Unexplained Chest Pain: Seeking Answers Beyond Cardiology

Q: Unexplained Chest Pain: Seeking Answers Beyond Cardiology

Dear Ms. <br>Su：<br>1. <br>There are many causes of chest pain; the most serious include acute myocardial infarction, aortic dissection, pulmonary embolism, pneumothorax, perforated ulcer, and esophageal rupture. <br>It is evident that your physician should have ruled out these a

Chest tightness and pain, primarily on the left side of the chest?

In the past two months, I have experienced intermittent tightness or mild stabbing pain in my chest, particularly on the left side.
Sometimes, I also feel pain in my left arm and fingers.
I have visited a cardiologist and undergone X-rays, an electrocardiogram (ECG), and an echocardiogram, all of which indicated no issues.
I have also had a breast examination, and the doctor confirmed it was a fibroadenoma with no significant concerns.
Since I have not been able to find the cause and there has been no improvement, which specialty should I consult next?

Ms. Su, 20~29 year old female. Ask Date: 2019/07/21

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Su:
1.
There are many causes of chest pain; the most serious include acute myocardial infarction, aortic dissection, pulmonary embolism, pneumothorax, perforated ulcer, and esophageal rupture.
It is evident that your physician should have ruled out these acute conditions.
2.
Other more common causes include costochondritis, spinal nerve root compression, breast diseases, esophagitis, pancreatitis, valvular heart disease, herpes zoster, tumors, anxiety disorders, panic disorders, and so on.
3.
Of course, there are many less common causes; generally, these are considered only after ruling out common acute conditions or causes.
However, I personally believe that the most likely cause in your case is inflammation of the costal cartilage.
4.
As a precaution, I think you should discuss this matter in detail with your family physician or a trusted doctor before making any decisions.

Reply Date: 2019/07/21

More Info

Unexplained chest pain can be a perplexing and concerning symptom, especially when initial evaluations by cardiology yield normal results. Given your description of intermittent chest discomfort, particularly on the left side, along with associated symptoms in your left arm and fingers, it is understandable that you are seeking further answers.

First, it is important to acknowledge that chest pain can arise from a variety of causes, not solely related to cardiac issues. Since you have already undergone a thorough evaluation by a cardiologist, including X-rays, electrocardiograms (ECGs), and echocardiograms, and all results were normal, it is less likely that your symptoms are due to a significant heart condition. The normal findings suggest that your heart structure and function are intact, which is reassuring.

Given that your symptoms persist, it may be beneficial to explore other potential causes of your chest pain. Here are some areas you might consider consulting:
1. Musculoskeletal Evaluation: Chest pain can often be related to musculoskeletal issues, such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum), muscle strain, or even rib injuries. A physical examination by a physician specializing in musculoskeletal disorders or a physical therapist may help identify any underlying issues.

2. Pulmonary Assessment: Although your chest X-ray was normal, it might be worthwhile to consult a pulmonologist if you have any respiratory symptoms, such as shortness of breath or a cough. Conditions like pleuritis (inflammation of the lining of the lungs) or even anxiety-related hyperventilation can manifest as chest pain.

3. Gastroenterology: Gastroesophageal reflux disease (GERD) or esophageal spasms can cause chest pain that may mimic cardiac pain. A gastroenterologist can evaluate for these conditions, possibly recommending tests such as an upper endoscopy or pH monitoring.

4. Neurology: If you are experiencing pain radiating to your left arm and fingers, a neurologist could evaluate for nerve-related issues, such as thoracic outlet syndrome or cervical radiculopathy, which can cause referred pain to the chest and upper extremities.

5. Psychological Evaluation: Anxiety and stress can manifest physically, leading to chest pain and discomfort. If you suspect that anxiety may be a contributing factor, consulting a mental health professional could provide strategies for managing stress and anxiety, which may alleviate your symptoms.

6. Alternative Therapies: Some patients find relief through complementary therapies such as acupuncture, chiropractic care, or physical therapy focused on relaxation techniques and muscle tension relief.

In summary, while your cardiac evaluations have ruled out significant heart disease, chest pain can stem from various sources. It is essential to pursue a multidisciplinary approach to identify the underlying cause of your symptoms. Keeping a symptom diary, noting when the pain occurs, its duration, and any associated activities or stressors, may also provide valuable information to your healthcare providers. Don't hesitate to advocate for yourself and seek further evaluations until you find the answers you need. Your health and peace of mind are paramount.

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