I find that tylenol can relieve a lot of the pain for me. You might want to mention this to your Dr. or google "costochondritis". Hope this helps.
how would you describe the pain or discomfort?
I looked it up but my pain is not really affected by breathing or lying down and tends to only last at most hours or a day and very specific and episodic eg like pulses of pain for 3 - 4 seconds . And I don’t feel these sensations at the centre of the chest . Not saying it couldn’t be but not sure it’s this.
Hello, the pains could be very sharp or acute shooting pain which I just had this morning and it can last for a few minutes or a couple of days and very painful and dis-comforting. I forgot to mention that heat usually takes the pain away also. It doesn't hurt all the time either while breathing, just sometimes but not too bad, the same lying down. That's why I have had many trips to the ER to reassure me I'm not having a heart attack. It can be very painful around the ribcage lower and upper sternum and makes eating hard because the pressure of your stomach pressing against the rib cage causes the pain like nauseousness. I certainly hope and pray that this is all it is rather than heart related as the numerous tests I have had like you shows everything was fine, it's just un-nerving at times. Good Luck.
I would say mine isn’t as bad as this in most of the symptoms you describe like feeling sick and lasting days . Trust things stabilise for you and arent heart related but if you have been checked out you can’t do much more
Thank You, nope, just ride them out.
and been to a and e three times !
Rob,
I would suggest you are probably safe waiting to discuss this with the surgeon who will consider an elective repair to your ascending (though nothing is ever for certain, of course).
From our AD Buddies group, I think there is some small amount of evidence that not every aortic problem is symptom-free.
I had strange upper left chest pains some years before I dissected. I doubt very much anything would have been found, had I sought medical advice, (slow aortic growth rate, moderate diameter) however, during my AD surgery my surgeon found a PAU (Penetrating Atherosclerotic Ulcer), right where I had felt the pain years before, and an IMH, (Intramural Heamatoma) nearby. I subsequently found that though my general cholesterol figures were barely on the margin of needing treatment, it turned out I had a very high marker, Lp(a) (lipoprotein A). My figures are around 200 where above 50 confers a risk, and normal is more like below 30. Lp(a) creates plaques independently of the other cholesterol figures. There is evidence that high Lp(a) is associated with aortic problems, and could well have been a reason for my PAU. PAUs can stay there for years before causing further problems.
Definitely discuss these pains with the surgeon and request that the CT is examined for PAU and IMH in case one of these could be the cause of the pain, and ask for an Lp(a) test.
Best wishes
great advice and you had mentioned the PAU in my recent post which I intend to follow up on. I presume LP (a) isn’t part of normal blood test results? Or might they be part of it and I need to ask. I have quite a few blood tests due to me taking anti coagulants.
Lp(a) would, I guess, only be requested by a lipids specialist. I only ever had one, when trying to get my post-AD cholesterol under control, from a very enlightened Consultant.
Re the pains and aortic problems 'always' being asymptomatic, I am seriously unconvinced that small tears (e.g. in the media) might not cause pain. They could easily be limited and transient (even a full AD can cause transient pain), and would need an investigative and aortic-knowledgable mind, and a timely ECG-gated CT to consider this.
ecg gated CT? Can you explain? I have a CT referal coming up in next month or two. Sorry if dull question but would a CT scan specifically requested re the ascending aorta and arch pick up the tears you mention? And also the PAU. Of course now you have told me I will be specifically asking the radiologist to look at this or does the radiologist not diagnose but does the CT and a cardiologist interprets?
Not a problem. ECG-gated means they fit ecg electrodes to your chest and fire the CT xrays in bursts at a constant point during the cardiac beating cycle. This "freezes" the not inconsiderable movement of the heart and aorta, and the pulsation of the aorta (which expands and contracts every beat). A non-gated CT can miss small aspects or issues, and can even make a non-dissected aorta look as if there is a dissection. CTs will pick up a PAU (or IMH) but I suspect it's difficult, especially if small, and the radiologist would probably need to be looking for the possibility. My reference to small tears is purely my speculation, but I would believe it if someone said it could happen.
A radiographer will conduct a CT according to the instructions given by a Consultant (cardiologist or surgeon). A Radiologist (consultant or registrar level) will be the first stage of interpretation; they know how to read and review scans, including the full range of possible anomalies. A cardiologist or surgeon will receive the Radiologist's report but may or may not also look at the CT themselves, depending on what they are looking for. You would only discuss the medical outcomes with your consultant. Radiographers will do the CT but aren't allowed to diagnose to the patient. A radiologist is not usually patient-facing.
