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What Causes Left-sided Chest Pain With Arm And Jaw Pain And Sweating?
Question: Dear Sir,
I'm a 29 year old active sporty man with ideal BMI no diabetes no high cholesterol or high blood pressure but I smoke 15 cigarettes per day ...for a long time I had diffuse pain in my chest and after a long day at work I experienced heart attack symptoms like pain in my left chest cold sweeting arm pain and pain in my jaw. It felt like a schock running through my body and lasted for XXXXXXX 5 minutes. Two weeks after that event I went to a doctor he did an ecg ant tropotonin test . Blood test was negative but he said the ecg shows an old infarct. He sent me to ER where the tests have been repeated both ecg and blood showed normal results. Meanwhile I did an two ecgs,24h ecg and 24 BP,normal Echo, stress ecg (Max. Heart frequency 175 / 220 watt), stress echo(max. Heart frequency 185 / 250 Watt), MRI with late enhancement and an cardiac CT. All tests have been normal...can I rule out a cardiac event(heart attack) due to the tests performed?I'm still scared and have panic attacks. Thanks in advance.
I'm a 29 year old active sporty man with ideal BMI no diabetes no high cholesterol or high blood pressure but I smoke 15 cigarettes per day ...for a long time I had diffuse pain in my chest and after a long day at work I experienced heart attack symptoms like pain in my left chest cold sweeting arm pain and pain in my jaw. It felt like a schock running through my body and lasted for XXXXXXX 5 minutes. Two weeks after that event I went to a doctor he did an ecg ant tropotonin test . Blood test was negative but he said the ecg shows an old infarct. He sent me to ER where the tests have been repeated both ecg and blood showed normal results. Meanwhile I did an two ecgs,24h ecg and 24 BP,normal Echo, stress ecg (Max. Heart frequency 175 / 220 watt), stress echo(max. Heart frequency 185 / 250 Watt), MRI with late enhancement and an cardiac CT. All tests have been normal...can I rule out a cardiac event(heart attack) due to the tests performed?I'm still scared and have panic attacks. Thanks in advance.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
Welcome and thank you for asking on HCM!
I passed carefully through your medical history and would like to explain as follows:
Your clinical symptomatology (chest pain irradiating to the jaw, sweating, etc), as you confirmed are really suggested for a cardiac ischemia episode.
But, even if it were really so, 5 minutes symptomatology are insufficient to cause any obvious myocardial damage (infarction).
From the other side, according to the current guideline of the universal definition of myocardial infarction, I could reassure you that there are not sufficient criteria for a myocardial infarction conclusion.
If you really had a myocardial infarction (heart attack), whichever it could be (old or a new one) the already performed cardiac CT and especially MRI with late enhancement would have revealed the myocardial scar (in case of a real heart attack: myocardial infarction).
The above interpretation is strongly supported by the other normal cardiac tests (resting ECGs, resting and stress ECHO, cardiac (ECG) stress test.
Besides what has confirmed the doctor form the first ECG, every other performed test has resulted normal, giving us the most powerful medical evidence of excluding a heart attack.
That's why I am glad to reassure you that no heart attack seems to exist. What you have experienced lately has not been a cardiac ischemia at all.
So relax again and don't worry about!
As you have not coronary risk factors (no diabetes, no obesity, no dyslipidemia, no hypertension) except for smoking, I would like to emphasize that smoking should be stopped immediately.
You are a young man, healthy, vivid, sporty; and nothing could stop you from being so for a very long time, except smoking.
You should consider smoking an aggressor ready to harm you unexpectedly.
Hope to have been helpful to you.
In case of further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello,
Welcome and thank you for asking on HCM!
I passed carefully through your medical history and would like to explain as follows:
Your clinical symptomatology (chest pain irradiating to the jaw, sweating, etc), as you confirmed are really suggested for a cardiac ischemia episode.
But, even if it were really so, 5 minutes symptomatology are insufficient to cause any obvious myocardial damage (infarction).
