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Have had pain in chest, back and arm. Xray and CT scan ruled out heart attack and aortic tear. Worrisome

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Practicing since : 2004
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Hi there, I have had chest/back/arm pains off and on over the past few months. In general, the pain feels almost like a giant gas bubble in my upper chest, but also goes to the arms and between the shoulder blades sometimes. It even radiates (occasionally) to the jaw. I had been taking Advil and using hot compresses or hot showers and sometimes this makes it feel better, usually not. On Monday, the pain was heavier than usual, felt achy, almost bone-deep but also felt burning/tightness in my center chest, which was new, so I went to the ER. The docs were great, did 2 EKGs, a chest Xray, and a CT scan with contrast to rule out both heart attack and aortic tear. They also did tons of blood work including cardiac enzymes and all came back fine. I have an appt with a cardiologist a week from now to have an echo stress test on the treadmill. They also drew blood for Lymes titer, Hormone tests, and Thyroid. The only thing on my bloodwork at the ER was a slightly elevated red count, and that was very small. I believe they said that normal high was 5.2 and it was something like 5.3. In the meantime, I am supposed to use antacids in case it is GERD related. I am comforted by the fact that I was not having a heart attack, but the pain still comes and goes and is there more often than not. Is anyone here a cardiologist and if so, have you ever seen anything like this before that is not heart related? If I take a XXXXXXX breath, and lean backwards to expand my lungs, I can feel some pain but I am concerned about it being in all the same places as it would be for heart issues. I am 47, female, in good health otherwise. I have not been short of breath at any time, although whenever your chest feels pain, it SEEMS like you can't get a breath even though you can. I can hold my breath for 2 minutes. Could this be hormone related? Could the ER docs have missed something cardiac? I am kind of nervous and would have liked to see the cardiologist sooner, but was told that it is most likely not cardiac. They just want to rule out the worst to see if they can isolate the issue. I am usually very calm but of course, anytime you worry about your heart, a small amount of anxiety may present itself now and then. I just want an additional opinion. I also had a chest xray that was negative. I forgot to add that I have never smoked. I am a vegetarian. I am 5'3 and 112 pounds. I have been active all of my life but not recently because along with this, I have been feeling a bit crappy off and on. I haven't had a period in about 4 months. I take Vitamin D3, Vitamin C, a B complex with Folic Acid, and Magnesium supplements. Some other women have said that hormones could play a part. I have always considered myself healthy and do a great deal to take care of myself but these last few months have been brutal. I'm tired of it and just want to get well.
Thanks for your time!
Posted Mon, 5 Nov 2012 in Heart Attack
Answered by Dr. Ashish Mittal 4 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

You case is interesting and but difficult too. Even your attending physician is facing to solve it. I will try to give my best effort to help you in this problem.

As your investigations like 2 EKGs, a chest Xray, and a CT scan with contrast to rule out both heart attack and aortic tear, blood work including cardiac enzymes, hearing test, are normal then there is no need to worry about any cardiac illness. These all investigation also rule out possibility of physical illness as a cause of symptoms.

From your description and normal investigations report we should strongly suspect presence of anxiety disorder. Anxiety disorder also present as somatoform disorder in which patient has multiple and disabling pain/other complaints with normal investigation.

Psychological issues can cause above symptoms by causing muscle spasm, as we used to have headache during tension due to forehead muscle spasm.

Other symptoms of anxiety which may or may not be present in your case: nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth. Let me know if you have them.

Following steps and measures will help you:
-Continue taking Vitamins
-You can take antacids as acidity used to increase during anxiety and it may be one of the cause of your symptoms.
-Get check up hormones as its imbalance can cause your symptoms by affecting psychological health. Like we have irritability before menstrual cycle due to hormonal changes.
-Healthy diet: Milk and fruits in diet.
-Daily morning walk and breathing exercise.
-Get concurrent opinion from psychiatrist apart from seeking opinion from other physicians.

I hope this information has been both informative and helpful for you.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Have had pain in chest, back and arm. Xray and CT scan ruled out heart attack and aortic tear. Worrisome 10 hours later
Thank you for your reply, and while I sincerely appreciate your time, I was not looking for the expertise of a psychiatrist. I do not think I have an anxiety disorder. I have not taken a sick day from work in 9 years, nor visited a doctor in many years, other than the recent ER visit. I take very good care of myself so as to avoid needing to take any medications or constantly be running to a doctor. I believe a lot of health issues can be solved by good diet, exercise, appropriate supplements and stress relief.

That being said, I do admit getting a bit anxious when something happens to my health, but this is because I do not expect much to happen to my health because of my lifestyle and I get frustrated when something that seems "odd" does happen. But this anxiety occurs after a physical thing occurs, not before. This is why I do not think it is related to anxiety. I have a fairly stress free life otherwise, with a job I love, a great relationship, and am generally very happy.

I do realize I am at the age of hormonal changes so the results of those tests will be interesting. I wake up every day with no expectations of having bad health. I go along just fine and then all of a sudden I feel crappy and that is when I get frustrated. After a few days of feeling great, if I have a day when i feel bad, I think, great...I thought I was past all this....then I get frustrated again.

Bottom line is I feel fine and don't think about it until my body does something weird and then I get frustrated because I don't understand why I would feel this way when I have always been healthy.

I agree that the tests are encouraging but disagree that the cardiac and blood tests mean that absolutely nothing physical could be wrong. There is obviously something wrong; I am not imagining or creating the symptoms. I do admit to excessive worry over my health, but this is only when something happens, otherwise I don't even think about it. I have no desire to be ill. Regarding your other list of possible symptoms, yes I do occasionally get headache (tension, it seems) more often than I did before I stopped having my period.

I will try the steps you suggested just in case this could be related to anxiety, but I just don't feel that it is because I already do most of those things. However, if it is, I have the same desire to fix it that I do with my physical symptoms.

Thank you!
Answered by Dr. Ashish Mittal 1 hour later
Hello again,
Thanks for follow up.

You have following symptoms as per your description:
-muscle spasm may lead to multiple pain complaints
-palpitation (lead to fear of cardiac problems)
-excessive worry regarding own health: I do admit getting a bit anxious when something happens to my health

It is good you are ready to follow advice and it will help you certainly.

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Above answer was peer-reviewed by
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