As ever Cliff - very helpful. so I also had a mri after my CT scan and this was a much longer and I guess ( in one sense) more detailed assessment . Or if not more detailed a different modality if I am using the correct term! As I know you are almost an expert on AD it is interesting that CT ascending aorta was 5.1, MRI two months later 4..9, echo 4 months later than mri 4.9; most recent echo 5.2 which with BAV helped me to argue ( based on European guidelines) to be a ‘consideration for surgery’. BYW my aortic root is dilated, ascending aorta aneurystic and proximal arch dilated. My mid and distal arch ok. In these circumstances is it Cliff your understanding that they do a hemi arch or anything else ( frozen elephant trunk seems over the top but what do I know) OR as the arch brings in the three main arteries upwards so to speak so they try and avoid that ( due to additional risks and complications) if they can. I appreciate this last question is off thread but I know how knowledgeable you are.
MRI avoids xrays, though the risk of that from CT has much reduced over time as techniques improved. Should provide equivalent results to a CT, overall, but I don't know if an MRI perhaps can be more detailed - certainly they use them for things like nerve studies.
Yes, you'd probably get at least a hemi-arch, but they can also do arch without an FET. FET is really for when the aorta is poor much after the left subclavian artery comes off but the descending is ok. There's also the question of potential future intervention, and if likely they'd hopefully do more rather than less, at the outset. A key thing is which centre does you, and the level of their expertise. With any arch involvement at all, I'd be wanting to go to the top tier such as Liverpool, Barts, Papworth.
With those diameters, I'd be wearing a med alert bracelet, since AD is not the easiest diagnosis ( - I wish I had done!) Good that you've dug out the European guidelines. The American ones have been more recenty updated.
Best wishes on your journey!
thanks again ( as always ) for taking the trouble to reply. Morriston Swansea is where it’s most likely I will be done if it gets to an operation ( which is what I am hoping for ) but obviously depends on operative risk and as you have indicated ( and what I knew from reading and what surgeon said at initial consultation) risks go up a level with arch repair! Actually do you know normal additional risk stratification with or without a hemi or with or without FET compared against just root and ascending aorta. 62/3 year old with no co morbidities although one bout of Afib last year with converted normally ( albeit after 12 days but HR 70s from normal 50s). BP mean is 120/82 with meds intervention . Many thanks
Not being a surgeon, but my guess is that the jump in risk comes with having to deal with the arch/head vessels, due to the need to protect the brain. The further jump in risk for an FET is probably not large. It's the head vessels that mark the change from an operation that can be done at many centres to those where you are best going to a big centre. Research has established that a key factor is the number done per year by any particular surgeon, needs to be at least 4 for simple repairs, preferably much higher.
Protection of the brain has progressed over the year from the simple deep hypothermia and a total circulation stop, then cutting out the entire affected aorta. This gives the surgeon only 45 minutes to do a lot of vital sewing. Nowadays, the brain is increasingly protected by using a side flow of blood to the head, forwards is best rather than in reverse, so "antegrade cerebral perfusion". Techniques are also evolving where circulation is not stopped more than a few minutess, or even at all. I had a further development of what's called a "branch-first" operation, where the surgeon tackles the head vessels first and has much more time to do the main part of the aorta (and FET).
Good BP!
yes I am sure that’s the main principles. I will be chatting this through with surgeon indeed!
Sent a pm
how do I see this?
Hi Cliff - I dont know how to read a pm and where to look for it?
For me on a browser you click the Chat paper dart icon at the top of the page
got to it somehow (!) and sent a reply. Many thanks and if you are able to get back to me that would be great. Thanks for your support to members on here suffering with TAA
’do they Try to avoid’ not ‘so they ‘
I would check out your digestive system. Sounds like it might be a hiatus hernia given the heartburn link. Have a look at the symptoms described in the British Hernia Association website. You might find their description of symptoms revealing.
thanks for reply. I have had an endoscopy but nothing showed
sing well - the related issue is then do people on here with either digestive or oesophageal issues ever get discomfort pains or pulses NOT behind their sternum but to mainly left upper chest but at least on one occasion right hand side?
Neither Lansoprazole or Omeprazole worked for me - now on Rabeprazole which works fine
how would you have described your symptoms as I currently have no idea whether oesophageal issues produce the periods of pains I have described! Rabeprazole is perhaps only one I haven’t tried!
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