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What Does Persistent Left-sided Chest Pain Indicate?

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Posted on Wed, 9 May 2018
Question: Hello,

I have been having left sided chest pains and discomfort for the past 6 months. This pain is a very dull ache only on the left side. Sometimes pain can be very prominent but not severe - other times just a dull constant ache. The pain is present during rest and does not exhibit change with activity. Sometimes the pain completely disappears after a 20 - 30 minute run. I have attached an image "Location_Pain" that shows the location of the pain. Sometime the pain shifts to the left hand side of left nipple as well. The pain does not change based on food intake - it is present from the time I wake up (empty stomach) and does not subside after a meal. It comes and goes randomly. I have not been able to ascertain any pattern.

Apart from this pain - there are no other worrying symptoms.I do not have shortness of breath, no dizziness. Normal fatigue levels - am able to do household chores, climb stairs and run with no significant fatigue. The pain is affecting me psychologically and causing a great deal of anxiety.

I have consulted several cardiologists and after ECG, 2D Echo, Stress Test and Holter study - they have informed me that only abnormality is frequent premature ventricular ectopics. I have 11% of my total heartbeat in 24hrs as PVC. They are not overly concerned about this and have prescribed Inderal (10mg) to be taken only if required.

I have also had a chest xray and an ultrasound of the abdomen - both of which came back as normal.

I also have a history of anxiety but am convinced that the chest pains are not a figment of my imagination. I have tried PPI medication to check if the pain could be gastric in origin and they had no effect.

Please advise from your experience as to what else could cause symptoms like this. Also if I had to follow further diagnostic route - what tests could be done? What specialists should I follow up with?

Is this pain characteristic comparable to someone suffering from stomach ulcers? Could this be a peptic ulcer? Please advise.
doctor
Answered by Dr. Panagiotis Zografakis (6 hours later)
Brief Answer:
anxiety is the most likely cause

Detailed Answer:
Hello,

although anxiety can only be diagnosed after excluding other potential causes, it does sound very likely in your case because the symptoms are atypical and the doctors (including me) cannot relate them to any particular disorder. There are some things to consider though...

Both the heart related issues and the gastrointestinal system related issues seem to have been excluded as no worrisome results came up with the cardiological tests and no improvement has been noted with the PPIs. The symptoms are not suggestive either.

The chest wall can be checked further for various disorders. One thing that I've not understood regarding your pain is whether you can reproduce it somehow. For example if you can reproduce the pain by exerting pressure on the chest wall... If this is true then a chest wall lesion is possible. Chest wall injuries (and other lesions) may also cause pain when breathing (particularly with deep breaths). Finally another cause that your doctor can look for is damage/injury/pressure on the nerves that run right under each rib. In cases like that the pain or discomfort is usually semi-circular and runs between the sternum and the spine on the affected side but (always single-sided) variations are possible.

A chest CT scan may identify masses or other chest wall lesions, so if this disorder is bothersome, this is something that your doctor may consider.

I don't believe that either an ulcer or other gastrointestinal disorders cause this pain as you've seen no improvement with the PPIs. Just make sure you've taken a PPI on its maximal dosage for a couple of months (so that even an esophagitis could heal).

I hope you find my comments helpful!
Please get back to me if you'd like further assistance or you'd like to continue this discussion; I'll be glad to do so.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Panagiotis Zografakis (18 hours later)
Thank you doctor. The pain is not reproducible in any manner by me. I have tried pressing on the affected area and there is not change in pain. Pain originates and disappears on its own and no changes on mechanical pressure, movement etc.

Additionally - I would like to inform you that I only tried PPI for a week, 10 days. Is this sufficient time to rule out GI issues. I am asking as you mentioned maximal dosage for a couple of months is required with PPI. Should I pursue an upper endoscopy to rule out Esophagitis/GERD?

Please advise. Thank you.
doctor
Answered by Dr. Panagiotis Zografakis (14 hours later)
Brief Answer:
yes

Detailed Answer:
You're welcome!

So this is what we doctors usually call atypical symptom. Such symptoms are not easy to approach both diagnostically and therepeutically. An upper endoscopy would indeed rule out gastrointestinal issues. I would have suggested that to you if you were my patient since there is no other clue to pursue. The treatment with the PPI was not sufficient. For esophagitis treatment with omeprazole would require 40mg per day, 80mg for esomeprazole, etc for two months.

If the endoscopy is negative then talking to a psychiatrist might sound appropriate as the diagnosis of an anxiety disorder would be much more likely.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3794 Questions

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What Does Persistent Left-sided Chest Pain Indicate?

Brief Answer: anxiety is the most likely cause Detailed Answer: Hello, although anxiety can only be diagnosed after excluding other potential causes, it does sound very likely in your case because the symptoms are atypical and the doctors (including me) cannot relate them to any particular disorder. There are some things to consider though... Both the heart related issues and the gastrointestinal system related issues seem to have been excluded as no worrisome results came up with the cardiological tests and no improvement has been noted with the PPIs. The symptoms are not suggestive either. The chest wall can be checked further for various disorders. One thing that I've not understood regarding your pain is whether you can reproduce it somehow. For example if you can reproduce the pain by exerting pressure on the chest wall... If this is true then a chest wall lesion is possible. Chest wall injuries (and other lesions) may also cause pain when breathing (particularly with deep breaths). Finally another cause that your doctor can look for is damage/injury/pressure on the nerves that run right under each rib. In cases like that the pain or discomfort is usually semi-circular and runs between the sternum and the spine on the affected side but (always single-sided) variations are possible. A chest CT scan may identify masses or other chest wall lesions, so if this disorder is bothersome, this is something that your doctor may consider. I don't believe that either an ulcer or other gastrointestinal disorders cause this pain as you've seen no improvement with the PPIs. Just make sure you've taken a PPI on its maximal dosage for a couple of months (so that even an esophagitis could heal). I hope you find my comments helpful! Please get back to me if you'd like further assistance or you'd like to continue this discussion; I'll be glad to do so. Kind regards!