Left Chest Pain: Causes, Diagnosis, and Next Steps

Left chest pain?

Hello, Doctor.
I started experiencing stomach pain in July, specifically in the epigastric area.
I went to Chang Gung Memorial Hospital for an endoscopy, and while nothing significant was found, I tested positive for Helicobacter pylori, which was subsequently treated.
However, in September, the symptoms shifted to my left chest, located approximately between the nipple and the epigastric area, accompanied by tightness and mild soreness in my left shoulder blade.
In November, I consulted with an internist at Chang Gung.
The doctor asked if I felt any pressure in my chest (I did not), what kind of pain I was experiencing (sharp, not persistent, lasting 2-3 seconds with low frequency), and noted that the symptoms were more pronounced after eating.
I usually have a habit of jogging, and everything feels normal during that activity.
The physician at Chang Gung concluded that it was not a cardiac issue but rather pain in the left shoulder blade radiating to the left chest, and prescribed muscle relaxants, which initially helped somewhat, but the symptoms became more pronounced again last week.
Prior to this, I felt some pressure while sleeping on my left side, but sleeping on my right side was completely normal, and I also slept normally on my back.
Last year, during a company health check, a chest X-ray suggested a possible nodule, but a chest X-ray taken in June during a health examination by the health bureau showed no significant abnormalities.
Due to a family history of lung cancer, I visited the thoracic surgery department at Tri-Service General Hospital last week and showed the doctor both X-ray reports.
The doctor believed there was no issue, but due to the family history, they scheduled a low-dose CT scan for January.
My question is, can a low-dose chest CT scan also check for heart problems? If not, what kind of cardiac examination should I undergo, and which department should I consult? Thank you.

Dada, 30~39 year old female. Ask Date: 2019/12/25

Dr. He Dongjin reply Cardiology

Hello, if you are jogging regularly, it is actually quite normal and does not seem to indicate a heart problem, especially since previous examinations were normal.
If you are still concerned, you may consider undergoing a coronary CT angiography for further reassurance.
Ping An Changhua Hospital cares about you.

Reply Date: 2019/12/25

More Info

Understanding left chest pain can be quite complex, as it can stem from various causes, some of which may be serious. Based on your description, you have experienced a transition of symptoms from gastric discomfort to left chest pain, which is accompanied by tightness in the left shoulder blade area. This progression of symptoms, along with your medical history, warrants a thorough evaluation.

Firstly, it is essential to recognize that left chest pain can originate from multiple sources, including gastrointestinal issues, musculoskeletal problems, and cardiac conditions. Given your previous gastrointestinal symptoms and the diagnosis of Helicobacter pylori, it is plausible that some of your discomfort may still be related to digestive issues. However, the fact that your symptoms have migrated to the chest area raises the need for further investigation.

The pain you describe as sharp and transient, lasting only a few seconds, is less typical of serious cardiac events, which often present with more persistent discomfort. Nevertheless, the association of pain with eating and the relief you experience when changing sleeping positions could suggest a musculoskeletal origin, possibly related to muscle strain or nerve irritation. The muscle relaxants prescribed by your physician may help alleviate this discomfort, but if symptoms persist or worsen, further evaluation is warranted.

Regarding your concern about the low-dose CT scan of the chest, it is important to note that while this imaging can provide detailed views of lung structures and may incidentally reveal some cardiac conditions, it is not specifically designed to assess heart issues. For a comprehensive evaluation of cardiac health, you would typically undergo tests such as an electrocardiogram (ECG), echocardiogram, or a stress test. These tests can help identify any underlying heart conditions, including arrhythmias, valvular heart disease, or ischemic heart disease.

Given your family history of lung cancer and the previous chest X-ray findings, it is prudent to follow through with the scheduled low-dose CT scan. This will help rule out any pulmonary issues, especially since lung cancer can present with nonspecific symptoms like chest pain. However, if you continue to experience chest pain or if new symptoms arise, I recommend consulting a cardiologist. They can perform a thorough assessment and determine the appropriate tests based on your symptoms and medical history.

In summary, while your left chest pain may be related to musculoskeletal issues, it is essential to remain vigilant, especially with your family history. The low-dose CT scan will provide valuable information regarding your lung health, but for a comprehensive cardiac evaluation, consider scheduling an appointment with a cardiologist. They can guide you through the necessary tests to ensure your heart health is thoroughly assessed. Always prioritize your health and seek immediate medical attention if you experience severe or worsening symptoms.

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