This story might apply to you if you are a:
- skinny, nondiabetic vegan
- life long runner
- amateur runner who is cranking up the volume right now
- have arthritis in other parts of your body (I got what one doctor called knee arthritis in one knee)
- have a mystery chest pain you didn't use to have
- you're an increasing old male, about 50 or older
If not, then my story might not apply to you, go read real medical advice.
So I wake up in the middle of the night with chest pains. I google to see if it is a heart attack-- no feeling of weight on chest, heart rate is slow, no arm pain, etc. I go back to sleep but figure I should get it checked out.
Chest continues to hurt during the day. Worse at the end of a hard run, fine in early morning, starts up again as the day goes on.
Dr Google suggests that as an old, 49 year old, male life long runner, I might have atrial fibrillation or something else, maybe costochondritis (rib cage arthritis) or heart burn. It probably is not heart burn.
A month later, I finally make it to heart doctor. He says he can't rule out coronary artery disease. Not what I was expecting. All of my stats say my odds of coronary artery disease puts be at <1% risk of CAD related heart attack for next decade-- my BP is pretty normal usually 120 to 130, lipids are great, diabetes test says I'm doing great, I exercise, I am freakishly strict about eating. As a skinny vegan, if I die, it probably won't be on account of eating hear-unhealthy food.
The ECG didn't turn up anything except that my heart rate is so slow the nurse told me to hold my breath to speed it up so that there would be more blimps to look at on the chart.
Doctor wanted to do a nuclear stress test to rule out CAD. But if I did have, say a 35% blockage from a childhood of eating meat and eating cheese up to age 40, then what would I do? I don't have angina, I'm not going to get a stent, statins aren't going to improve my already good lipids. I could eliminate all fats from my diet- a sort of nuclear option to drive cholesterol even further down. So I was leery that there was value to ruling out CAD. Those stress tests cost me lots of radiation (400 in 8 million chance of cancer, tiny but not nothing) and they cost $$. Also, a nuclear stress test is unclear if they are good for telling an old man if he's safe to run to exhaustion.
I work out that I can reliably reproduce systems by breathing fast and make symptoms go away by not breathing so fast AND I can reproduce symptoms by finger poking and by bending over and twisting left or right. Collectively, this all points to a diagnosis of costochondritis. I ask the doctor to release me from my nuclear stress test appointment. He agree and now I'm just getting an echocardiogram to see if there is any structural defects that should discourage me from going out and running as fast as I can.
So final conclusion, I have costochondritis. Everyone dies of something and even otherwise healthy people, if old enough, still die from their hearts failing, so from now on I will have to try to distinguish rib cage pain from my heart failing.
I still don't know if I do or don't have afib. I think to figure that out I would need a consumer grade EKG device. My fitbit Sense has an EKG, but it likes to say "no afib!" or it says "heart to slow/fast, I refused to say anything at all!" and the "generate PDF of chart" has only worked once. So I'd need to buy another device and read the squiggles myself to diagnose afib. I'm tempted to buy the device, but Afib is normally a problem for elite runners. I am no elite athlete, I just like to think I am.
The story is still ongoing, but maybe this will help someone.
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