Q: My son recently visited his local emergency room because of chest pain and difficulty breathing. He was well-treated and had two EKGs, a chest X-ray, lab work twice to check for any cardiac markers, a flu swab, plus two IVs because of possible dehydration. Everything was negative. He returned home and five days later went to see his primary care physician because the chest pain and breathing problem didn’t go away. He was prescribed a steroid to, in the doctor’s words, “loosen up his chest” so he could breathe better.
Well, I’m worried. Can you help me understand just what is going on?
A: I don’t know the age of your son but feel his trip to the ER was warranted to rule out cardiac issues. A heart attack occurs when the flow of blood to a section of the heart muscle becomes reduced, depriving the heart from receiving blood that is rich in oxygen. An attack most frequently occurs because of coronary artery disease – a condition in which plaque builds up within the coronary arteries that supply that oxygen rich blood to the heart.
Symptoms of an attack include breaking out in a cold sweat, shortness of breath, chest pain or discomfort in the center of or left side of the chest described as pressure, squeezing, or even as if an elephant were sitting on the person’s chest. The pain may radiate to the neck, jaw, back and arms, so it’s no wonder he thought the way he did. It’s likely his two EKGs and lab work were spaced out to better allow the ER physician to determine if there were any cardiac markers present that didn’t show initially.
Influenza is a viral infection that may present with fever, painful muscles, dry cough, fatigue, headache, and nasal congestion. Influenza viruses travel through the air in droplet form when an individual who is infected coughs, sneezes, or simply talks. Droplets can also be inhaled from such things as a telephone receiver or computer keyboard. Treatment involves fluids and bed rest. For some, anti-viral medication taken within the first 48 hours of symptoms may reduce the duration of the illness. Prevention includes avoiding crowds, frequent hand washing and above all, annual immunization.
Water makes up almost 75% of a person’s body weight and is a critical element to keep the body adequately hydrated. Dehydration occurs when the amount of water leaving the body through urination, sweating, diarrhea, vomiting and for other reasons exceeds the amount taken in. Other than what appears to be an insatiable thirst, muscle cramps, heart palpitations, dry mouth, nausea and vomiting may occur. Electrolyte abnormalities may cause, among other things, heart rhythm abnormalities. Treatment is through fluid replacement, either taken by mouth or in more severe cases, intravenously.
The ER doc ruled out several potentially critical issues. However, I remain concerned about the chest pain that could represent an unidentified viral, bacterial or fungal infection,or even gastroesophageal reflux disease (GERD). Non-cardiac chest pain is common, affecting up to one fourth of the adult population in our country. It can present in any number of ways to suggest either a chest muscle or lung problem or an atypical type of pain. The physician may have been leaning toward inflammation in the lungs which can be a remnant of bronchitis. Therefore, I recommend he run the course of the steroid prescription which must be taken precisely as directed. Then in follow-up, he should be seen by a cardiologist for a full workup. The peace of mind will be well-worth the effort and you should have the answers you are seeking.