From the other side, according to the current guideline of the universal definition of myocardial infarction, I could reassure you that there are not sufficient criteria for a myocardial infarction conclusion.
If you really had a myocardial infarction (heart attack), whichever it could be (old or a new one) the already performed cardiac CT and especially MRI with late enhancement would have revealed the myocardial scar (in case of a real heart attack: myocardial infarction).
The above interpretation is strongly supported by the other normal cardiac tests (resting ECGs, resting and stress ECHO, cardiac (ECG) stress test.
Besides what has confirmed the doctor form the first ECG, every other performed test has resulted normal, giving us the most powerful medical evidence of excluding a heart attack.
That's why I am glad to reassure you that no heart attack seems to exist. What you have experienced lately has not been a cardiac ischemia at all.
So relax again and don't worry about!
As you have not coronary risk factors (no diabetes, no obesity, no dyslipidemia, no hypertension) except for smoking, I would like to emphasize that smoking should be stopped immediately.
You are a young man, healthy, vivid, sporty; and nothing could stop you from being so for a very long time, except smoking.
You should consider smoking an aggressor ready to harm you unexpectedly.
Hope to have been helpful to you.
In case of further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. lliri,
thanks for your statement. Is an MRI with late enhancement a reliable tool to identify a scare? It was performed by a well trained radiologist. You read so many different information in the internet some say yes nearly 100% sensitivity some say no only a angiography can give a answer. The same with the echo and the ecg. Definitely my girl encouraged me to do so well in 2016 I will be a non smoker I do not want to experience fears like that knowing that this was my fault. XXXX
thanks for your statement. Is an MRI with late enhancement a reliable tool to identify a scare? It was performed by a well trained radiologist. You read so many different information in the internet some say yes nearly 100% sensitivity some say no only a angiography can give a answer. The same with the echo and the ecg. Definitely my girl encouraged me to do so well in 2016 I will be a non smoker I do not want to experience fears like that knowing that this was my fault. XXXX
Brief Answer:
Opinion as follows:
Detailed Answer:
Hi again,
Regarding your concern about MRI with late enhancement, I could explain that it is not only scientifically approved standard for detecting myocardial perfusion defects related to myocardial damage and scar, but also to differentiate between underlying causes (myocardial infarction [subendocardial or transmural enhancement patterns], dilated cardiomyopathy or late stages of heart failure [mid-wall or central enhancement], healthy tissue or diffuse fibrosis [no-hyperenhancement], etc).
So if correctly performed and in expert hands; also using inversion recovery gradient recalled echo sequence, which is commonly accepted as the standard of reference for cardiac MRI with delayed enhancement, this test is very highly sensitive and specific (>98%); quite superior to other usual cardiac tests.
Cardiac MRI may detect myocardial infarction even when coronary arteries have resulted normal by coronary angiogram (a minority of myocardial infarctions occur in the absence of coronary lesions).
With that 5 minute-chest discomfort and all the medical tests normal you don't need a coronary angiogram.
I would conclude that, facing all the above mentioned normal cardiac tests, you have not suffered from any heart attack.
So, relax and don't worry about!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hi again,
Regarding your concern about MRI with late enhancement, I could explain that it is not only scientifically approved standard for detecting myocardial perfusion defects related to myocardial damage and scar, but also to differentiate between underlying causes (myocardial infarction [subendocardial or transmural enhancement patterns], dilated cardiomyopathy or late stages of heart failure [mid-wall or central enhancement], healthy tissue or diffuse fibrosis [no-hyperenhancement], etc).
So if correctly performed and in expert hands; also using inversion recovery gradient recalled echo sequence, which is commonly accepted as the standard of reference for cardiac MRI with delayed enhancement, this test is very highly sensitive and specific (>98%); quite superior to other usual cardiac tests.
Cardiac MRI may detect myocardial infarction even when coronary arteries have resulted normal by coronary angiogram (a minority of myocardial infarctions occur in the absence of coronary lesions).
With that 5 minute-chest discomfort and all the medical tests normal you don't need a coronary angiogram.
