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Had chest pain, pins and needles in arms, neck and face. ECG showed ST depression but blood tests normal. Cause?

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A week ago I had acute centre chest pain like there was a heavy weight on my chest. I had pins and needles in arms, my neck and face. I was short of breath and felt like was passing out. I was admitted for tests. I think the acuteness of it lasted about 3 hours. At one point one lead on the ECG showed ST depression but blood tests were normal. Trop negative and no blood clots. Vital signs were normal and I was discharged with outpt tests. I had an echo today which was normal and I am yet to have a stress tolerance test.

I still get short of breath, am tired. I have centre chest dull ache all the time which rises to my throat like pressure and I have a dull ache most of the time in my left arm and shoulder. It is there to some degree most of the time even at rest and is worse when I lay flat on my left side. Chest pressure/ache is worse if I eat but is still there if I haven’t eaten for hours. I can feel it slightly more when I breath in and I get lightheaded.

I’m normal weight, at the gym 5 days a week, eat well, have cholesterol of 4 and never had this before. I am asthmatic. My mother had an MI at 56.
I’m frustrated that I can’t be as activate as normal and can’t do the gym since this happened. what is it???? I also need advise whether I can fly next week, as we are due to go on holiday.
Posted Sat, 7 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 3 hours later
Brief Answer:
needs further evaluation. Hold journey till consul

Detailed Answer:
Respected Ma'm
1. There are certain atypical features in your history.The chest pain of angina will not worsen with lying flat on your left side. It will not worsen with eating normally. It will not last all the time and if it is so severe that it lasts all the time the ECHO will not be normal as the case is. Does your chest pain/ discomfort worsens on exertion?
2. When was the sample for troponin was taken? Was it taken/repeated after 12 hours of onset of symptoms?
3. Do you have anything like cough/ expectoration/ fever or wheezing? A second possibility may be a persistent attack of asthma. Do you get some relief with your inhalers?
4. In any case, the symptoms you described and which lasted for 3 hours can not be ignored. You have to get a stress test done and looking at the atypical features you must also consult an XXXXXXX medicine specialist to look into possibilities other than anginal heart disease (esp asthma). I would like you to consult your internist and get a diagnosis establish before you take the journey by air.
Hope this helps.
Feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Had chest pain, pins and needles in arms, neck and face. ECG showed ST depression but blood tests normal. Cause? 11 minutes later
thank you

exertion makes me short of breath, light headed, tired with some increase in central chest pressure but not acute.

The troponin was test was taken about 10/11 hours after the initial acute attack but not repeated to my knowledge.

I've never had an asthma attack before but I got control my breathing and still can. Inhalers don't make any difference to current symptoms. It still feels like a dull ache in the left arm/shoulder and upper central chest dull pressure like something is stuck you know like when you get food stuck. Ibruprofen has taken the edge off it today.

sorry forgot to say no fever, no wheeze, occasional dry cough but it doesn't make symptoms worse
Is pericarditis likely do you think?
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
There are many possibilities with riders.

Detailed Answer:
Respected Ma'm
I apologize for the delay in replying.
1. The pain of pericarditis typically increases on deep inspiration and cough, it may radiate to the area between shoulder blades. It worsens on lying flat but improves if you sit bending forward. However a clinical examination is a must before one can diagnose pericarditis. The possibility of this being pericarditis can not be ruled out altogether without examination.
2. An atypical chest infection will be close possibility if we keep pericariditis as a cause of your symptoms but again fever and cough both are absent, which are normally there.
3. Two other possibilities (although lower in preference) could be a musculo-skeletal pain and a pain from upper gut. Musculoskeletal pain will not induce shortness of breath unless you feel that pain is hindering breathing. It will be a localized pain with some possible area of tenderness. Upper gut pain will also not induce shortness of breath and there will be more GI symptoms
4. Since you have exertional symptoms anginal heart disease still remains a possibility with the atypical features as I detailed above. By now there would have been new ECG changes both in case of pericarditis and anginal disease. It would be worthwhile if you can approach your internist now or if that is not possible then you may go to ER. So that they can examine you afresh for new findings (if any) and they can get another ECG to look for new changes.
5. This is how I think about your symptoms as per your history. Any of these possibilities require a clinical examination (as I suggested). If something else strikes you, please feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Had chest pain, pins and needles in arms, neck and face. ECG showed ST depression but blood tests normal. Cause? 32 hours later
hello the stress tolerance tested showed psueonormalised T wave inversion in III & avf but i have to wait to been seen by a cardiologist which could take weeks. She didn't think it was anything significant.

what does this ecg change mean? my symptoms are lingering but signifcantly improved.

many thanks for you advise
Answered by Dr. Sukhvinder Singh 51 minutes later
Brief Answer:
please see details below...

Detailed Answer:
Respected Ma'm
I hope you underwent "Exercise ECG" stress testing by a treadmill or cycle ergometer (Please confirm this that what that exactly you undertook.). If that is the case, then T wave abnormalities do not carry any significance. Only ST changes (that too specific ones) are considered important.
If feasible upload your baseline, peak exercise and recovery ECG pictures by the facility on this page, I will be able to throw more light on it.
For a stress test, "pseudonormalised T wave inversion" carry no meaning; otherwise (in suggestive clinical circumstances only) it may indicate decrease blood supply to heart muscles or ischemia. In such cases, patients have T wave inversion in baseline ECG and when they develop chest pain or discomfort or any other symptoms equivalent to angina, the T waves get normal in shape.
Hope this helps.

Above answer was peer-reviewed by
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