The Question
I had a heart attack three years ago, followed by quadruple heart bypass surgery and rehab. I thought I was fully recovered until terrible pain twice forced me to hospital emergency this spring. A cardiologist ordered a stress test. He found no sign of a blockage, nor any problems with my heart. When I asked why I felt chest pain, he dismissed it as having anything to do with my heart and told me to take pain killers. If the pain doesn't get better, should I go to emergency? Should I find out the cause?
The Answer
It's not unusual to have chest pain after coronary-artery-bypass graft surgery and it's no wonder: In order for surgeons to access your heart, they use a surgical saw to open your sternum, and then stitch the bones back together with wire. It's invasive, physical work.
After heart-bypass surgery, some patients feel pain for several months, while a few experience ongoing, nagging pain for life. Most have no pain, according to Chris Simpson, chief of cardiology at Kingston General and Hotel Dieu hospitals.
"I see this in a lot of patients when they come back, they kind of feel dismissed by physicians," said Dr. Simpson, who is also a board member of the Canadian Cardiovascular Society. "What I think is happening is that a physician will make a diagnosis of non-cardiac chest pain, and so they feel themselves reassured. But they don't do a good job communicating that to the patient. They appear dismissive when they intended to be reassuring."
Your case is unusual in that the pain is three years after the operation. The surgery repaired the heart's plumbing problems; the cardiologist's workup this spring probed the heart's electrical issues. It sounds as if the heart has been ruled out as the source of the pain. That meansyou should keep looking for the cause, but in a different area.
A golden rule in cardiology, according to Dr. Simpson, is that anything in the abdomen can cause pain in the chest and anything in the chest can cause pain in the abdomen.
Since the heart and esophagus are located close together in the chest cavity, they have a similar nerve supply. Consequently, pain from either organ can have similar features, making it hard to differentiate one from the other.
There are probably a dozen things that could be causing your pain and doctors may look at whether it is gastroesophageal-reflux disease, chest- wall pain, a muscle pull, inflammation in the lining of the lung from a viral infection, gallbladder or pancreas problems.
I recommend you make an appointment with your family doctor. Confirm whether the cardiologist's diagnosis is non-cardiac chest pain. If that is the case, work with your physician to help devise a plan to investigate the pain's cause.
Pilots always navigate from a known point. The same is true of patients with symptoms. Until you know the cause of the pain, it's impossible to know what next steps to take to resolve it.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.