Chronic Left Chest and Back Pain: Heart Issues or Acid Reflux?

Chronic pain in the left chest, left back, and left armpit?

Hello doctor, I am 34 years old and weigh 135 kilograms.
For the past five years, I have been experiencing pain in my left chest, left back, and left armpit.
The pain is persistent, and sometimes it is accompanied by shortness of breath.
The discomfort worsens after eating or during periods of high stress and anxiety.
I have frequently visited the emergency room, undergone electrocardiograms, and cardiac enzyme tests, and I have also had a nuclear stress test (with contrast agent injection) in cardiology.
After 4 to 5 tests, they all indicated that there was nothing wrong.
However, there are times when the pain becomes very uncomfortable, and I am worried that it might be a heart issue (I have diabetes and hypertension, both of which are being managed with medication).
I am unsure whether my condition is related to heart problems or gastroesophageal reflux disease (GERD), as I sometimes wake up from acid reflux.
Is it common for angina to last that long?

A Nong, 30~39 year old female. Ask Date: 2018/11/29

Dr. Bai Xiyan reply Cardiology

The response to the chest pain inquiry from an online user is as follows:
1.
Chest pain can arise from various locations and may include conditions such as angina pectoris, aortic dissection, pericarditis, pulmonary embolism, mitral valve prolapse, pleuritis, myositis, neuralgia, gastroesophageal reflux disease (GERD), and shingles, among others.

2.
The user is a 34-year-old male with cardiovascular risk factors including hypertension, diabetes, and obesity.
Based on the described symptoms and examinations, it appears less likely that the chest pain is cardiac in nature.
However, for safety, it is recommended to seek emergency care for an electrocardiogram (ECG) if the chest pain persists, and to consider blood tests for cardiac enzymes if necessary.
It is also advised to maintain a diet low in salt, sugar, and fat, engage in moderate exercise, control weight, and continue treatment for hypertension and diabetes.
3.
If serious cardiopulmonary conditions are ruled out, the pain may often be due to neuromuscular issues, which can typically be alleviated with anti-inflammatory and analgesic medications.
Alternatively, if the pain is related to acid reflux or gastroesophageal inflammation, an endoscopy and appropriate medication may be required.
4.
You are welcome to visit our outpatient clinic; the staff at Chiayi Hospital are dedicated to serving you! (Love)

Reply Date: 2018/11/29

More Info

Chronic left chest and back pain can be a source of significant anxiety, especially when there is a history of heart disease or risk factors such as diabetes and hypertension. Given your situation, it is essential to consider both cardiac and gastrointestinal causes for your symptoms.

Firstly, it is reassuring that you have undergone multiple cardiac evaluations, including electrocardiograms (ECGs), cardiac enzyme tests, and nuclear imaging, all of which have returned normal results. These tests are designed to assess the heart's function and rule out conditions such as myocardial infarction (heart attack) or significant coronary artery disease. The fact that these tests have consistently shown no abnormalities suggests that your heart is likely functioning well, despite your ongoing symptoms.

However, the persistence of your left chest and back pain, especially when associated with factors like eating or stress, raises the possibility of gastroesophageal reflux disease (GERD) or other gastrointestinal issues. GERD can cause symptoms such as chest pain, which may mimic cardiac pain, and it is not uncommon for individuals to experience discomfort in the chest area due to acid reflux. This discomfort can sometimes radiate to the back or shoulder, leading to confusion about the source of the pain.

In your case, the fact that the pain intensifies after eating or during periods of stress aligns with typical GERD symptoms. Additionally, the experience of being awakened by acid reflux suggests that this could be a contributing factor to your discomfort. It is also worth noting that anxiety and stress can exacerbate both cardiac and gastrointestinal symptoms, creating a cycle of discomfort that can be challenging to break.

Regarding your concern about angina (chest pain due to heart issues), it is important to clarify that typical angina tends to be transient, often triggered by exertion or stress, and usually resolves with rest or the use of nitroglycerin. In contrast, the pain you describe as chronic and persistent for several years is less characteristic of angina. Chronic pain that lasts for extended periods is more likely to be related to musculoskeletal issues, nerve irritation, or gastrointestinal problems rather than a primary cardiac issue.

Given your history of diabetes and hypertension, it is crucial to maintain regular follow-ups with your healthcare provider to manage these conditions effectively. Additionally, if you suspect that GERD may be contributing to your symptoms, it would be beneficial to discuss this with your doctor. They may recommend lifestyle modifications, dietary changes, or medications to help manage acid reflux.

In conclusion, while your ongoing left chest and back pain is understandably concerning, the extensive cardiac evaluations you have undergone suggest that significant heart disease is unlikely. It would be prudent to explore gastrointestinal causes, particularly GERD, and consider the impact of stress and anxiety on your symptoms. If your pain persists or worsens, or if you develop new symptoms, do not hesitate to seek further medical evaluation. Your health and peace of mind are paramount, and addressing these concerns with your healthcare provider can help you find relief and reassurance.

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