I think I'm in serious condition and can't get straight answers from my doctor(s).?

Question

For the past 5 years I have high blood pressure. It has been corrected (so they say) with 5/20 mg daily with Lotrel. During the this same time my heart has enlarged by 10% and I have developed (low grade at 2-3 times per day) stinging neck and chest pains over the last two or three years. I was not warned that any of this would happened to me. For the past three months my neck and chest pains got so bad it scared me. I went to the ER 2-3 weeks ago thinking I was doing the right and responsible thing. My EKG and blood work "both came back normal. I was released with no help provided and an $18,000 medical bill for taking up space for 24 hours ...and I still have my stinging neck and chest pains! I am outraged at my own stupidity for not being and informed patient and not knowing how to ask an intelligent question(s).about my own welfare. Can you help give me with some additional insite on what I should have done. I'm getting a sonogram tomorrow of my neck and chest from a new doctor.

Answer 1

This is going to be a long answer - sorry - but I feel that the health issues you have raised need dealing with accurately.

In the first instance, it is not clear that your stinging neck and chest pains are coming from the heart. There may be other reasons for it.

However, some of the other stuff you have mentioned is of concern.

(1) you have high blood pressure
(2) you describe heart enlargement

(1) gives you a risk factor for ischaemic heart disease, which MIGHT be the source of your pain. Your doctors should, given this sort of suspicion, arrange for you to have an exercise stress test - a kind of ambulatory EKG where you walk on a treadmill and the speed and incline is increased to make your heart work and possibly provoke a situation where it is lacking oxygen and complains (detectable electrically as well as if you have pain).

Write a letter of complaint to the ER if they did not arrange for you to have cardiac follow up. That is suboptimal care and they should know it.

(2) certainly indicates suboptimal cardiac therapy. Enlargement of the heart beyond a certain level of stretch of the heart muscle fibres causes the muscle fibres to be less effective and puts your heart on the downward spiral to cardiac failure. This is a bad way to die.

Your doctor is doing the right thing looking at the heart with an ECHOcardiogram. I'm not sure what the ultrasound of your neck will show.

Your doctor should check you for causes of this chest/neck pain. These can include:

Skin
o Shingles - herpes zoster can cause a blistering rash on the skin and it can hurt if you move/laugh/breathe. - You can usually notice the rash. Sometimes the pain precedes the rash. You should see the rash by now, if it is there.

Chest Wall
o Cracked rib can cause this sort of pain. You'd have to ask yourself if you've done anything that might crack a rib (usually trauma - being struck in the chest)
o Strained Rib Muscle - the muscles between the ribs (intercostal muscles) can be strained if you are moving the chest wall excessively - exercise, particularly forceful vomiting or laughter, etc.
o Strained Neck/Back/Shoulder Muscle - the muscles of the neck, shoulder and back can cause pains in the area you describe - usually not stinging though.
o Costochondritis - viral infections or other inflammatory conditions can cause inflammation of the cartilages where the rib joins the breastbone (sternum). Tietze's syndrome, it's called in medical terminology.
- Usually all of these pains are sore if you press on the spot that is affected. They are self limiting (ie. the body heals itself) but painful and you should take pain relief.

Lung
This stuff is unlikely as the ER should have picked it up. Still, people can make mistakes.
o Pneumonia - infection in the lung substance can cause this sort of pain. Classically you would feel unwell, short of breath, have a moist cough and fever. Clinical examination, chest X-ray and blood tests can reveal the pneumonia and you would need antibiotics usually. Severe pneumonias are potentially life threatening, even today with modern antibiotics.
o Pneumothorax - air between the lung and the chest wall. This can happen spontaneously in young people (often tall, thin), and comes on all of a sudden. This is diagnosed on chest x-ray. If it is small, it can go away by itself, but big pneumothoraces need drainage with a chest tube. Most pneumothoraces are not life threatening. You did not have a tension pneumothorax or untreated you would not have survived to post your question.
o Pleurisy - viruses or other inflammatory conditions can cause part of the lining of the lung to be inflamed and cause pain on breathing. This condition usually is associated with a clear chest x-ray and will settle by itself with some pain relief.
o Pulmonary Embolism - clot in the lung. Usually this arises in the legs, particularly of someone who has had immobility. If you have been on an airflight or through surgery - anything that keeps your legs still, or if you have had a clot in your legs (Deep Vein Thrombosis DVT) or clot in your lungs (pulmonary embolus PE) before, if you have an active cancer or other conditions that make your blood prone to clotting, you could be at risk of this condition. Pregnancy is also a minor risk factor, but may I assume this is highly unlikely with you? The clot from the veins (usually legs) can break off and return with de-oxygenated blood to the heart where it is pumped to the lungs to get oxygen. Unfortunately the clot would stick in the blood vessels of the lungs and block off the circulation. If this was to irritate the lining of the lung (pleura) by means of blocking the blood supply there, you could get this pleuritic type of chest pain. Pulmonary embolism is potentially life threatening.

Heart
o Pericarditis is an inflammation of the lining of the heart. Somewhat similar to pleurisy (above) but it can occasionally be severe and complicated requiring further treatment.

o ISCHAEMIC HEART DISEASE is the illness of greatest concern in your situation. This is where the blood supply to the heart is poor - ie. the blood vessels have some degree of blockage. This means when the heart works hard, there is insufficient blood supply to the heart and the muscle cells do not get adequate oxygen. This results in pain - usually a typical story of angina, but sometimes the pain can be atypical. You already have a risk factor for ischaemic heart disease (do you smoke, do you have diabetes, high cholesterol, or a close relative with IHD - father/mother/sibling?, are you male, are you >50yo?) and so have an increased risk of having this compared with the general population.

The pain you describe would be a little atypical for heart pains such as angina or heart attack. It would also be atypical for reflux pains. Nevertheless, it could be something mentioned above.

Your doctor should exclude ischaemic heart disease with further investigations and consider:
o The source of the pain (if not IHD)
o Aspirin, Beta blocker and ACE inhibitor medication for you to reverse the cardiac enlargement

Answer 2

Does COPD turn in to pleurisy? My shoulders and neck swell as someone else mentioned. My throat swells on the outside (looks like edema). I can feel my back filled with edema and when it loosens, it comes down like a waterfall, down to my hips. During these episodes I cannot breath, I have fever, headache and stomach ache, I m Type 2 and my Blood Glucose searches for the skies at around 500. I don t know what is wrong with my body. One doctor came to my hospital in 2011 and said I had "old fashioned pleurisy". It was no where in my release papers nor diagnosed on record. and this is the fourth or fifth time I have had these symptoms for at least the last 5 years. Can anyone help me by telling me more about pleurisy/COPD. My lips were blue and my nails w ere blue. I called my "doctor" and she said she would see me in two weeks. OMG - if this condition I have is not serious, I don t know what the definition of serious . My Oxygen went down to 70. Thank you in advance if you can tell me anything.

Answer 3

I think you've already done the best thing which is find another doctor. Now remember, this is your body and your life. If a doctor won't answer your questions or treats your concern as frivolous they are not the person you want treating you. I once had a doctor tell me I treated him like a plumber, my answer was "I don't see a whole lot of difference, I pay the plumber to fix my pipes and I pay you to fix me. If you can't or don't seem to want to be bothered with my concerns I can certainly find someone who can and does. After a minute of thought he smiled and said " Your Right". That was nearly twenty years ago and he's still my doctor.

Answer 4

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Answer 5

Read and copy the previous answer. They are giving you the best advice possible.