Which Medical Specialty Should I Consult for Chest Pain?

Which department should I see?

I often experience chest pain, ranging from the upper inner left chest to the upper inner right chest.
Yesterday at noon, while trying to take a nap, I suddenly felt intense pain in the center of my chest halfway through lying down.
It hurt whether I was lying down or sitting up, and I had some difficulty breathing.
This episode lasted about 10-15 minutes, after which it gradually improved, but I still felt quite uncomfortable.
I occasionally experience sharp pains, and this has been ongoing for several years, with yesterday's pain being much worse than usual.
I have seen specialists in cardiology, breast surgery, and pulmonology, but the doctors have all said there is no issue.
Which specialist should I consult next? Thank you.

V, 30~39 year old female. Ask Date: 2017/05/03

Dr. Chen Taicheng reply Family Medicine

● Many specialties have ruled out related issues.
If the pain occurs primarily when lying down, consider problems such as gastroesophageal reflux disease (GERD), esophageal ulcers, or pancreatitis.
It is advisable to consult a gastroenterologist or a family medicine physician for further evaluation.
● Additionally, musculoskeletal issues should be considered, as sometimes it may involve inflammation of the nearby muscle fascia; less commonly, it could be related to anxiety or specific conditions like fibromyalgia.
● Based on your situation, gastrointestinal issues should be prioritized for exclusion.
It is recommended to visit a gastroenterologist (to rule out GERD, peptic ulcers—note that symptoms of GERD or ulcers can sometimes be atypical, but can be identified through endoscopy—pancreatitis, etc.) → then to an orthopedic or rehabilitation specialist (to rule out musculoskeletal problems) → if issues remain unresolved, you may consult a rheumatologist to exclude rarer conditions such as synovitis or autoimmune diseases.
● For similar articles for your reference, please visit https://goo.gl/1TU2b.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/05/03

More Info

If you are experiencing persistent chest pain, especially with the symptoms you described, it is crucial to seek further medical evaluation. Given that you have already consulted with cardiology, breast surgery, and thoracic medicine without a definitive diagnosis, it may be time to consider other specialties or a multidisciplinary approach to your symptoms.

1. Primary Care Physician (PCP): Start with your primary care physician if you haven't already. They can conduct a comprehensive evaluation, review your medical history, and coordinate referrals to specialists as needed. They can also assess for any underlying conditions that may not have been considered in your previous consultations.

2. Gastroenterology: Sometimes, chest pain can be related to gastrointestinal issues, such as gastroesophageal reflux disease (GERD) or esophageal spasms. A gastroenterologist can evaluate these conditions, which can mimic cardiac pain.

3. Pulmonology: If your chest pain is associated with breathing difficulties, a pulmonologist can assess for respiratory issues, including asthma, chronic obstructive pulmonary disease (COPD), or other lung-related conditions.

4. Musculoskeletal Specialist: Given that you mentioned the pain is located in the chest area and has been persistent for several years, it may be worthwhile to consult a specialist in musculoskeletal disorders, such as an orthopedic doctor or a rheumatologist. They can evaluate for conditions like costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum, or other musculoskeletal issues that could be causing your pain.

5. Pain Management Specialist: If your pain is chronic and has not responded to previous treatments, a pain management specialist may be able to offer alternative therapies, including physical therapy, injections, or other modalities to help manage your symptoms.

6. Psychiatry/Psychology: Sometimes, chronic pain can have a psychological component. If you find that your pain is affecting your mental health or if there are stressors contributing to your symptoms, consulting a mental health professional may be beneficial.

In addition to seeking further medical advice, keep a detailed record of your symptoms, including when they occur, their intensity, duration, and any associated factors (like physical activity, eating, or stress). This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

Remember, chest pain should always be taken seriously, especially if it is new or has changed in character. If you experience severe pain, shortness of breath, or any other alarming symptoms, seek emergency medical attention immediately. Your health and safety are paramount, and persistent symptoms warrant thorough investigation to rule out any serious underlying conditions.

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