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Losing weight. EKG reports normal. No family history of heart disease. Having chest pain. Worrisome

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Practicing since : 2004
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37 y/o male; 6'1" 260lbs large build, engage in strength training twice a week and cardio three to four times a week. Have lost 40 pounds since December 2011. Clean EKG and general physical about six months ago for part of work-up prior to heading overseas for work. No family history of heart disease on mothers side, fathers side is unknown. Began having intermittent chest pain approx two days ago. Initially pain was very mild and followed a day in bed from a bad sinus headache, so assumed was skeletal/muscular. Pain feels as though it is rear left quadrant of chest, about six inches left of spine, under shoulder blade, located behind the rib cage with repect to depth (although does "move forward" from time to time). Pain comes and goes, with total relief as it disappears. Pain level varies from a 1 to about 4. Frequency started as a few times an hour, but now is basically alternating between a minute of relief followed by about a minute of pain. No other pain or symptoms at first, but now feeling some shoulder and neck (but may be anxiety?).
Posted Thu, 19 Jul 2012 in General Health
Answered by Dr. Ashish Mittal 21 minutes later
Thanks for your query.

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

You case is interesting and but difficult too considering symptoms profile. I will try to give my best effort to help you in this problem.

I would like to consider multiple possibilities in following hierarchy:
•     Anxiety disorder: specially if it is associated with excessive worry, restlessness, dry mouth, tremors and sleep difficulty. Anxiety increases chances muscle spasm and pain. As you are already having thyroid problem which further increases chances of developing anxiety.
•     Thyroid related problem: As you are already on Synthyroid 125mcg. Get thyroid hormonal assay (T3/T4 and TSH) done. Thyroid problem may be one of the cause for weight loss apart from exercise.
•     Vitamin deficiency: Get serum B12 level. Start multi vitamins as they are easily available.
•     Side effect of substance use (stop use gradually, if present)
•     Cardiac illness: need electrocardiogram (ECG) and 2D-Echo to confirm.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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