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What Causes Brief Chest Pains Despite Having Normal Ultrasound And EKG?
Question: Hi,
I have been to the ER to have my heart checked out a few times after having what turned out to be anxiety sleeping. In that process I ended up going to a cardiologist locally as I was having anxiety wanting to have everything checked. I've had 5 ekg since April and a 48 hour Holter monitor. The ekg showed an unspecified delay or incomplete and the drs in the er weren't worried about it. Should I rest in that or is there any concern? Also I had a full ultrasound, had trivial reurgitaion on my mitrial and tricuspid valves and my heart function is normal. They said there was no follow up needed and was set. I've been having pinpoint chest pains since the ultrasound oddly enough and will have a stress test done. The pains are breif and come an go seemingly randomly and some cases depending on how I move my arm or shoulder. I also have had a more upset stomach, heart burn, and seem to get bloated much more easily. Sometimes it feels like there's a contraction in the lower center of my chest feeling like almost as if I burped inside my body while exhaling, it's a very weird sensation or like a short of breath for a second on the exhale. I'm not sure if I'm causing a vagus reflex by doing that, but I'm jus looking for some peace of mind. The Dr's don't seem to be worried and I want to be sure it justified. Thanks, XXX BTW I'm 27, fit, parents are both alive 60 and 66.
I am trying to relax and sleep tonight, my biggest fear is a heart attack and not waking up tomorrow. I was hoping for some reassurance.
I have been to the ER to have my heart checked out a few times after having what turned out to be anxiety sleeping. In that process I ended up going to a cardiologist locally as I was having anxiety wanting to have everything checked. I've had 5 ekg since April and a 48 hour Holter monitor. The ekg showed an unspecified delay or incomplete and the drs in the er weren't worried about it. Should I rest in that or is there any concern? Also I had a full ultrasound, had trivial reurgitaion on my mitrial and tricuspid valves and my heart function is normal. They said there was no follow up needed and was set. I've been having pinpoint chest pains since the ultrasound oddly enough and will have a stress test done. The pains are breif and come an go seemingly randomly and some cases depending on how I move my arm or shoulder. I also have had a more upset stomach, heart burn, and seem to get bloated much more easily. Sometimes it feels like there's a contraction in the lower center of my chest feeling like almost as if I burped inside my body while exhaling, it's a very weird sensation or like a short of breath for a second on the exhale. I'm not sure if I'm causing a vagus reflex by doing that, but I'm jus looking for some peace of mind. The Dr's don't seem to be worried and I want to be sure it justified. Thanks, XXX BTW I'm 27, fit, parents are both alive 60 and 66.
I am trying to relax and sleep tonight, my biggest fear is a heart attack and not waking up tomorrow. I was hoping for some reassurance.
Brief Answer:
Your pain is likely from you gastrointestinal tract, and or musculoskeletal, not heart.
Detailed Answer:
Hi XXXXXXX
Having the type of pain you are describing can be nerve wracking, but reading all the information you provided, it sounds like it is from your gastrointestinal tract (such as gastroesphogeal reflux - GERD) and possibly musculoskeletal.
When people come into the ER with chest pain, there are 3 main things that are likely the cause: heart problems (heart strain/angina, or heart attack), gastric problems, or musculoskeletal problems. Anxiety can make people feel like this too by causing rapid heart contractions. In the ER, suspicious heart problems are always the first focus if the cause of the chest pain is not clear.
Cardiac causes of pain do not increase with or occur specifically with movement of arm or shoulder as you describe. This is more likely related to musculoskeletal pain.
And you mention several GI symptoms - upset stomach, heartburn, bloating.
I feel comfortable with the cardiac work up you have had. And if the docs you've seen thought you are likely to have a sudden heart attack, they wouldn't have you do a stress test.
About the unspecified delay on the EKG, I don't know specifically what it is they saw. However, with 5 EKGs and a 48 hour Holter, if something truly concerning in the EKG tracing were to be present, it would have shown on these. There are many anomolous things that can show up on the EKG that are not concerning - i.e. do not indicate anything wrong. Cardiologists are truly experts at knowing which of these things can be ignored, so I think you can rest assured that whatever was seen on the EKG isn't anything to worry about.
Given all of these things together, plus your family history, your age, the normal tests, and the nature of your pain, I feel strongly that you can safely go to sleep without risk of heart attack during the night.
So what to do now. For tonight, if you are still having trouble sleeping, try counting your breaths. One technique is to inhale counting to 4 in your mind and exhale counting to 4 in your mind. Do this for 4 breath cycles and then start over. Focus on your breaths throughout. If worrisome thoughts come in to your mind, just acknowledge these thoughts, don't try to fight them, and then gently let them go and return to thinking about your breaths.