I would conclude that, facing all the above mentioned normal cardiac tests, you have not suffered from any heart attack.
So, relax and don't worry about!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor, thanks so much. I still feel discomfort /pain in my left chest arm and shoulder for the last two month. Im also very tired and stressed. I stopped all my activities maybe this made it more worse and the symptoms are anxiety driven. I should 're visit my orthopedic and maybe a neurological doctor cause this often feels like nerve pain. what do you think about the CT? It only was a 64 slice and I saw the picture once and from the view of a non professional the 3D pictures looked useless but the black and white pictures where you can see the way of the coronary arteries looked fine. Do the doctors have special diagnostic opportunities or "just" watching on the pictures? In the letter from my doctor stated calcium score=0 and no plaque related stenosis identified in LCA, Riva, RCA and RCX. Normal wall thickness of left chamber, no evidence of a heart attack.Do you see an MI in the CT?where do you practice? Very sympathic THX!!!
Brief Answer:
I could explain:
Detailed Answer:
Hi,
I could say that optimal views of your cardiac CT would clearly rule in/out possible coronary lesion.
The fact no plaque related stenosis are identified in your coronary arteries, furthermore your calcium score is 0, supports the strong conclusion you are not suffering from ischemic heart disease.
I would reassure you that all the set of possible cardiac tests confirms you have not suffered from any heart attack or stable coronary disease.
You should relax!
I stead try to control your anxiety and also discuss with the other doctors (orthopedist, neurologist) for properly addressing alternative causes of your chest discomfort.
I have my daily medical practice at University Hospital "Mother Theresa" Tirana, ICCU.
Feel free to discuss with me further possible medical uncertainties.
Regards,
Dr. Iliri
I could explain:
Detailed Answer:
Hi,
I could say that optimal views of your cardiac CT would clearly rule in/out possible coronary lesion.
The fact no plaque related stenosis are identified in your coronary arteries, furthermore your calcium score is 0, supports the strong conclusion you are not suffering from ischemic heart disease.
I would reassure you that all the set of possible cardiac tests confirms you have not suffered from any heart attack or stable coronary disease.
You should relax!
I stead try to control your anxiety and also discuss with the other doctors (orthopedist, neurologist) for properly addressing alternative causes of your chest discomfort.
I have my daily medical practice at University Hospital "Mother Theresa" Tirana, ICCU.
Feel free to discuss with me further possible medical uncertainties.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hey, last question, if I would come to your hospital telling you my story what kind of tests would you have done? is stress echo testing sensitivie in identifying heart attacks? I'm going on vacation on the 25th, based on the information given you would tell me not to worry I was scared but I try to relax. I wish you merry Christmas and a happy New year . Thank you very much and best regards from Germany
Brief Answer:
You are welcome!
Detailed Answer:
Hi,
Probably after a careful physical exam, resting ECG, lab tests (cardiac enzymes), cardiac ultrasound, stress test, I would conclude my investigation regarding possible cardiac issues after reviewing your coronary angio CT.
Stress echo is highly sensitive in detecting hidden cardiac ischemia, but after undergoing coronary angio CT and cardiac MRI it would be useless.
I am repeating again that your symptoms have nothing to do with your heart, other alternatives should be sought instead.
Hoping you have a nice time on your vacation.
Wishing you all the best for the New Year!
Merry Christmas!
Dr. Iliri
You are welcome!
Detailed Answer:
Hi,
Probably after a careful physical exam, resting ECG, lab tests (cardiac enzymes), cardiac ultrasound, stress test, I would conclude my investigation regarding possible cardiac issues after reviewing your coronary angio CT.
Stress echo is highly sensitive in detecting hidden cardiac ischemia, but after undergoing coronary angio CT and cardiac MRI it would be useless.
I am repeating again that your symptoms have nothing to do with your heart, other alternatives should be sought instead.
Hoping you have a nice time on your vacation.
Wishing you all the best for the New Year!
Merry Christmas!
Dr. Iliri
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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