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July 19, 2008

Aches and Pains

Question from Bogota, Colombia:

I had a strong pain in my chest for which I needed to call an ambulance service. The doctor of the ambulance requested an electrocardiogram but, in addition, he requested a blood sugar test because of my diabetes. The cardiac exam did not present big changes to a normal one, but the result of the sugar blood test was 39 mg/dl [2.2 mmol/L]. It is important to note that I do not recognize low blood sugar levels and I did not show importance to my sugar level, because the pain in my chest presented itself after my normal dinner time. Regarding both symptoms and the presence of the chest pain twice during the doctor’s review, I was transferred to an Emergency Room (ER) of a local hospital where the doctors performed several electrocardiograms and several checks of my cardiac enzymes. The results of both type of exams were normal and after 15 hours in the ER, I left without a clear diagnosis. When I asked them about my condition, the medical personnel said that I could have had digestive problems; however they were not very sure given my 34 years with type 1 diabetes. Is it possible that the chest pains I had were due to a digestive problem?


From: DTeam Staff

The list of problems that could present as chest pain are many. The obvious one that everyone worries about is coronary heart disease with a blockage of one of the vessels in your heart. However, people with diabetes do not always have characteristic pain from coronary heart disease because the nerves are involved from the diabetes. So, pain or even no pain with fatigue and shortness of breath are worrisome. Even though you did not have a diagnosis of a heart attack made, you still could be having heart pain. This would best be screened through the use of a stress test. I would recommend you speak with your doctor about this.

Other causes of chest pain include the following:
Gallbladder pain
Ulcers or irritation of the esophagus or stomach
Lung pain from a clot, pneumonia, or viral illness involving the outside lining
Chest wall pain involving the sternum or ribs or the area where they come together
Overactive thyroid
Fast heart rate not caused by any other problem

So you see, there are many other causes. First, it is important to rule out the heart as the cause.