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Chest pain, jaw pain, neck and arm pain. Doctors unable to find cause

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
healthyes for the past few months off n on I've have been having chest pains different types from Sharp to pressure ,or tightness,also have had jaw pain ,neck n ARM I've been to cardiogisit ,er like thousands of times and family Dr can't seem to find the problem
Posted Tue, 22 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 16 hours later
Thank you for the query.

In order to find a solution to your problem of chest pain, I need to know a few more details from you.

1. What is your age and gender?
2. Have you any cardiac risk factors like diabetes, hypertension, abnormal cholesterol, smoking, sedentary lifestyle, family history of heart disease, etc.?
3. You must have had an ECG taken. If so, is it possible to upload a scanned image of the latest ECG, preferably one taken during the episode of chest pain?
4. If the ECG has been reported as normal, you need to undergo a stress test. If already done, please upload the results.
5. If an echo of the heart, chest x-ray and any other relevant blood tests have been done, please upload the results.
6. Chest pain can have a multitude of causes that range from cardiac (ischemic, or non-ischemic), pericardial, pleuritic, lung-related, musculo-skeletal, intercostal neuralgia, zoster, gastric, esophageal, and even, psycho-somatic causes. To pin-point the exact cause, you will need a complete physical examination and then, relevant investigations to diagnose the exact cause.

I hope this explains things for you. I can give you a more specific reply after you give me the answers to the questions above.
Awaiting your response,
With regards,
DR Raja Sekhar Varma,
Consultant Cardiologist
Above answer was peer-reviewed by
Follow-up: Chest pain, jaw pain, neck and arm pain. Doctors unable to find cause 8 hours later
I'm 27 female my dads dad had heart attack and his dad,I only have thyroid dieases ,and acid reflux,anxiety,I've been to cardiogisit and had xray,stress test,sono ,ekg, and I don't no if the did ecg I've had blood work and all that was normal but still the chest pain, dizziness ,and other symptoms
Answered by Dr. Raja Sekhar Varma 13 hours later
Thank you for the reply.

Since the ECG, x-ray, echo, stress test and blood tests are all normal, it is highly unlikely that the chest pain is from a cardiac cause. At 27 years of age, a lady is unlikely to get ischemic heart disease in the absence of strong risk factors like diabetes and smoking.

Since you have acid reflux, this condition can cause chest discomfort. Upper GI endoscopy can be done and appropriate treatment as advised by a gastro-enterologist will help to solve this problem.

Anxiety can precipitate many of these symptoms and may cause symptoms to be worse than they actually are. You also need to find a way of dealing with your anxiety problems in consultation with a psychologist/psychiatrist.

I hope this answers your query. Feel free to ask for any further specific clarifications.
With regards,
DR RS Varma
Above answer was peer-reviewed by
Follow-up: Chest pain, jaw pain, neck and arm pain. Doctors unable to find cause 28 minutes later
Well as you mentioned I do not have diabete,or I don't smoke ,my blood pressure runs pretty good most the time and cholerstrol is back to normal my thyroid was off whack but now its good but I do take protnix for my reflux, and klonopin for my anxiety but still seem to get chest pains so bad some are Sharp right under left breast ,some are pressure in betwen strenum,plus I get these horrible pains in arms,or ill get numbness under my arm,down to my hand but sometimes I can make my arm have pain n numbness ,I don't sleep well due to the fact I feel imma die of heart attack or clot my legs cause me Sharp pains in the back of Calfs for over 6 months now I've also had ,a few doppler test, and arital blood gas test ,and d dimer test,I just in aware of why I feel so bad all the time most of the time I do notice pain more a few hrs after eating,or doing something then is when I worry arms ,neck shoulder aches more than anything sometimes n elbows pain will be so bad and if I push on my gums it hurt, if I move my arm it will hurt and go numb I sleep heavy and a lot of times when I wake up ill notice I've slept on that side for hrs straight could that cause it I just want to get some different insight on what my prob could be I would appreicate ne thing else u could offer
Answered by Dr. Raja Sekhar Varma 4 hours later
Thank you for the reply.

