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Consistent sharp chest pain that is noticeable with deep breathing, arm numbness. ECHO normal. Any ideas?

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Practicing since : 1966
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I am after some much needed advice. In January this year I went to the ER with chest pains I had the night before, and in the morning I had a numbness in my left arm. I had x rays, ECG and blood tests done. All came back ok, they said it could be due to stress? I over the last few months have had continous chest pains, and left arm numbness. I have had echo cardio and stress echo tests, and again all fine. My cholesterol levels are ok, and blood pressure is slighlty high but on average over a 24 hour period after weraing a monitor it is ok.

The pain is generally sharp and in the middle of my chest but can move, but generally settles in the middle high or low. I tend to notice the pain more when I take a deep breath, although it is there other times also. If I take pain killers it eases the pain.

I have been referred to a physio and chiro and still getting pains. After a session with them last week for a few days I had no pain, but it returned and now after a secound visit it has again returned and back on the pain killers.

My doctor seems out of ideas. I am at my wits end, I am becoming more and more depressed and it is affecting my daily life. My wife tells me to man up and get on with it but I cant. I was a smoker and gave up 6 weeks ago to see if would help, but still get pains.

I have asked my doctor for another x XXXXXXX but he doesent see the point as had 2 this year.I spend the majority of my time looking online for help. Would a CT scan help me?

Any assistnace would be greatly appreciated.

Thank you.
Posted Sun, 26 May 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 55 minutes later
Hi friend,
Welcome to Health Care Magic
- The characteristics of the pain are not typical of heart. Pain from the heart is oppressing, in central chest (and left), worse on effort, relieved by rest, may radiate to shoulders and arms, associated with sweating and so on.
- Normal ECHOcardiogram rules out problem of heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) / clots...
- Stress test excludes Ischemia (reduced blood flow).
The chance of heart disease is remote...
It is no use repeating the simple x-ray several times.
CT or MRI (no radiation exposure) of the chest AND spine may rule out most of the other possibilities...
It is probably muscle pain / Anxiety has a large if not an exclusive role.
Psychiatric consultation will be useful. Like a cardiologist excluding heart disease, they may at least be able to exclude or entertain the role of anxiety... Relaxation / yoga / Psychological assessment and assistance – will help
It is great that you stopped smoking / You have managed to come out of the clutches of the smoking diseases and addiction / Congratulations / Keep it up / it shows you have motivation and strong will – and you will come out of the present problem too...

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Consistent sharp chest pain that is noticeable with deep breathing, arm numbness. ECHO normal. Any ideas? 12 minutes later
Hi and thanks got your reply.

Could it be a chest infection? And what about left arm numbness? Could it be a lung problem? The pain comes before the anxiety? If it is muscle how long can it last for? As I am taking pain killers on a regular basis and worried of long term effects? Thanks.
Also when chiro presses around chest area it is quite sore and tender in spots. He works on the areas via the chest and back but pain still comes. Although one area he worked on the pain ceased but moved higher up the chest.
Answered by Dr. Anantharamakrishnan 4 hours later
- Infection is unlikely. It will be accompanied by local phenomena like cough / and systemic signs like fever, unless one is immuno-compromised. It will be reflected in blood tests - raised white cell count, ESR and so on...
- So will be the lung problem / if there was anything of importance, cough or breathlessness will follow / pneumonia is difficult to miss in X-ray!
- The pain can come before anxiety / it is a manifestation of anxiety / a physical symptom of psychological problem – hence called psychosomatic. Anxiety can cause pain > pain can cause anxiety > vicious cycle sets in
- The duration of muscle pain is variable / if it is spasm, it may be as short as a few seconds / or it can prolong for several days...
- The arm numbness is similar / also irritation of the nerve root is a possibility – that is why x-ray or MRI of spine is to be done
- Long term use of pain relievers can have side effects – stomach irritation / rise of pressure and so on. Some of them may be habit-forming.
- Tender spots and/or sore areas mean the problem is localised. Its moving up can be explained by from anxiety
Get yourself busy all through the weekdays / get deeply engrossed in work – you will have no time to think of illness!
Get out in the weekends – beach, park, cinema, play / XXXXXXX people, XXXXXXX family and friends, go places
As your wife rightly said, ‘man up’ / for every successful man, there is a woman behind! – you seem to have a sensible, strong and supportive one; take her help...

All the best
Above answer was peer-reviewed by
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