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Had TMT, chest Xray and EGC done, all normal. Have chest pain and gastric issues with anxiety. Suggest?

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Practicing since : 1998
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I had a TMT chest Xray and EGC done.. They all show normal, but I at times feel pain in the chest. I also have gastric issues for over a year now, and I also have anxiety. No matter how much I convince my self I still feel there could be something wrong in my heart
Posted Sun, 22 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 28 minutes later
Brief Answer:
Good results. may get ECHO, Non-cardiac issues may

Detailed Answer:
Dear Sir
1. I have seen your TMT report. The cardiologist has reported it to be NEGATIVE FOR INDUCIBLE ISCHEMIA. That means there is no evidence of ischemic heart disease or anginal heart disease. Your exercise capacity is excellent (13.30 METs). For your age exercise capacity of > 11.7 METs is excellent. Hence there are no issues on this front. (I hope you remained asymptomatic during TMT)
2. Your ECG and x-ray chest are also reported to be Normal.
3. A chest pain can have many causes which include (but not the complete list) local pain arsing from soft tissue/ muscles/ bone, pain from gut, pain from spine. pain from lungs/ its coverings/ pain form upper abdominal organs. Each one of them has a characteristic history and physical examination. However the most dreadful cause i.e. anginal heart disease is not there. A cause related to heart which can cause atypical chest pain and which is not picked up on TMT is "Mitral valve prolapse". For this a cardiac ultrasound or ECHO has to be done. That will also help in ruling out other structural heart diseases also and will reassure you.
4. For other , non-cardiac causes you need to get yourself examined by a physician.
Hope this helps. Feel free to discuss further.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Had TMT, chest Xray and EGC done, all normal. Have chest pain and gastric issues with anxiety. Suggest? 10 minutes later
Dr. Sukhvinder Sing, Thanks for your reply. I would like you to know that the pain I get is very dull.. It sometimes feels like a strain in the muscle and it is mostly where the ribcage XXXXXXX in the pit or just below shoulder ... I am told my my physician that I will require no more tests as he feels that the issue is not serious are requires my attention. But I just wanted a reassurance that I am fine.. However, my situation does not prevent me from doing my day to day work.. Could you please let me know if the ECHO is really necessary?
Answered by Dr. Sukhvinder Singh 43 minutes later
Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. The possibility of this pain to be related to anginal heart disease has been ruled out by your TMT to a large extent. If your pain is elicitable by touch pressure or a particular movement, then it is more likely to be skeletal or muscular.
2. The chances of MVP (atypical chest pain which can not be detected on TMT. It requires ECHO to be ruled out and ECHO will give other information too. Without examination, it can not be said that if ECHO is essential or non-essential. Your cardiologist is best judge. However your TMT result is very reassuring & it is a good indicator that you have a healthy heart.
Hope this helps.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Had TMT, chest Xray and EGC done, all normal. Have chest pain and gastric issues with anxiety. Suggest? 8 minutes later
Thank you very much ,For the time and effort put.. It have brought in a calmness within me after being re assured that my heart is healthy. However, I shall take your advice and get an ECHO done though I have not observed anything as mentioned above. Further to your analysis I might just conclude the pain to be Non- Cardiac chest pain which could be due to my gastric or Anxiety... I assume you would feel the same too/...
Answered by Dr. Sukhvinder Singh 3 hours later
Brief Answer:

Detailed Answer:
Dear Sir
Definitely if a pain does not come up with 13.3 METS of exercise, it surely can not be anginal.
Above answer was peer-reviewed by
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