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What Causes Chest Pain Inspite Of Having Negative D-dimer?

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Posted on Tue, 22 Apr 2014
Question: Hi, I have been suffering from sharp chest pains, directly above the heart, for 4 days now. I am also experiencing shortness of breath. The pain initially started in my lower abdomen. The pain is not made worse/brought on by applying pressure anywhere on the left side of my chest. I went to a clinic, where I had a work-up of a chest X-ray, blood work, and an EKG. I was called in and told to go directly to the emergency room, as they were suspicious of a possible clot or an aortic dissection. The hospital performed the same tests mentioned previously, as well as a D-Dimer test and a lung scan. They did not look into my heart or aorta besides the EKG. I continue to have these pains, and am concerned about my CXR. The doctor had mentioned a few things that worried me... that my AP window (?) was not very pronounced, and that my pulmonary valve seemed enlarged. They sent me home and told me to wait and see, mentioning that it was probably chest wall pain (even though the pain is not worsened or brought on by pressure). My blood work and EKG were normal (though the first doctor I saw said that only a CT scan could rule out the aorta issue, hence my worry). I have a copy of my chest X-Ray I can show you. Thank you,
doctor
Answered by Dr. Jorge Brenes-Salazar (53 minutes later)
Brief Answer: Reasonable to request Echo (heart ultrasound) Detailed Answer: Dear XXXXXXX Thanks for the query. The chest pain is not typical for coronary artery disease, which is quite rare in your young age group. A negative d-dimer (normal) virtually excludes an acute aortic dissection; I agree that your pulmonary artery seems at least on the CXR a bit prominent; the best next step, if there are concerns about structural heart disease would be an echocardiogram, or ultrasound of the heart, given the shortness of breath associated with the symptoms; this will give you a great assessment of the heart valves and can look at the proximal aorta and pulmonary artery. If it is a normal heart ultrasound, it would provide reassurance and extra-cardiac causes of the symptoms should be sought. Hope that helps, wish you the best, Dr Brenes-Salazar MD Mayo Clinic MN Cardiology
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Jorge Brenes-Salazar

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Practicing since :2007

Answered : 1198 Questions

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What Causes Chest Pain Inspite Of Having Negative D-dimer?

Brief Answer: Reasonable to request Echo (heart ultrasound) Detailed Answer: Dear XXXXXXX Thanks for the query. The chest pain is not typical for coronary artery disease, which is quite rare in your young age group. A negative d-dimer (normal) virtually excludes an acute aortic dissection; I agree that your pulmonary artery seems at least on the CXR a bit prominent; the best next step, if there are concerns about structural heart disease would be an echocardiogram, or ultrasound of the heart, given the shortness of breath associated with the symptoms; this will give you a great assessment of the heart valves and can look at the proximal aorta and pulmonary artery. If it is a normal heart ultrasound, it would provide reassurance and extra-cardiac causes of the symptoms should be sought. Hope that helps, wish you the best, Dr Brenes-Salazar MD Mayo Clinic MN Cardiology