Low Risk with Angina discomfort

[AktivGuy]

28 yo male, run about 5k and 1 to 2 gym sessions a week. My diet is fairly average – 1 take out a week, about 2 cups of coffee a day, 1 or 2 beers a week. I am very in shape but have a stressful job and dont sleep great - I push myself even if fatigued which has taken a toll over the past few years. I suffered a pneumothorax last year, recovered well, now have a retinopathy in my right eye.

3 weeks ago I was away for a weekend and had 3 nights of 4-5 hours sleep. Wasnt drinking heavily and was in work afterwards carrying on with a week as normal and training despite fatigue.

After a gym session I noticed discomfort - a pain, left of center, like sandpaper against my heart as if it were rubbing against a rib. I put it down to muscle recovery and ignored it. The week progressed, the sharpness faded but I developed a feeling of pressure across the whole chest, from upper abdomen (making me feel nauseous) to my neck: as if my chest might burst outwards through my breast plate. Its not constant, I associate it with afternoon and evenings when I get tired. Along with it, I get a neck and head ache and a weird sensation of feeling my heart beat in my left ear. The restrictive pressure becomes worse when in bed and sometimes causes arrythmia if Im lying on my side so I sleep on my back. In the mornings the pressure feeling is better but I have an aching weakness in my left shoulder, sometimes running from my tricep to my neck and in the evening the pressure feeling returns.

I visited a physician. Tested bp (140/80), blood and resting ECG (slow rhythm 50bpm, blood test showed no pulmonary embolism and NTproBNP was 6pmol/l and triponin T was 6 pg/l): normal.

I was sent to a cardio for a stress ECG. The night before the ECG I felt really bad but by the morning I was ok. The result was normal. Cardio was dismissive said likely a nerve.

What is going on?! Is it possible that angina can be caused by fatigue alone without atherosclerosis?

Thanks,

a frustrated AktivGuy

[CCFHeartMD19]

Angina refers to chest pain or chest discomfort that arises as a result of obstruction in coronary arteries due to deposition of cholesterol (atherosclerosis).
That being said, chest pain can be caused due to multiple reasons including heart ailments, lung ailments, food pipe ailments as well as disorders of chest wall. Often times, it is very hard to distinguish reliably as to what is responsible for your symptoms.
Being of a young age, you are at a relatively lower risk for atherosclerotic heart disease. With the limited information provided and without examining you in person, it is hard to provide an accurate diagnosis but it is not unreasonable to seek a second opinion if you continue to have distressing symptoms. A normal stress test ECG, especially if there were no symptoms during stress, certainly is reassuring for absence of active cardiac ischemia (lack of blood supply to heart muscle).

[is_something_wrong]

Hi, just a question:

From the spelling of your name "Aktiv" instead of "Active", and that you mentioned a certain athlete treated for nerve issues that turned out to be coronary artery disease, could it be that you are Norwegian and are reading too many articles about a certain swimmer?

Just to mention: After this happened, I felt chest and back pain when walking up hills, and I got very afraid. Turned out to be nothing and when I had a carotid ultrasound done, the issue went away completely.

Your symptoms may be stress related but I would watch the blood pressure if I was you, 140/80 is slightly high to be a young athlete, you should be more in the 120/70 range. Retinopathy can be blood pressure related but would usually require a blood pressure far higher.

Try to manage your stress and continue to live healthy. I know that fear of coronary artery disease can be very frustrating, causing a lot of fear and anxiety.

[AktivGuy]

Thanks, for the feedback. Its appreciated.

Yeah, the word count limits detail but I think I will undertake a follow up. I asked to see a sports medicine specialist who ran a host of blood tests and also wants to repeat the stress ECG (tomorrow).

Part of the problem is that I had taken a quantity of aspirin the night before the ECG I mention above. It helped me with the discomfort and the headache but obviously I realise now that this thins the blood and could disrupt any symptoms that may show on an ECG...

Im also slightly worried by stories I have heard about athletes undertaking ECG stress tests which showed normal results, going on to be treated for presumed nerve issues effecting the shoulder, only to suffer heart heart attack due to arterial obstructions that were missed. It makes me question to what degree I can rely on an ECG given the symptoms (I have grandparents who died early on both sides from presumed sudden cardiac arrests).

I am not scared of a heart condition if that is what this is (it is whatever it is, I cant change that) but I am scared of a misdiagnosis and want to know that I can rely on the test result with certainty and move on to seek other answers as to what this is.