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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes pain in the chest radiating towards the neck and back?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5761 Questions

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Posted on Sat, 14 Apr 2018 in General Health
Question: I had an episode of chest burning radiating up my neck and into my back. I also had this aching , burning and heaviness in my left arm and an ache in my right arm pit and this overwhelming fatigue and weakness the other day. It came and went in intensity over 4 hours or so. I had seen a cardiologist before and they said that I had cardiac vasospasms but do they normally last that long? It certainly felt like A heart attack. How long can heart attack pain last if you don't get intervention? I'm attaching an ekg from today and one I had a few months ago. Please let me know what you think. Also. My heart was pounding when I got today's ekg. I was laying flat. What's weird is I have a history of POTS and only get tachycardia when standing. It was totally weird that it happened laying down
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Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your question and would explain that episodes of coronary vasospasm sometimes may be frequent and repeated for several hours.

In such case they may lead to important ischemia (cardiac muscle suffering from inadequate blood supply).

If this happens, then an increased in laboratory levels of cardiac enzymes (CK-MB, Troponin) may be detected.

In general when cardiac vasospasm occur the ECG shows ST segment elevation. After the episode subsides, the ST segment returns to normal isoline and nothing can be detected.

Sometimes, a T wave inversion may be seen.

Now, returning to your ECG recordings, I would explain that it indicates a pattern of incomplete right bundle branch block (RBBB) and there are no specific signs of cardiac ischemia or coronary vasospasm.

In order to explore better the possible presence of coronary vasospasm some provocative tests may be applied:

- Ergonovine test
- Acetilcholine test
- Hyperventilation test

combined with perfusional cardiac imaging test.

If vasospastic angina is produced, then further investigation for the presence of possible coronary atherosclerosis is necessary as these two disorders not rarely coexist.

In addition, clinical investigation of coronary risk factors are necessary. In this regard, I would recommend:

- complete blood count
- blood lipid profile
- blood electrolytes levels
- fasting blood glucose levels
- kidney and liver function tests

If coronary vasospasm is confirmed, then magnesium supplements and calcium channel blockers may be a reasonable treatment option.

You should discuss with your doctor on the above issues.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 5 minutes later
So my ekg looks normal? The symptoms were 2 days ago so if I had some kind of heart attack the ekg would show it right? So it was probably nothing? I had called my doctor when it was happening and they said my symptoms were probably non cardiac. What would cause someone to develop incomplete rbb if they didn't have it before? I had so many ekgs before and they were all normal until recently they detected the irbb

Oh I forgot to ask what is possible left atrial abnormality and st junctional depression? Does this ekg look different than my other one?
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

I carefully reviewed your uploaded ECGs and would explain that they are exactly the same.

So, besides the incomplete right Bundle Branch Block, no signs of cardiac ischemia or myocardial infarction are present.

If those pains that you have experienced recently were from a heart attack, they would have been reflected on your last ECG.

But, no new changes could be detected compared with the previous ECG.

What could be the reason of incomplete RBBB should be explored with further tests.

Not rarely an incomplete RBBB is a normal variant and no any health disorder could be detected. But in some cases, certain cardiac or pulmonary disorders could be the reason.

For example: an exacerbated chronic pulmonary disorder such as COPD or a micro pulmonary embolism could be a cause.

In other cases overweight and obesity may explain this ECG pattern.

In addition, certain cardiac issues could be blamed such as a right heart cardiomyopathy, or a congenital inter-atrial septal defect.

That is why, I would recommend performing further tests to identify the possible underlying causes:

- a cardiac ultrasound
- a chest X ray study
- pulmonary function tests
- pulmonary angio CT scan (if suspicions of pulmonary embolism are raised).

Regarding your last question on left atrial abnormality, this is suspected by the ECG machine software because of an inverted P wave in precordial leads V1-V2.

Whether this is true, it will be explained by the cardiac ultrasound.

Hope to have clarified some of your uncertainties!

Feel free to ask me again, whenever you have any other questions.

Wishing good health,

Dr. Iliri


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