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Dr. Andrew Rynne

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What causes chest pain radiating through the left arm?

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Dr. Benard Shehu

Cardiologist

Practicing since :2004

Answered : 2254 Questions

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Posted on Wed, 6 Aug 2014 in Hypertension and Heart Disease
Question: Unspecified chest pain:
Hello I've been having chest pain radiating through my left arm. It is not persistent. It comes and goes. When it comes, it stays longer. I've been to cardiologists and ER. But unfortunately, I did not have the symptoms when I went to doctor. I have got many EKGs, 2 stress tests. Everything normal. But I still have the pain which comes and goes. I also have irregular heart beats. My heart rate goes up when I standup. now a days, I am easily getting tired. Could you please suggest anything? Should I get done any angiography or CT angiogram to make sure there is no blockage for sure?
doctor
Answered by Dr. Benard Shehu 1 hour later
Brief Answer:
Non-cardiac problems to rule out...

Detailed Answer:
Hi there,

I have gone through your medical history and understood your concerns.

At this point when your EKGs, stress test resulted normal, then, we should look for causes not related to heart. Therefore, I advise to run following tests:
- abdominal ultrasound and upper endoscopy to exclude stomach problems (gastritis, ulcer, GERD)
- chest X-ray (lateral view) to exclude pulmonary and vertebral problems
- thyroid function tests
- measure the electrolytes and gases in blood
- run further biochemical testings

No need to run angiography as all other cardiac tests resulted normal. You can run the above-mentioned tests and can send the reports to me!
Dr.Benard
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Benard Shehu 22 hours later
Hello Doctor,
Thank you for the reply. Below are the test that are done till now
- Chest X-ray twice: Normal
- Electrolytes: Normal
- Thyroid level: Normal
Below are the symptoms that are bothering me
- Left arm pain originating either from neck, or just below the collar bone or from chest. Sometimes it lasts for a day.
- Sudden numbness or tingling in left arm: I had this symptom 3 times this week. Yesterday night, I woke up twice with numbness or tingling in left arm which lasted for couple of minutes.
- Sometimes, I feel tingling or numbness on left part of the head
- Sometimes, I feel tightness in my left leg
- My heart rate goes up when I standup suddenly. I feel as if I am going to fall down
- Sometimes, I feel tightness on back side of my neck when I standup and start walking.
- Sometimes, I feel chills for no reason

Below are my questions:
- Could there be any blockages that are missed in EKG and stress test
- I didn't have the pain when EKG or stress test was being done. So, could they be missing anything?
- Could it be unstable angina which is not being detected during the tests.
Please suggest.
Thanks,
XXXX
doctor
Answered by Dr. Benard Shehu 32 hours later
Brief Answer:
Following answers to your queries...

Detailed Answer:
Hi back,

Thank you for following up.

- Could there be any blockages that are missed in EKG and stress test

There is less chance to get any blockage missed in EKG (20-30%) while there is only low probability to miss it in a stress test.

- I didn't have the pain when EKG or stress test was being done. So, could they be missing anything?

The stress test is done where you are at least 48 hours free of pain and one of the criteria of a positive stress test is pain during exercise. There is little chance to miss anything (theoretically).


- Could it be unstable angina which is not being detected during the tests.

Even in case of angina, there is almost 0 chance not to get detected during the tests.

To my opinion, you have a high probability having an extra-cardiac condition (i.e. GERD) that should be treated accordingly.

I advise to get stress test repeated after 6 months to exclude completely any doubt about cardiac problems.

Hope it answered to your queries!
Dr.Benard
Above answer was peer-reviewed by : Dr. Yogesh D
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