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What causes unexplained recurring chest pain and discomfort in left arm shoulder?

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Posted on Wed, 20 Jul 2016
Question: Dear sir having recurring chest pain and discomfort sometime severe type pain in chest shoulder left arm till finger its happen more then a year but frm last month onward its frequency is more .. TMT and echo done result normal ,done CT Coronory Angio notmal except "Long segment of myocardial bridging in MID of LAd" i m too much worried after reading abt this on internet and now i feel i m suffering some life threatening heart problem after Dr suggestion Done "Stress thillium nuclear test" which is also normal" i m also diagnosed with Cervical Spondylitis. Sir pls advice is i m a patient of life threatening heart problem??? Or something else causing the pain
doctor
Answered by Dr. Sukhvinder Singh (21 hours later)
Brief Answer:
please provide details of your symptoms.

Detailed Answer:
Dear XXXXXXX
1. First of all relax. As any kind of mental stress is bad for your health.

2. Your TMT and stress thallium is negative with good exercise capacity. This is big relief. There is no test in world which can definitely predict future occurrence of heart attack. However, the test can tell about current status and TMT & Thallium are reassuring. Your ECHO is also normal, so you do not have any structural heart disease.

3. Myocardial bridging may or may not lead to symptoms. since your TMT is normal. I would like to go into details of your symptoms.

How long they last? what provokes them? How do they get relieved? Where exactly pain occurs?

Does it shift site? What are accompanying symptoms? Did you have any similar symptom while doing TMT?

Please answer all these queries, before I deliberate more on the topic.

Sincerely
Dr Sukhvinder
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sukhvinder Singh (30 minutes later)
Dear sir thanks for you reply pain is generelly in center or upper center sometimes radiate to left arm till fingers ... Generally starts in morning after wake mild pain till eve and then and soentime chronic type .. Some time shifting to right side also .. While walking pain is less but after long walk mild pressure and pain at upper chest area bleow to neck .. To found out Myocardial bridging cause pain or not Dr suggest for stress thaillium test which i attached the report ...pain got relieved when i m resting on bed or sitting on chair and doing my job very confusing pain .. Its relax automatically but TMT was done in XXXXXXX 2016 end ya almost similer symptoms while doing TMT and while doing Stress thillium test ... Sir my worry is this Myocardial bridging after read lots of stuff on google ... Air pls advice further as Dr said its not a angina pain and MB doesnt any role init as Stress thillium is normal do need to worry abt this is insiginificant in u case ... I m lots of stress and anxeity .. Sir i m suffering frm cervical also which MRI report attached already pls suggest me to how to wash out this MB tension which is in my mind
doctor
Answered by Dr. Sukhvinder Singh (12 minutes later)
Brief Answer:
please see details below.

Detailed Answer:
Dear XXXXXXX

1. It is not clear from your answer that if you had similar symptoms, as you usually have, while doing TMT or it was just fatigue. If you did not have any similar symptoms while doing TMT or thallium, then the likelihood of your symptoms to be anginal is very low. Secondly, Your Stress thallium and MRI report did not get uploaded. So please re-upload them.

2. Medical literature is not very sure that myocardial bridging definitely causes serious troubles like heart attack or sudden death. It proposes medical treatment initially for those with symptoms. I do agree with your doctor that your symptoms are not likely due to bridging.

The nature of your symptoms is not anginal. I would prefer that you manage all the risk factors for anginal heart disease diligently like smoking, BP, diabetes, blood cholesterol, obesity and stress well and consult your cardiologist periodically. Any symptoms which appears to be because of myocardial bridging needs to be tackled first by medicines like beta-blockers.

Only if they fail, some intervention may be done.
Feel free to discuss further.
Sincerely
Dr Sukhvinder
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sukhvinder Singh (30 minutes later)
Sir i attached again my stress thillium reports and MRI for cervical spine ... Yes sir while doing test TMT and stress thillium i do not have any icrease pain sweting any other problem but before the test having with chest pain and done exg doe the yes feel fatiuge feeling only tired feel ... My concern is only if m having on high risk or XXXXXXX this MB as Dr not prescribe any medicine except anxiety tab at night ...
doctor
Answered by Dr. Sukhvinder Singh (13 hours later)
Brief Answer:
Cervical spine issues are there, destress yourself

Detailed Answer:
Dear XXXXXXX
1. I still could not find your thallium report. However It is reassuring that you did not have symptoms while doing exercise during TMT or Thallium. This tells us that symptoms are not likely to be anginal in nature.
2. The MRI report says there are problems with cervical spine which needs to be discussed with your neurologist and orthopedician.
3. As I have told you earlier also, the condition of myocardial bridging is usually considered to be benign. Medical literature is not very sure if Heart attack, anginal episodes or sudden death can really be attributed to myocardial bridging. However, every individual is unique, so case to case approach is preferable. If the symptoms are individual are anginal in nature, only the medicines or intervention is warranted. In your case, the symptoms are not shown to be anginal in nature by history and by stress tests you have undergone. Hence your doctors advised simple followup.
4. Try to destress your self. Try to maintain a healthy lifestyle. do not think too much about your condition. consult your orthopedician for cervical spine evaluation which may be a cause of your symptoms. Take advise of your cardiologist whenever you have change in symptoms.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Sukhvinder Singh (2 hours later)
Sir thanks again ... Actully after reading on google too much i m afraid and even cant sleep properly due to stress and anxiety ..sir can i meet you in person and can i send u my reports to you on whatsapp if possible its will be really help full .. Becuase of anxiety and stress i feel i got painic attack also frm two days ... Sir can i hv words with u on phone for 5 min ...
doctor
Answered by Dr. Sukhvinder Singh (16 hours later)
Brief Answer:
relax.

Detailed Answer:
Dear XXXXXXX
1. Whatever i told you is from standard literature. If you wish to read yourself, you can read the following article.
MYOCARDIAL BRIDGING.BY MS XXXXXXX & C CHEN. JOURNAL OF INVASIVE CARDIOLOGY. NOV 2015. VOL 27. PAGE 521-28.
2. My current clinic address and timings are available on this website. You may visit, if really required.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Sukhvinder Singh

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Practicing since :1998

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What causes unexplained recurring chest pain and discomfort in left arm shoulder?

Brief Answer: please provide details of your symptoms. Detailed Answer: Dear XXXXXXX 1. First of all relax. As any kind of mental stress is bad for your health. 2. Your TMT and stress thallium is negative with good exercise capacity. This is big relief. There is no test in world which can definitely predict future occurrence of heart attack. However, the test can tell about current status and TMT & Thallium are reassuring. Your ECHO is also normal, so you do not have any structural heart disease. 3. Myocardial bridging may or may not lead to symptoms. since your TMT is normal. I would like to go into details of your symptoms. How long they last? what provokes them? How do they get relieved? Where exactly pain occurs? Does it shift site? What are accompanying symptoms? Did you have any similar symptom while doing TMT? Please answer all these queries, before I deliberate more on the topic. Sincerely Dr Sukhvinder