Now I think the GI symptoms need to be addressed. Tonight if it is bothering you, you can try an antacid, such as Mylanta or Tums if you have such things around. Tomorrow consider going to a drug store and getting Zantac 150mg. Take this twice a day - it may take a few weeks until you are healed if there is any gastro-esophogeal irritation. If it is not getting better, consider seeing your primary doctor. The proton pump inhibitor acid reducers may work faster and better than Zantac, but new studies show they can cause a rebound in acid production when discontinued, and can lead to heart problems. The H2 blockers such as Zantac, however, have been around longer and do not cause either of these problems. You can go up to 300mg twice a day of the Zantac, but I would want you to be seen by your primary doctor before doing this.
By the way, the location you described of the trapped burp sensation - lower center of your chest - is most likely the lower part of your esophagus.
The 2nd thing that will help is addressing the anxiety. If you never had anxiety before and it has come on now because of concern over the chest symptoms, then I would expect it to be getting better with reassurance; and perhaps you could benefit from a prescription for an anti anxiety medicine for a short time. Such as a brief prescription for lorazepam or alprazolam. These might help you sleep too.
But if you feel that anxiety has been an ongoing problem for some time, you may want to see your doctor about starting a daily prescription with a long term anti anxiety medicine such as an SSRI. Lexapro (escitalopram) has one of the best side effect profiles, and good efficacy. SSRIs take some time to work (Lexapro takes around 2 weeks to really kick in) and so an as-needed anti anxiety medicine like those mentioned above can be used during this time too.
I hope you get some sleep tonight, and feel better soon. Please let me know if I can help provide more information or clarification.
Your pain is likely from you gastrointestinal tract, and or musculoskeletal, not heart.
Detailed Answer:
Hi XXXXXXX
Having the type of pain you are describing can be nerve wracking, but reading all the information you provided, it sounds like it is from your gastrointestinal tract (such as gastroesphogeal reflux - GERD) and possibly musculoskeletal.
When people come into the ER with chest pain, there are 3 main things that are likely the cause: heart problems (heart strain/angina, or heart attack), gastric problems, or musculoskeletal problems. Anxiety can make people feel like this too by causing rapid heart contractions. In the ER, suspicious heart problems are always the first focus if the cause of the chest pain is not clear.
Cardiac causes of pain do not increase with or occur specifically with movement of arm or shoulder as you describe. This is more likely related to musculoskeletal pain.
And you mention several GI symptoms - upset stomach, heartburn, bloating.
I feel comfortable with the cardiac work up you have had. And if the docs you've seen thought you are likely to have a sudden heart attack, they wouldn't have you do a stress test.
About the unspecified delay on the EKG, I don't know specifically what it is they saw. However, with 5 EKGs and a 48 hour Holter, if something truly concerning in the EKG tracing were to be present, it would have shown on these. There are many anomolous things that can show up on the EKG that are not concerning - i.e. do not indicate anything wrong. Cardiologists are truly experts at knowing which of these things can be ignored, so I think you can rest assured that whatever was seen on the EKG isn't anything to worry about.
Given all of these things together, plus your family history, your age, the normal tests, and the nature of your pain, I feel strongly that you can safely go to sleep without risk of heart attack during the night.
So what to do now. For tonight, if you are still having trouble sleeping, try counting your breaths. One technique is to inhale counting to 4 in your mind and exhale counting to 4 in your mind. Do this for 4 breath cycles and then start over. Focus on your breaths throughout. If worrisome thoughts come in to your mind, just acknowledge these thoughts, don't try to fight them, and then gently let them go and return to thinking about your breaths.
Now I think the GI symptoms need to be addressed. Tonight if it is bothering you, you can try an antacid, such as Mylanta or Tums if you have such things around. Tomorrow consider going to a drug store and getting Zantac 150mg. Take this twice a day - it may take a few weeks until you are healed if there is any gastro-esophogeal irritation. If it is not getting better, consider seeing your primary doctor. The proton pump inhibitor acid reducers may work faster and better than Zantac, but new studies show they can cause a rebound in acid production when discontinued, and can lead to heart problems. The H2 blockers such as Zantac, however, have been around longer and do not cause either of these problems. You can go up to 300mg twice a day of the Zantac, but I would want you to be seen by your primary doctor before doing this.
By the way, the location you described of the trapped burp sensation - lower center of your chest - is most likely the lower part of your esophagus.
The 2nd thing that will help is addressing the anxiety. If you never had anxiety before and it has come on now because of concern over the chest symptoms, then I would expect it to be getting better with reassurance; and perhaps you could benefit from a prescription for an anti anxiety medicine for a short time. Such as a brief prescription for lorazepam or alprazolam. These might help you sleep too.
But if you feel that anxiety has been an ongoing problem for some time, you may want to see your doctor about starting a daily prescription with a long term anti anxiety medicine such as an SSRI. Lexapro (escitalopram) has one of the best side effect profiles, and good efficacy. SSRIs take some time to work (Lexapro takes around 2 weeks to really kick in) and so an as-needed anti anxiety medicine like those mentioned above can be used during this time too.
I hope you get some sleep tonight, and feel better soon. Please let me know if I can help provide more information or clarification.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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