Chest and Back Discomfort: When to Seek Medical Help - Family Medicine

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It sounds like you have been experiencing a range of concerning symptoms related to your chest and back discomfort. Given the complexity of your situation, it's important to approach this systematically.
From your description, you have experienced left chest tightness, a sensation of pressure, and occasional sharp pain that radiates to your back. Additionally, you mentioned symptoms such as cold sweats, numbness in your hands, and feelings of anxiety and fear. These symptoms can be quite distressing and may lead to multiple visits to the emergency room, especially when accompanied by normal tests such as blood work, electrocardiograms (EKGs), and chest X-rays.

The fact that you have undergone various tests, including echocardiograms, 24-hour Holter monitoring, and even gastrointestinal evaluations, suggests that your healthcare providers are taking your symptoms seriously. The findings of mild left ventricular hypertrophy and mitral valve prolapse are noteworthy but are often benign and may not directly explain your symptoms. However, the mention of "mild anterior wall ischemia" could indicate that there is some degree of reduced blood flow to the heart muscle, which warrants further investigation.

Given that your symptoms seem to fluctuate and sometimes improve when lying down or during work, it may be beneficial to consider a few potential causes:
1. Musculoskeletal Issues: Given the nature of your symptoms, it is possible that they could be related to musculoskeletal problems, such as costochondritis or muscle strain. These conditions can cause chest pain that mimics cardiac issues but are often benign.

2. Anxiety and Panic Attacks: The feelings of tightness, cold sweats, and numbness can also be associated with anxiety or panic attacks. It's not uncommon for individuals to experience physical symptoms that are linked to psychological stress.

3. Gastroesophageal Reflux Disease (GERD): Although your endoscopy did not show reflux, it is worth noting that some patients can have reflux symptoms that are not visible during an endoscopy. GERD can cause chest discomfort and mimic cardiac symptoms.

4. Cardiac Evaluation: Since you have a history of mild ischemia and structural heart changes, it may be prudent to follow up with a cardiologist for a more comprehensive evaluation. This could include a stress test or advanced imaging to assess for any underlying cardiac issues that may not have been detected in previous tests.

5. Neurological Evaluation: If your symptoms persist and are accompanied by numbness or tingling, a consultation with a neurologist may be warranted to rule out any neurological conditions.

In terms of which specialist to see next, I would recommend starting with a cardiologist, given your history and the nature of your symptoms. They can provide a thorough evaluation of your heart health and determine if any further testing is necessary. If cardiac causes are ruled out, then considering a referral to a pulmonologist or a gastroenterologist may also be beneficial, depending on the results of your cardiac evaluation.

In summary, while your symptoms are concerning, the extensive testing you've already undergone is reassuring in that serious conditions have been ruled out. However, continued symptoms warrant further investigation, and a multidisciplinary approach may be necessary to get to the root of your discomfort. Always trust your instincts; if you feel something is wrong, don't hesitate to seek further medical advice.