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Dr. Andrew Rynne

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What causes chest pain?

Answered by
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Dr. Sukhvinder Singh

Cardiologist

Practicing since :1998

Answered : 1306 Questions

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Posted on Mon, 11 Aug 2014 in Hypertension and Heart Disease
Question: Unspecified chest pain
doctor
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see below.

Detailed Answer:
Dear madam
Will you please elaborate more on your pain. It's exact site, duration, where it goes, how is it precipitated and relieved, what are other complaints associated with it like cough, breathlessness, fever, local swelling etc.
All this will help me understanding the nature of your pain. Please also do mention your current medical illnesses and treatment.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sukhvinder Singh 15 hours later
Thank you for the reply. Below are the details.

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?

Below are other tests 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. Sukhvinder Singh 20 minutes later
Brief Answer:
please see below.

Detailed Answer:
Dear madam
A normal stress test and absence of repetition of symptoms during stress are strong points against anginal chest pain. No angiography is not I dictated if stress test is normal with good exercise capacity. Unstable angina is medical emergency and is not a chronic disease. It is a precursor of heart attack. A female with age 32 with normal menses with no history of smoking or diabetes or steroid intake, is unlikely to have heart attack.
Historically, there are two different things. First , tingling , numbness and discomfort in hand, arm and neck may be related to cervical spine problem. At your age it is mostly weakness of muscles around cervical spine. Do see a neurologist.
Second, palpitation, high heart rate, giddiness on sudden standing may be features of orthostatic hypotension. You have to get it confirmed by a neurologist by simple BP measurements in office. Drink a lot of water. Take adequate amount of salt.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh 24 hours later
Doctor:
Thank you for the response. I'll check with neurologist. Before that I would like to clarify few things listed below:
- My first stress tested lasted only for 8 minutes. My heart rate reached 180 at 8th minute and was tired. So the test was stopped
- 2nd stress test lasted only for 5 minutes. I was tired really soon and HR reached 180 and the test was stopped.
This concerns me a lot.
Also, I am having chills, cold feet and cold hand. Are these related to any symptoms of heart disease or blockage? should I get any further test done just to rule out any heart problems?
Please advise
doctor
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see below.

Detailed Answer:
Dear madam
Low exercise capacity is bad for general health. The apparent cause for low exercise capacity should be looked into before getting further tests. Low hemoglobin, unaccustomed muscles due to sedantary life style, heart disease, kidney disease etc may be responsible. Further cardiac testing should be done if no other cause is apparent or there are clinical clues towards heart disease. You should consult a good clinical cardiologist before getting any more tests.
The symptoms of cold feet etc occur in heart disease if pumping is too low which can be ascertained by ECHO. Hope ECHO was done at time of stress test.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh 8 hours later
Hello Doctor:
Thank you very much for your inputs. My first test was stress echo in XXXXXXX 1st. This came out normal. 2nd test was only treadmill test 2 last week, which lasted only for 5 minutes. I am recently developing these symptoms. So my questions are:
Should I get another echo done?
What does an echo detect?, does it detect any blocked arteries or any plaque built up around the arteries? what does the test reveal?
Could you please let me know?

Thanks,
XXXX
doctor
Answered by Dr. Sukhvinder Singh 3 hours later
Brief Answer:
please see details

Detailed Answer:
Dear madam
1. If your first ECHO was normal, another ECHO should be done only if you have new clinical signs suggestive of cardiac dysfunction. They can be ascertained by any good clinician/ physician/ cardiologist.
2. An ECHO is ultrasound of heart. It shows structure of heart and flow of blood. It can detect valve damage, leakage or obstruction of valve, evidence of major heart attack and general functions of heart. It does not show the arteries or plaque directly, However stress ECHO is indirect test for arterial blockade.
3. In case of easy fatigability or low exercise capacity, it can detect low pumping, relaxation abnormality or valve damage.
A clinical examination is first thing you should undergo.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh 2 days later
Thank you, Doctor for your reply.
I had another echo on Friday with my cardiac. Echo came out normal. What more frustrating is, I am getting everyday different types pain on left side chest area. For example, Friday evening I got a sudden pain which started near arm pit and radiated towards to the center of the chest. It lasted for 2-3 minutes. Then, it went off. Saturday entire day, I had pain below left collar bone. The pain was radiating to my throat, my left arm and lower jaw. Whenever I bent, it hurt a lot. Sometimes, it also used to hurt when I took my breath. From yesterday, I am also observing I get a sharp electric pain at my chest and radiates to left arm whenever I climbed the stairs. But, I am just calming down myself because my echo was normal. Do you have any idea what might be going on? Please help me
doctor
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see details.

Detailed Answer:
Dear madam
Pain which comes at different site in chest, has different character in different episodes, sharp or electrical in nature or which worsens on bending are least likely to be cardiac in origin. We always look for other causes first in such cases.
A neurologist or orthopedician will be in a better position to guide you. Preferably a good orthopedician. Anxiety also aggravates such kind of pain.
An ECHO does not essentially rule out cardiac origin of pain and stress echo is the test of choice for same. But as I suggested before, get yourself evaluated by a good clinician before any test.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sukhvinder Singh 32 hours later
Thank you, Doctor.
I'll check with my family doctor and follow up with you accordingly.
doctor
Answered by Dr. Sukhvinder Singh 43 minutes later
Brief Answer:
You are welcome

Detailed Answer:
Dear Madam
You are welcome.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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