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Expert Q&A

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Is my chest pain related to heart disease?

Asked by Kent Curran, Lehigh Acres, Florida

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I was diagnosed with dilated cardiomyopathy about four years ago. Recently I noticed that when I am lying down flat on my back I experience chest pain/tightness and difficulty breathing. Is this related to my heart disease?

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer:

Dear Kent,

Of course you should be talking frankly with your doctor as this can be very serious. You would benefit from seeing a cardiologist.

A cardiomyopathy is when the heart muscle is weakened. There are at least five types of cardiomyopathy. In the type known as "dilated cardiomyopathy," the heart is larger than normal and the muscular walls are usually thicker than normal.

All cardiomyopathies can lead to congestive heart failure, which is when the heart is unable to pump an adequate supply of blood throughout the body. The thickening of the heart muscle seen in dilated cardiomyopathy can also lead to rhythm disturbances which are abnormalities of the heart beat. Both heart failure and rhythm disturbances can be quite serious.

Perhaps the most common reason for chest pain, tightness in the chest and difficulty breathing specifically when lying down is gastroesophageal reflux disease which I discussed last week.

These symptoms occur when the act of lying flat causes acidic gastric contents to move up into the esophagus and burn it. It is a mistake for any patient to assume that the symptoms of chest pain, tightness in the chest and difficulty breathing are caused by GERD. Very importantly these symptoms can be caused by congestive heart failure, certain diseases of the heart valves, and diseases of the great vessels such as an aortic aneurysm.

The textbook example of congestive heart failure is a patient who has shortness of breath when lying flat that is relieved by sitting up. Anyone with the symptoms described needs to be accurately diagnosed and treated aggressively by a skilled physician.

The evaluation for GERD is one of several nuclear medicine or radiologic tests. It is also common to do an endoscopy. In this test a flexible fiberoptic scope is passed through the mouth in order to look for inflammation of the esophagus and stomach. Even if there is evidence of GERD, the physician may choose to do a cardiac work-up as both can occur in the same patient.

The heart is commonly evaluated with a series of electrocardiograms, an echocardiogram, and anuclear medicine tests of the heart. An echocardiogram is a sophisticated ultrasound of the heart.

A patient may also be a candidate for a cardiac catheterization to measure the pressures in the heart and assess the status of the arteries of the heart (coronary arteries). Treatment of CHF usually involves medications to lower blood pressure and decrease the amount of fluid the heart needs to pump.

Aneurysms or out pouching of blood vessels are less likely the cause of the symptoms. They are usually seen with echocardiogram or through radiologic imaging. They often need to be corrected with a vascular surgery but can sometimes be treated though minimally invasive catheterization.

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