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What causes severe persistent chest pain?

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Posted on Wed, 31 May 2017
Question: What diagnostic tests should my cardiologist use for 2 different chest pains I've been experiencing for a couple of years? I've had a single, mild "needle-like poke" left-side chest pain and I've also had a sudden strong chest pain that feels like a single muscle spasm that lasts for a single heart "contraction" or beat; I feel this "spasm" pain only on exertion in cold weather that happens maybe around every 6 months or so. These two very different heart/chest sensations were never captured on an EKG, holter monitor or long-term (2 weeks) holter monitor. However, the long-term holter monitor did capture PVC arrythmias.
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Answered by Dr. Rishu Saxena (37 minutes later)
Brief Answer:
First pain sounds like gastric while second one can be muscular.

Detailed Answer:
Hi,
Firstly thanks for choosing health care magic for your query .
As per your query Coronary angiogram is the gold standard test for diagnosis of coronary artery disease with a sensitivity level as high as 99.9% ,However initially to rule out cardiac cause a stress thallim(not stress test) should be done.Stres thallium is a nuclear based non invasive test with sensitivity level of around 98%.Once this test is normal this pain can not be cardiac in origin.Though needle like pain and sudden strong chest pain are not characterstic of heart pain(usually dull heaviness) yet in rare cases pain can have different presentation.

There are some other causes which can present with the same symptoms and can mimic pain of cardiac origin and can cause chest pain
few of them are
gastritis
heart burn
acid peptic disorder
a muscular origin pain
anxiety
As per the description of second type of pain,it can be a sprain to any of the muscles or a hidden internal injury to muscles of the chest , a thorough evaluation by a physiotherapist or sports medicine doctor is required to see if there is any sprain or internal injury to muscle.

Once confirmed he would prescribe you with some anti inflammatory medicines for few days and would advise you rest!!
As you have not mentioned any history of acid peptic disorder or heart burn ; and your chest pain is not related to exertion its most likely muscular origin pain.
Another rare entity is Prinzmetals angina also called as vasospastic angina and is due to spasm in coronary arteries and occurs usually at rest,but as off now i would suggest you that your history points more towards muscular origin of pain.
However initially investigations suggested should be done.

Role of holter is usually more in ruling out cause of palpitations and not the cause of chest pain.
So follow the protocol as suggested by me.

Hope i answered your query well.
In case of further queries feel free to ask.

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Rishu Saxena (5 hours later)
What is "angina" and are there different kinds of angina? What do people describe angina pain as? I have had strong and mild heartburn so I can eliminate heartburn as the pains I am feeling; the 2 types of chest pains that I have do not resemble heartburn whatsoever. Thank you for your help.
doctor
Answered by Dr. Rishu Saxena (6 hours later)
Brief Answer:
Follow up answer.

Detailed Answer:
Hi Dear.
Angina means pain caused due to compromised blood supply to heart.
There are two types of angina-
1) Stable angina-Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress.It reponds to nitrogylcerine and relieves on resting.

2) Unstable angina-Unstable angina is a condition in which your heart doesn't get enough blood flow and oxygen. It may lead to a heart attack.This does not relieves on resting.

Classically patient describe it as a feeling of retrosternal chest heaviness(A feeling as if the chest is compressed by a heavy stone) rather then XXXXXXX pain.However only 40% of patients having cardiac disease have classical feature of angina, So just because pain is different in nature does not mean that we could neglect it.

Easiest way to differenciate the pain from heartburn is take Nexium 40 mg twice daily along with a antacid if pain responds to it then most likely its due to GERD and heartburn.

Hope you got your answers.
Follow ups are welcome.

Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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What causes severe persistent chest pain?

Brief Answer: First pain sounds like gastric while second one can be muscular. Detailed Answer: Hi, Firstly thanks for choosing health care magic for your query . As per your query Coronary angiogram is the gold standard test for diagnosis of coronary artery disease with a sensitivity level as high as 99.9% ,However initially to rule out cardiac cause a stress thallim(not stress test) should be done.Stres thallium is a nuclear based non invasive test with sensitivity level of around 98%.Once this test is normal this pain can not be cardiac in origin.Though needle like pain and sudden strong chest pain are not characterstic of heart pain(usually dull heaviness) yet in rare cases pain can have different presentation. There are some other causes which can present with the same symptoms and can mimic pain of cardiac origin and can cause chest pain few of them are gastritis heart burn acid peptic disorder a muscular origin pain anxiety As per the description of second type of pain,it can be a sprain to any of the muscles or a hidden internal injury to muscles of the chest , a thorough evaluation by a physiotherapist or sports medicine doctor is required to see if there is any sprain or internal injury to muscle. Once confirmed he would prescribe you with some anti inflammatory medicines for few days and would advise you rest!! As you have not mentioned any history of acid peptic disorder or heart burn ; and your chest pain is not related to exertion its most likely muscular origin pain. Another rare entity is Prinzmetals angina also called as vasospastic angina and is due to spasm in coronary arteries and occurs usually at rest,but as off now i would suggest you that your history points more towards muscular origin of pain. However initially investigations suggested should be done. Role of holter is usually more in ruling out cause of palpitations and not the cause of chest pain. So follow the protocol as suggested by me. Hope i answered your query well. In case of further queries feel free to ask. Regards.