Heart Palpitations Forum

Heart Palpitations Forum
http://palps.chemicalforums.com/cgi-bin/YaBB.pl
Heart Palpitations Forum >> Symptoms and other concerns >> Something about my ribs
http://palps.chemicalforums.com/cgi-bin/YaBB.pl?num=1272837897

Message started by johnny on May 2^nd, 2010, 3:04pm

Title: Something about my ribs
Post by johnny on May 2^nd, 2010, 3:04pm

Hi RLR, I've got a few things to ask you.
I started having ache around my heart area for 1-2 weeks. Just ache. No speeding up. Normal beats continue and I get this constant for about 5-10 seconds. Also they may come in multiple runs one after another. The exact spot changes but it is between my 3th and 5th left ribs.
It could be my irrational thoughts and it may sound funny but my left and right ribs are not symmetric. Hard to explain it but let me try. If I stand still and look down at my feet I can see the last ribs of the left side stick out more to the front than the right ones. Also 5th ribs of both sides are a bit inner than all others. What I mean is if you look at me from side, my ribcage isn't following a uniform line. Bottom ribs stick outer. Bottom left ones even outer. I should tell you that I sit hunched almost all the time. In addition to these I sleep lying on my sides usually. When I lie on my left, the part where the bottom ribs connect to sternum cause mild pain as if they push against the sternum too much.

Another thing is I started having too many muscular twitches in many spots than ever before for the past months. Although I believe it is normal due to anxiety which I deny to have all the time. However my left fingers shake and tick more than ever when I hold my hand in mid air.

Finally I wrote in another post a few weeks back about burping. Sometimes I feel the urge to burp but I simply can't. There is too much air but I can't get it out. I just swallow more air without realizing. I can feel the air going down into my stomach. I sometimes feel like there is a balloon moving when I press below the ribcage.

As I wrote this post sometimes I felt like I would pass out and kept burping all the time. I want to believe it is just anxiety but these issues prevent me from that. Do you think I should get myself checked? I don't want to visit the doctor for some funny reason and get embarrassed there. I feel already embarrassed telling you these. Thank you

Title: Re: Something about my ribs
Post by RLR on May 2^nd, 2010, 7:05pm

Well, your health concerns are certainly nothing to be embarrased about and always remember that your doctor is being paid to address your concerns regardless of what else they may think, which by the way is a lot less of a concern than patients may think. We see countless patients and we simply don't pause to ruminate about whether one patient is being more rational than another.

The important point is to never try and supplant direct evaluation by your primary care doctor or specialist by utilizing the internet. While I can provide people here with insight based upon my former years as a physician, my single purpose is to offer reassurance and a more firm understanding of health care concerns. You should never look upon an online heath source as possessing a diagnostic capacity in any manner.

When you speak of pain, you'll have to be far more specific than the generalization made. Realize that the internet is a very poor venue for evaluation of this type and in the absence of direct contact, I need to know more specifics in order to better inform you. Is the pain sharp or dull, does it radiate to any other area of your chest, is it made worse by activity or is it more present at rest and do you experience any other symptoms besides the pain? Is there anything which relieves the discomfort?

Based upon your description as it stands, I would likely lean to something called costochondritis, which is a common inflammation of the cartilage associated with the ribcage. Pericarditis is an inflammation of the sac lining the heart, but typically tends to be extremely painful and other symptoms are present as well. I would not be concerned about angina pectoris, or ischemic pain associated with the heart itself at this point. The description as it stands would be inconsistent with such a problem.

Pertaining to your body symmetry, it's important to realize that the ribcage is binded not by bone, but rather cartilage in a manner designed to permit expansion of the chest wall. While general symmetry is observed in all people to some extent, normal variants wherein the lower costal borders flare or protrude is an incidental finding and would not constitute a gross anatomical deformity. The costal border regions also tend to be tender and many people complain that lying on one side versus the other can produce discomfort.

The tremor observed in your hand and or fingers is known as an intention or action tremor. We tend to regard them as normal when they constitute fine motor activity and are quite common in persons under stress or demonstrating anxiety. We become more concerned if this type of tremor results in myoclonic type activity that amplifies when elicited by action or intentional movements, which looks like the person is unable to control the limb as it jerks about.

We also seek to differentiate muscle twitches from something called fasciculations, which are more diagnostic of a problem. The main factor relating to the difference is whether the twitches involve large muscle groups like the thighs, biceps and triceps and whether they are constant or more erratic in their appearance. It would really only be a concern if you were also experiencing other problems such as with your balance and make reports of muscle wasting and increased trip and fall episodes and that sort of thing.

Swallowing air is common by persons with anxiety and is clinically described as aerophagia. Many people try to relieve the pressure by intentionally swallowing air in order to exceed the threshold and cause eructation, or burping. This can be a problem wherein stress or anxiety may be affecting the esophageal sphincter, which produces dysregulation that may prevent or restrict the ability to belch or release the trapped air. Always try to relieve the pressure drinking liquids rather than swallowing more air. Walking will help to produce belching as well. Many patients feel that they can't breathe deeply or describe feeling short of breath, but this is common and due to the fact that the trapped air presses against the diaphragm muscle used to draw the lungs downward enough to acheive full tidal respiratory function.

Your symptoms all sound like those commonly observed in patients with anxiety disorder. It's important, however, to feel more relaxed in approaching your doctor to seek understanding and reassurance. If you have concerns, then by all means seek an evaluation from your doctor and avoid embarassment by realizing that it's well within reason to seek medical advice in the presence of symptoms which you either don't find to be normal for you or ones that you don't understand sufficiently and produce concern.

You'll be fine. You simply need to make the choice of whether to address your doctor.

Best regards and Good Health

Title: Re: Something about my ribs
Post by johnny on May 3^rd, 2010, 4:39am

Thank you for making me understand and for the reassurance.
Right, I forgot to mention the type of pain. It should be dull pain. it is not like a needle sticking pain, there is not an exact center of pain. It is about a circle with 1-2 cm of radius. It can come any time. I mean it is not triggered with excercizing. It can happen at rest, when lying down on my back, sitting or walking. It doesn't radiate to other organs. 5-10 seconds constant then it goes away. Sometimes it changes location but stays within my left chest area.

Also I told my doctor at my last visit(about 3 months ago) that my left arm feels weaker than before and it still does feel so. However he said I can move it, lift things so there should be no problem. When I told him I have pain with my ribs he told me to lie down and pressed on them and around my abdomen and said I'm ok. He seemed not to believe anything just because I have anxiety but I believe if they were to threat my health he would have taken care. So I guess there is no danger and I try to ignore most of the things.

As a side note I don't excersize at all. I only walk 5 km's with fast pace every other day. I don't get any problems during this walking.

Title: Re: Something about my ribs
Post by RLR on May 3^rd, 2010, 3:33pm

Five km every other day would certainly qualify as regular exercise.

The pain is most likely mere chest wall pain and is indeed common among persons with anxiety. Attempting to self-evaluate muscle weakness is subjective at best. If you truly sense muscle weakness that can be objectively measured, then it warrants further investigation. Again, this would have to be determined by your doctors since the ability to make such a determination by your own perceptions would not constitute an accurate assessment.

I see nothing of your complaint at this point which would suggest the presence of any type of pathology. Try and relax. If you continue to experience what appears to be weakness that increases, seek a referral to a neurologist to have an EMG and other tests to determine if a problem exists. At this point, I think it's entirely unwarranted.

Best regards and Good Health