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Thread: Burning, Chest Tightness

  1. #1

    Burning, Chest Tightness

    Wise, This is a more detailed description. I get chest tightness out of the blue while driving. Sometimes I think it may be anxiety, but I get it more intense when I first lay down at night. If I sit up or pull over for a few minutes it will subside. I recently completed a clinical trial downtown Detroit (RIM) with Dr. Birk and Dr. Neishoff with the tilt table. I had a major case of hypertension after being in an upright position, and again subsided after I sat up and held a sit-up position for a bit. During the trial,I can understand the possibility of stretching muscles, pinched skin or bound clothing to cause pain and hypertension, but during a normal day, I am puzzled. I do not feel tired, no headaches, or flushing of the skin, so I do not believe my blood pressure is erratic. My injury was April 98' in the Bahamas. My level is a c5, with some c6/7 movement, no pins in the spine but I do have titanium plates in my neck. Spastisity is not an issue, actually the spasms I do have help keep the tone in my legs. I can control them to an extent, pain in my shoulders can trigger them while stretching. The chest tightness concerns me, I am very healthy, but not being active could spark heart disease. With my work schecule, school, and incompetent home aides I do not get the exercise I should. When I get these attacks, I get nervous and can intensify the reaction. My guess is that the muscles and nerves around the diapram, rib cage and around the heart are having their own spasms to create this feeling. I would like your input and any one else. Dr. Birk and Dr. Neishoff are great, but they also are puzzled. If you have not met or heard of these doctors, you should try to. They have been working very hard over the years on SCI.

  2. #2
    backspace,

    Like your doctors, I am not sure what is going on. My first approach is to dissociate the person from the spinal cord injury. Too often, doctors tend to blame things on spinal cord injury. However, people with spinal cord injury get other health problems like everybody.

    So, if I met a person who is realtively young and healthy, what would be my differential diagnosis list. I would go down the list of organs.
    1. Heart. You probably should get an EKG done to make sure that you don't have an arrythmia or ischemia of the heart.
    2. Lung. The transient nature of the problem rules out a lot of things such as pleuritis, pneumonia. However, if you have not had one already, a chest x-ray probably would be advisable.
    3. Upper GI. You may have esophageal reflux. The symptoms that you describe are not typical of reflux or indigestion but it is often hard to tell with people who are spinal-injured.

    Of the potential problems that might be associated with spinal cord injury
    1. Gallstones are very common in people with spinal cord injury. The pain should be more on the right side.
    2. Emboli from deep vein thromboses to the lung. I think that this is unlikely and the transient nature of your symptoms don't fit.
    3. Broken or strained rib (from transfer) to the car.
    4. Spasm of rib muscles and diaphragm. These of course can occur but I have very seldom heard of anybody describing such spasms as chest tightness.

    Unless you have shortness of breath and other associated neurological symptoms indicating that you are having difficulties breathing, I don't think that what you are describing is life-threatening.

    Wise.

  3. #3
    Wise, Thank you. I will go to my family doctor and he will be least likely to blame it on the SCI. I do believe your on to something when you discussed:
    3. Upper GI. You may have esophageal reflux. The symptoms that you describe are not typical of reflux or indigestion but it is often hard to tell with people who are spinal-injured.

    I have had some stomache issues, I am in the process of changing my diet. I change slowly......to see what works and what does not. And no I do not have shortness of breath, so I am a little at ease. But you also mentioned:
    1. Gallstones are very common in people with spinal cord injury. The pain should be more on the right side.

    I do seem to have pain in the right side, but I have had this for years. Since my level of injury keeps me from feeling anything below the chest, I believe this is phantom pain, not gallstones.

    Thanks

  4. #4
    backspace...

    About Gallstones:

    I am not spinal cord injured. I was diagnosed with gall bladder disease several months after I began having symptoms just like yours. My pain was dead in the center of my chest, and during the biggest attack, radiated through my right shoulder..I had these symptoms on and off a couple of years before the big attack happened to tip off the diagnosis. Before that I had a zillion tests! Please consider the gall bladder seriously, as it is common for people with a sci to develop stones. Multiple stones can shift and block the necessary bile flow when you change positions and could be a source of the pressure and pain you are feeling. A simple ultrasound will show one way or the other. I hope you are better soon.


    Mary----1finern

  5. #5
    Dear Backspace,

    The kind of chest tightening you describe is one of the very oldest reported symptoms of Central Pain. It should not therefore come as a surprise. You can read more about muscle pains by reading anything Jorgen Boivie has ever written, articles by Aleksandre Beric, or you can look at painonline.org under "Doctor's Corner" and then Articles and Abstracts online and find the article "Lessons from my Central Pain", which recounts the literature on muscle cramping. Muscle pain is thought to come from the little sensory fibers, called muscle spindles, which intersperse among groups of muscle fibers. They become hypersenstive just like other sensory groups in Central Pain. Dr. Young addresses treatment with baclofen or klonopin elsewhere at this site. It is of course also prudent to have the other conditions Dr. Wise mentions under consideration, but if all you have is what many experience with CP, then it isn't mysterious at all. We have to find words of stark reality so our doctors can latch onto what we are saying. Be very specific and do your best to confine your words to a vocabulary that is very precise and clear. If I read what you are saying correctly, it doesnt' sound any different than what most authors on central pain describe, but then you must rely on your doctors, not the "friends" you meet here.

  6. #6
    dejerine, I am glad that you posted what you did. I neglected to mention central pain as the cause of the burning sensation and chest tightness. I wonder how many people with cervical spinal cord injury have this particular feeling? C4/5 is the most common level of cervical injury and we probably have well over 1000 people with cervical spinal cord injuries visiting to this site. It would be interesting to know how common this sensation is. I have set up a poll for this purpose Wise.

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