Chest pain needs more diagnosis

Q. I'm a 46-year-old female in generally good health. I don't smoke, drink rarely, eat right and exercise. I am a slim 109 pounds and 5 feet, 1 inch. My blood pressure and cholesterol are low. In the past 10 years, I've been sick only twice.

Recently, I decided to increase the intensity of my exercise routine by walking on a treadmill 30 minutes each day at a rapid clip. After four days, I began to have chest pains. A couple of times, the pain woke me from a deep sleep. They are sharp, stabbing and on the left side of my chest. They intensify when I breathe deeply. Shallow breathing prevents the pain. I should mention the pains are not new to me. I have felt them before over the years.

I am certain there is a link between this increased cardio-exercise plan and the pain because when I quit the treadmill, the pain also quit.

I was checked out by a cardiologist about a year ago because of skipped beats and a racing pulse. I had an EKG and ultrasound, and was told my heart is fine. My heart is not enlarged based on an X-ray. A recent chest film showed no signs of pleurisy.

I do take Xanax for anxiety, when needed, Zoloft for depression, Astelin and Nasonex nasal sprays for allergies and Restasis for dry eyes. I'm on a birth-control pill and suffer occasional migraine headaches, for which I take butalbital with codeine.

I have another appointment with my cardiologist, and this time they will do a treadmill stress test. My cardiologist and regular doctor don't seem concerned, but until I know this is benign pain, I am reluctant to exercise.

A. Any stress-induced pain has an underlying cause that should be investigated.

Chest pain can be the result of many things, including pleurisy (inflammation of the lining of the lungs) and heart conditions. The ribs, esophagus, muscles, nerves and tendons within the chest can also cause pain. Asthma, inflammation of a nerve or tendon, muscle sprain or strain, pneumonia, blood clots and acid reflux may be the root of the problem.

I urge you to undergo the treadmill stress test. Even if your heart isn't to blame, the physicians, nurses or other medical staff performing the test will be able to witness the "attack." Once a medical professional sees what is happening, it should point him or her in the right direction for diagnosis and treatment, if necessary..

If you are concerned that neither physician is willing to help you, get a second opinion. You may be best served by requesting a referral to an internal-medicine specialist.

In the meantime, continue to exercise at a slower, easier pace. Take over-the-counter pain relievers, such as ibuprofen or naproxen, if needed. Try using hot or cold compresses to ease the pain.

© 2009, Newspaper Enterprise Assn.