Umberto (Gary) Fontana, MD

There are a number of potential causes for that constellation of symptoms in a young person. In addition to a thorough history and physical exam, a panel of lab work (CBC, BMP and see rate), an echocardiogram and stress test may be part of the work up.

Pectus excavatum is a congenital malformation of the breast bone more common in males and can appear more severe during the adolescent growth spurt. It can cause chest pain, shortness of breath, exercise intolerance and palpitations. It can be associated with connective tissue diseases like Marfan’s and Ehlers Danlos. It can make one self conscious about one’s appearance. It can be surgically corrected. If that would something you would like to discuss, would have your PCP refer you to a thoracic or cardiothoracic surgeon. I hope this helps!

Stabbing chest pain is usually related to arrhythmias (Afib, PVCs, PACs), musculoskeletal pains or pain from inflammation of the sac around the heart or lungs (pericarditis, pleurisy). Rarely, it is related to lack of blood flow. With your history, it is likely related to a rhythm issue. Your cardiologist may want you to wear a monitor if symptoms are significant or frequent. Hope this was helpful!

Myocarditis is as the name implies inflammation of the heart muscle. It is caused by viruses, toxins, chemo drugs, and auto immune diseases (lupus, Rheumatoid Arthritis). It is marked by heart failure symptoms, arrhythmias, chest pain and sudden cardiac death. Diagnosis is made by echocardiogram, MRI, elevated heart muscle enzymes (troponin) and invasively by biopsy. Outcomes are related to the severity of symptoms (heart failure), presence of arrhythmias, need for mechanical support (left ventricular assist devices, etc). Most patients are treated with heart failure medications (beta blockers, ACE inhibitors) and make a full recovery. Follow up echocardiograms are performed in 1 month, 6 months and a year to document recovery. Hope this was helpful!

After a heart attack there is a healing process that ensues. I assume you had a heart cath and balloon and stent to open up the artery. Return of blood flow reduces the damage ultimately but temporarily the showering down stream of blood clot and inflammatory molecules can cause “stunning” of muscle cells and cause reversible dysfunction. Certain medications reduce the likelihood of “negative remodeling” or a healing process that puts strain on the surrounding undamaged muscle. These include beta blockers, ACE inhibitors and statins. Modest exercise and a heart healthy diet rich in anti oxidants is also advisable. Hope this helps!

An EKG is reflective of a steady state. Unless you have had a heart attack you may have a normal EKG at rest. Provocative test like a treadmill stress increase the sensitivity of picking up a blockage but a treadmill stress test is only 70% sensitive (30% are missed). A stress nuclear or stress echocardiogram improves the sensitivity to 80-90%. Hope this helps!

Actually a low heart could be a good thing! High vagal tone is seen in marathon runners and cyclists because of aerobic conditioning. Their resting heart rates can be in the 30’s and 40’s! If you are not a marathoner a low heart rate could be a result of medications for high BP (beta blockers, calcium channel blockers and Clonidine) or indicative of a failing natural pacemaker of the heart , the sinus nose. This so called “sick sinus syndrome “ can cause fatigue, shortness of breath, dizziness and syncope (passing out) and may require a pacemaker. Hope this helps!

The goal of revascularization is to relieve all ischemic symptoms (angina). If you are having similar symptoms to pre balloon/stent, it could be due to trapping of a side branch, distal spasm or distal embolization. You need to discuss these symptoms with your cardiologist. There are benign causes as well such as so called “stretch pain” but this is transient. Hope this was helpful!