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Having pain in arm and back, feeling shortness of breath. Medical test normal. Any heart related problem?

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Hi a few days ago I was awoken with pain in my left arm and upper back. It was on and off but after going up my basement stairs i became moderatley out of breath, so I went to the ER. They gave me an ekg and blood work as well as a nitro pill. The ER Dr on call said that woman who present with these symptoms are kept overnight. The ekg was normal and bloodwork was negative for enzymes. The next day they gave me a stress test and an echo cardiogram all were perfect in Drs words. My questions are the tests that were performed enough to rule out any heart problem? I know an echo tests the functionality of the heart and the stress test checks for any blockage etc. I also read that if the nitro takes the symptoms away if usually heart related? but they also gave me toderol as well so I know thats a pain killer. The Dr also informed me that nitro can also take other pain away its not always directley related? I just want to make sure this is a clean XXXXXXX of health, I am following up with my GP but I dont know what can be done that aready wasnt? Thank you for your time and answer.
Posted Tue, 6 Nov 2012 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 2 hours later
Thanks for writing to us.
You seem to a very intelligent person indeed! – you have rightly suspected Coronary Artery Disease (CAD) and sought timely medical attention. And the best has been done.
> A negative blood work (cardiac markers / enzymes) has ruled out recent injury to the heart
> A negative stress EKG has ruled out chronic or underlying CAD, as the cause of your symptoms.
> An ECHOcardiography has also ruled out effects of coronary insufficiency – like abnormal wall thickness, movement and so on

> Yes – these tests are ENOUGH TO RULE out the PROBLEM

> Relief by nitroglycerine does NOT confirm Angina (heart pain) - the drug dilates and relieves spasm – esophageal spasm is also relieved. There are instances where it has been used to reduce severe spam in anal fissure! (Sorry for the example – but true).
In an emergency, it is generally given even without waiting for a diagnosis – for pain relief. No harm is done, if it is not heart pain / it helps if it is heart pain. For - in ER - treatment goes hand in hand and/or precedes diagnosis – Benefits must accrue early / No harm should be done.

There is nothing whatever to suggest a heart problem in the whole picture – except your initial description of the pain. And in a situation like this, we tend to think of the worst scenario and project it subconsciously.
It is very very uncommon to have CAD at this age, in the absence of positive risk factors (Family history / Smoking / Cholesterol / Diabetes etc...)
They might have done your lipid profile / or will be planning in a month
Everything has been done properly / everything is normal so far.
I don’t think you need anything else for the present – by way of medicine or investigation.

All the best
Good luck
Above answer was peer-reviewed by
Follow-up: Having pain in arm and back, feeling shortness of breath. Medical test normal. Any heart related problem? 21 hours later
Thank you very much Dr for your reply. Do you have any type of guess what might have caused those symptoms? Thanks again for you quick and thorough response.

Answered by Dr. Anantharamakrishnan 1 hour later
Thanks for writing back.
We know what it is not / We don't know what it is!
> Muscle spasm is the most likely cause - muscles of the chest wall...compounded or caused by tension of the situation.
> Cervical spondylosis - aging or degenerative changes of the neck vertebrae can press on the nerves and could cause pain at front or back of upper chest.
> Food pipe and wind pipe are there too. These structures can be involved by a variety of processes.
As you rightly said, it is a guess - watch for any pointers - following the lead may throw some light. If there is nothing, try to forget it and enjoy life...

God bless you
Good luck
Above answer was peer-reviewed by
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