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What causes pain and discomfort in left arm radiating to chest?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5460 Questions

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Posted on Thu, 10 Sep 2015 in Hypertension and Heart Disease
Question: Some background:
I am 42 year old male who is diabetic that suffers from high blood pressure. I take Janumet, Atenelol and Actos and a daily aspirin. My blood sugars in the morning are between 150-200 and by blood pressure is usually 140/95 to 156/103. I now take clonodine when my diastolic number goes above 100. I also feel bloated a lot.

I feeling a dull aching discomfort in my left arm and a moving discomfort around my chest. One moment it is on the right side of my left chest, then it is in the middle then it is right below my left chest.

I went to a doctor. He stated that it was neuropathy and gave me gabapentin.

I EKG that came back negative in February of this year. I had an echo done in April of this year which was negative. I had a holter monitor placed on me for 3 days in 2013 and that was negative. I had a CT of my head done in the Summer of 2014-negative.

The continuous discomfort as me concerned. Especially when I am laying down. I feel a pressure on my chest when I shift to the left or to the right. I was previously feeling almost like "blood pressure" to my head (but that has not happen recently).

Should I trust the diagnosis of being neuropathy or possibly a pinch nerve (not stated by the doctor)?
doctor
Answered by Dr. Ilir Sharka 59 minutes later
Brief Answer:
A careful differential diagnosis is necessary.

Detailed Answer:
Hello XXXXX!

Welcome and thank you for asking on HCM!

Regarding your left arm and chest discomfort, I would like to explain that it is highly suspicious; and a comprehensive differential diagnosis should be performed to exclude first of all an ischemic heart disorder.

In fact, your pain has several features, which make it quite atypical for being cardiac ischemia related (its fast migratory character, posture-related pain modulation, prolonged duration).

Your doctor conclusion seems to be rationale at first look. As you are suffering from diabetes, the possibility of a diabetic neuropathy should be promptly ruled in/out by performing a careful neurological evaluation coupled with electroneuromyography which will define if the disorder is present.

But, as you have several coronary risk factors and the pain nature is a bit confounding, it is necessary to exclude/confirm an ischemic heart disorder.

A standart exercise cardiac stress test, or more sophisticated imagine tests alternatives (such as coronary angio CT, Cardiolite, etc) would be helpful to properly investigate coronary artery disease.

If evidence of myocardial ischemia is revealed, then a coronary angiography is the next step to follow.

Meanwhile, a continuing control of your coronary risk factors (hypertension, blood glucose, dyslipidemia, etc) should be done.

If the above BP values persist, then an antihypertensive therapy modulation is necessary. After excluding liver and renal function disorders, an ACEI (ramipril, lisinopril, etc), ARB (valsartan, irbesartan, etc) or a calcium channel blocker should be added as well (amlodipine, lercanidipine, etc).

You need to talk to your attending physician about the above mentioned issues.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greeting! Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 14 minutes later
If my echo and EKG was negative you still think it might be ischemic heart disorder?
doctor
Answered by Dr. Ilir Sharka 23 minutes later
Brief Answer:
Other cardiac tests are necessary.

Detailed Answer:
Hi again!

Ischemic heart disease is a possibility to be excluded/confirmed. There is not enough evidence to conclude such an option, but it is supported by a suspicious pain and your coronary risk factors profile.

Resting ECG and ECHO don't offer sufficient specificity to detect coronary artery disease (they may confirm the disorder when lòok abnormal, but can't exclude when negative).

That's why additional cardiac tests are necessary.

Wish you a good health!

Regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 29 minutes later
I believe I took a stress test about 2 1/2-3 years ago. That was negative. Is that enough time to develop Ischemic heart disease?
I re-looked at the Echo results from April of this year-not sure if this is worth mentioning but it states following -1. Trace mitral regurgitation noted.
-2. Trace tricuspid regurgitation noted.
-3. Ejection Fraction is 55%

I took a blood test in February of this year-
It stated under the cardio section-
Troponin <0.02 ng/ml
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
After two years it is necessary to re-evaluate cardiac status.

Detailed Answer:

Dear XXXX!

Your cardiac ultrasound results seem to be within normal ranges. Your Troponin, too.

What I would like to explain is that in diabetics not rarely, an ischemic chest pain is presented with atypical characteristics (such as yours), so it is necessary for additional tests to differentiate.

As your actual chest and arm discomfort has appeared after the period of your last performed cardiac stress test, it is necessary to repeat such an exam.

Other complementary cardiac tests (I mentioned above), would be of great help in the differential diagnosis work up.

Two years is quite a sufficient period for coronary heart disease to progress to a clinically significant degree.

Wish you a good health!

Best regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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