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Getting chest pain when in tension. What treatment should be done?

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Cardiologist
Practicing since : 1998
Answered : 1306 Questions
Question
Dear sir
I have a chest pain very often when there is a little tension , The pain extends to my left hand some times. Pl. advice for test which will diagnose the real problem.

Best regards
Posted Sun, 19 May 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Sukhvinder Singh 29 minutes later
Dear Mr. XXXXXXX
Thanks for writing to us.
A pain which comes on exertion/emotional stress and relieves at rest can be anginal (heart related) pain. This is definitely one of the important serious causes of pain but this is not the only cause for such a pain. i would like to know if
1. Do you have similar pain on exercise/using stairs/running/ carrying heavy weights/ walking after meals?
2.What is the exact location of pain?
3. how does it comes (beside tension)?
4. Do you smoke? Are you a diabetic? do you have high blood pressure / high cholesterol?
5. Does the pain increases on touching/ pressing or moving body?
all these will help me in understanding your pain better. Please revert back with answers of above questions for further analysis and discussion.
First step in evaluation of this pain would be to see your physician because a preliminary clinical examination is must.
For a cardiac or anginal pain first step would be to get an ECG and ECHO done. if they do not show any old heart attack and also do not show any structural heart disease, then a stress would be next logical step to rule out cardiac reason for your pain chest (if your doctor suggests so).
waiting for your follow-up questions
Sincerely
sukhvinder XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Getting chest pain when in tension. What treatment should be done? 2 hours later
Thank You Dr Sukhvinder, Pl. find the answers below
1. No , No pain during exercise , running , carrying heavy wts, walking after meals etc.

2. Just left of the middle of chest.

3. as of now main reason is tension. Some times due to sudden anxiety or fearness.

4. I don't smoke.No diabetic , BP is normal - 130/70

5. Pain increases if pressed at that point.
 
 
Answered by Dr. Sukhvinder Singh 20 minutes later
Dear Sir
Thanks for details.
1. A pain not coming on exercise/running/carrying weights but increasing on pressing locally as mentioned by you above (points no 1 &5 ) is highly unlikely to be cardiac/anginal and more likely to be a local pain.
2. The reason for pain during tension/anxiety/fear may be totally an issue of perception ( psychological ) rather than organic.
3. Overall best would be to get yourself examined and proceed accordingly as your description suggest more possibility of a non-cardiac cause for pain rather than cardiac cause and physician may pick up the cause on clinical examination without even going into any investigations.
4. Still, details of how we proceed to rule out cardiac involvement have already been mentioned above. {For a cardiac or anginal pain first step would be to get an ECG and ECHO done. if they do not show any old heart attack and also do not show any structural heart disease, then a stress test (TMT/Stress ECHO/Stress Thallium) would be next logical step to rule out cardiac reason for your pain chest (if your doctor suggests so). }
i hope you understand this better now.
sincerely
sukhvinder XXXXXXX
Above answer was peer-reviewed by
 
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