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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Suggest remedy for persistent pain in chest

Answered by
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Dr. Shailja Puri

Pathologist and Microbiologist

Practicing since :2006

Answered : 7059 Questions

How do I rule out Angina?
Have had chest pain off and on for 3-4 years, Pain is quite concentrated behind breast bone. No sweating or nausea,
3 yrs ago - went to emerg - Troponin levels normal, EKG normal; Stress test - Normal.
1 year ago - still had pain - physician did stress test and Barium swallow. Both Normal, After pain it feels like soreness and scratchiness in my esophagus,
Physician thought it was due to stress.
I retired and went to 2 days a week in January 2014.
The frequency did lessen but I still get the pains.
Thu, 14 Aug 2014 in Hypertension and Heart Disease
Answered by Dr. Shailja Puri 3 hours later
Brief Answer:
Cardiovascular evaluation...

Detailed Answer:

Chest pain can occur due to one of the following causes:
1. Ischemia of cardiac muscles- most common cause commonly called angina pectoris.
2. Gastro-esophageal reflux diseases (GERD): In GERD there is relfux of gastric contents into the esophagus. This causes burning sensation and also pain in the chest region which can radiate to shoulders and back.
3. Dissection of aorta: Dissection of aorta is usually an emergency, however, when the dissection is mild or when in its initial stage it can cause just pain in the chest
4. Esophageal causes: Esophagitis in the upper part of esophagus (besides GERD associated esophagitis) e.g. herpes or cytomagalovirus associated esophagitis.
5. Musculoskeletal pain: This can be associated with muscle associated or bone related disease.

Of these causes pain originating from heart condition - ischemia and dissection of aorta are classically reported as severe debilitation pain often associated with breathing difficulty and sweating. If you do not have this classical symptoms it is less likely to be from heart ischemia (angina). However we do not rule out angina pain based on symptoms alone.

Considering you had stress tests, ECG and troponin value as normal, if the pain characteristics hasn't changed from what it was few years ago (before tests), I would not include angina in my differentials now. But if the pain characteristics has changed, you will need to repeat the tests - stress test to assess the current status. Further a MRI of the chest region can also be done to know the status of blood vessels and muscloskeletal system.

Hope this answers your question. If you have more queries, I will be glad to answer.
Dr Shailja P Wahal

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