Left Chest Pain and Its Possible Causes: When to Seek Help - Internal Medicine

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Chronic pain in the left chest area and underarm?


Hello Dr.
Hong, about a week ago I suddenly experienced pain in the upper left back, specifically in the area of the scapula.
Subsequently, I began to feel sharp pain in the corresponding left anterior chest.
Over the past two days, the most noticeable symptoms have been persistent sharp and stabbing pain between the outer left chest and the anterior axillary line.
I have been experiencing prolonged pain for a week, and the discomfort in my chest and back becomes more pronounced when lying down, affecting my sleep.
I would like to ask what symptoms or underlying conditions I might have.
Which specialty clinic should I visit? Should I go directly to a large hospital or a general clinic? Thank you for your professional assistance, Dr.
Hong.

Miss Wang, 60~69 year old female. Ask Date: 2021/09/24

Dr. Hong Yuanbin reply Internal Medicine


Hello, based on your description, there are two likely possibilities.
The first is a muscle strain, which is characterized by increased pain during movement.
The second possibility is pleuritis, which may have resulted from a previous respiratory infection, and is characterized by sharp pain during breathing.
I recommend consulting a pulmonologist, as you may need an X-ray for further confirmation.
Thank you for your inquiry.

Reply Date: 2021/09/24

More Info


Hello! Thank you for reaching out with your concerns regarding the left chest pain and associated symptoms. Based on your description, it sounds like you are experiencing significant discomfort in the left upper back and chest area, which has persisted for about a week. The pain you describe as sharp and stabbing, particularly when lying down, can be concerning and warrants a thorough evaluation.


Possible Causes of Left Chest Pain
1. Musculoskeletal Issues: Given that your pain is located in the upper back and chest, one of the most common causes could be musculoskeletal in nature. This includes muscle strain, rib dysfunction, or inflammation of the cartilage connecting the ribs to the sternum (costochondritis). These conditions can cause localized pain that may worsen with certain movements or positions, especially when lying down.

2. Nerve-Related Pain: Conditions such as intercostal neuralgia, where the nerves running between the ribs become irritated or compressed, can lead to sharp, stabbing pains in the chest and back. This type of pain may be exacerbated by certain movements or postures.

3. Cardiac Concerns: While musculoskeletal issues are more common, it is crucial to rule out any cardiac problems, especially since you are experiencing pain in the chest area. Conditions such as angina or even myocardial infarction (heart attack) can present with left-sided chest pain. Symptoms like shortness of breath, sweating, nausea, or pain radiating to the arm, neck, or jaw would be particularly concerning.

4. Gastrointestinal Issues: Sometimes, gastrointestinal problems such as acid reflux or esophageal spasms can cause pain that mimics cardiac pain. This type of pain can also be sharp and may worsen when lying down.

5. Pulmonary Issues: Conditions affecting the lungs, such as pleuritis (inflammation of the lung lining) or pulmonary embolism, can also cause chest pain. These conditions are often accompanied by other symptoms like difficulty breathing or coughing.


When to Seek Medical Help
Given that your pain has persisted for a week and is affecting your sleep, it is advisable to seek medical attention. Here are some guidelines on when to seek help:
- Immediate Attention: If you experience severe chest pain, especially if it feels like pressure or squeezing, or if it is accompanied by shortness of breath, sweating, nausea, or pain radiating to other areas (like the arm or jaw), you should seek emergency medical care immediately.

- Routine Evaluation: If your pain is persistent but not severe, you should schedule an appointment with a healthcare provider. A primary care physician can perform a thorough evaluation, including a physical examination and possibly ordering imaging studies (like X-rays or an ECG) to rule out serious conditions.


Where to Go for Help
- General Practitioner or Family Doctor: For initial evaluation, a visit to a general practitioner or family doctor is a good starting point. They can assess your symptoms, perform necessary tests, and refer you to a specialist if needed.

- Emergency Room: If your symptoms worsen or if you have any concerning symptoms as mentioned earlier, do not hesitate to go to the emergency room.

- Specialist Consultation: Depending on the findings, you may be referred to a cardiologist, pulmonologist, or orthopedic specialist for further evaluation.


Conclusion
In summary, while musculoskeletal issues are a common cause of left-sided chest pain, it is essential to consider other potential causes, including cardiac, gastrointestinal, and pulmonary conditions. Given the duration and nature of your symptoms, I recommend seeking medical evaluation promptly. Early diagnosis and treatment can help alleviate your discomfort and address any underlying issues effectively. Please take care and prioritize your health!

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