Let us start with the acid reflux problem.
1. I would suggest that you see a dietician and get a good diet prescription that will help you in controlling the refux.
2. Walking for at least half an hour daily (preferably before food) will do wonders for your overall health, aid your digestion, and reduce the risks of a heart attack.
3. Do not lie down immediately after eating. This worsens reflux.
4. Get an endoscopy done and see if there are any other associated problems like hiatus hernia, lax esophageal sphincter, gall stones, etc that needs further attention.
5. In addition to the pantoprazole that you are already taking, a dose of domperidone before each meal and/or sucralfate syrup will further improve matters.

Now, let us consider the aches and pains.
Clearly, from your description, these are non-cardiac. These might be musculo-skeletal. Such aches are well known when there is a thyroid problem. These are usually harmless and get solved when you correct the thyroid issues.

It is also quite common and normal to experience numbness in the arms and forearms when you sleep with your arms raised/tucked under your head and undue pressure is felt on the radial nerve. The simple solution is to avoid such postures that precipitate such symptoms.

Also, I would like to look a little more closely at the levels of anxiety and stress that you seem to be undergoing. Is there some depression also? You may need to undergo some objective questionnaire testing to detect any mood disorders as well. The stress and anxiety as also depression may result not only from external factors but may also be due to XXXXXXX conflicts. These need resolution. You could be feeling extra discomfort from minor aches and pains as a result of your low mood. Your medication may also need to be re-adjusted. Thyroid issues also can worsen your mood and anxiety problems.

I can re-assure you that, based on your profile and the negative tests, the risk of a heart attack at this age is extremely low and negligible. I really do think that you should take a positive attitude, distract your mind from focussing too much on the aches and pains, keep yourself active both physically and mentally, so that you can lead a happy and healthy life.

Wishing you all the very best in life,
With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Chest pain, jaw pain, neck and arm pain. Doctors unable to find cause 36 hours later
Okaay well as far as my reflux I've had 2 scopes ran they looked good ,have been checked for ulcers and hernia ans do on.. As we speak I'm up with horrible pain in left arm,shoulder n jaw sometimes it hurts worse if I move or so I think it does and I like to get it rubbed but seemed to make it worse after wards. But my thyroid has been checked here recently and its good now and it has brought my cholesterol down, and other blood work good. I try not to focus on every ache n pain but I have 4 kids, just lost my papa in Sept and been thru a lot since then sometimes I think I might just have two or three different types of pain and maybe all hit at once like tooth infection for jaw,and shoulder neck, arm pain from pinched nerve maybe, I don't know anymore I feel as if I'm losing my mind I stay up all night thinking an waiting on when I might die I know that sounds crazy but I worry when I'm gone who will be here for my kids :) I try to do the walking but I always feel so bad I can't push myself to do it I did see a psychiatrist last year said I had ocd read of dying ,hpocodract, and anxiety but its so hard to let myself believe that all these pains are from something I could control I just need help as to what would cause this does stress and anxiety make u feel this bad even when u don't feel like your stressed or paniced I don't understand maybe this post will tell u more and I can't wait to hear back on what u think:) Thank you
Answered by Dr. Raja Sekhar Varma 21 hours later
Thank you for the reply.

From the description of the left arm, shoulder and jaw pain, it appears very likely to be a musculo-skeletal pain. It could be peri-arthritis of the shoulder joint, or it could be cervical spondylosis. Your physician should examine you and get the relevant x-rays of the shoulder and neck, and if required, MR scanning. The best treatment for this is a combination of physiotherapy, local applications and if absolutely essential, oral analgesics.

I think you should review your problems with your psychiatrist once again and re-assess the medications that you are currently on. You will be amazed at the difference that appropriate medicines can make. The mind plays a large role in how you emotionally respond to situations. The pain that you feel is amplified by negative thoughts and a depressed mind.

Walking will be a very good form of exercise and therapy, both for the mind and the body. Do spare some time for this.

Since the thyroid problem is under control, you will definitely be better now. But, periodic (at least 3 monthly) checkups are required to ensure that the hormone profile is normal.

I can understand that managing 4 kids is stressful, but, surely, it has its joys as well. You should remain mentally strong so that you can continue your supportive role in their development. There is no clinical indication that your heart is weak or that you are likely to develop a heart attack. You should re-assure yourself about that and continue to live a healthy and happy life.

With regards,
Dr RS Varma
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