Persistent Chest Pain: Causes and Concerns Explained

Q: Persistent Chest Pain: Causes and Concerns Explained

Hello, Xin Xin： A CT scan can clearly reveal the presence or absence of aortic dissection. <br>You have been experiencing chest pain for nearly a month, and since the cardiologist found no issues, it may be necessary to consider whether there are any musculoskeletal problems. <br

Chest pain issues?

Hello doctor, I started experiencing pain in the center of my chest around early June, which later became a mild ache.
Sometimes I also feel pain on the left side of my chest, but most of the time, the pain is in the center.
After feeling that it had persisted for too long, I decided to see a doctor.
However, the chest pain did not improve significantly.
I visited a cardiologist who performed an echocardiogram and a stress electrocardiogram, both of which were normal.
The emergency doctor also conducted a CT scan because I was very concerned about aortic dissection.
Can a CT scan effectively determine if there is an aortic dissection? I did some research and found that there are atypical presentations.
The cardiologist reviewed my CT scan and told me there was no aortic dissection and no blockage in the heart.
Currently, I still experience pain in the center of my chest, which previously felt like a slight tearing pain, but my back does not hurt.
Now, I feel only a little pain, and the center of my chest often hurts.
Changing positions or lying on my stomach sometimes triggers the pain in the center of my chest.
Could this be caused by other factors? I would appreciate your clarification.
Thank you!

Xin Xin, 40~49 year old female. Ask Date: 2022/07/20

Dr. Liu Hongxiang reply Family Medicine

Hello, Xin Xin: A CT scan can clearly reveal the presence or absence of aortic dissection.
You have been experiencing chest pain for nearly a month, and since the cardiologist found no issues, it may be necessary to consider whether there are any musculoskeletal problems.
At this time, the pain is not very pronounced when at rest, but it can easily be triggered by pressure or movement.
If this is the case, prescribing some pain relief medication and reducing vigorous chest expansion activities may help alleviate the pain.
If possible, please visit a hospital for diagnosis to confirm the cause.
Thank you! Wishing you good health both physically and mentally.

Dr.
Liu Hongxiang

Reply Date: 2022/07/20

More Info

Persistent chest pain can be a concerning symptom, and it’s good that you have sought medical attention to rule out serious conditions such as aortic dissection or cardiac issues. Based on your description, it seems that you have undergone several diagnostic tests, including echocardiograms and CT scans, which have shown no signs of aortic dissection or significant heart problems. This is reassuring, but it does not completely explain your ongoing symptoms.

Chest pain can arise from a variety of causes, and understanding these can help in managing your condition. Here are some potential causes of persistent chest pain that you might consider discussing further with your healthcare provider:
1. Musculoskeletal Issues: Given that you mentioned changes in pain with posture and sleeping positions, musculoskeletal pain could be a significant factor. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain can cause localized chest pain that may mimic cardiac pain.
2. Gastroesophageal Reflux Disease (GERD): Acid reflux can cause a burning sensation in the chest, often mistaken for heart pain. This can be exacerbated by certain foods, lying down after eating, or stress. If you notice that your symptoms worsen after meals or when lying down, this could be a contributing factor.

3. Anxiety and Stress: Psychological factors can manifest as physical symptoms, including chest pain. Anxiety can lead to muscle tension, hyperventilation, and even panic attacks, which may present as chest discomfort. If you are experiencing significant stress or anxiety, it may be beneficial to address these issues through counseling or stress management techniques.

4. Pulmonary Issues: Although your CT scan likely ruled out serious pulmonary conditions, issues like pleuritis (inflammation of the lining of the lungs) or even mild infections can cause chest pain. If you experience any respiratory symptoms, such as coughing or shortness of breath, this should be evaluated.

5. Cardiac Syndrome X: This is a condition where patients experience chest pain due to microvascular dysfunction, even when major coronary arteries are clear. It’s less common but can be a consideration if other causes are ruled out.

6. Other Gastrointestinal Issues: Conditions such as esophageal spasms or peptic ulcers can also lead to chest pain. If you have any gastrointestinal symptoms, discussing these with your doctor may be helpful.

Since your symptoms have persisted despite normal cardiac evaluations, it may be worthwhile to follow up with a specialist, such as a gastroenterologist or a pain management specialist, to explore these other potential causes. Additionally, keeping a symptom diary can help identify any patterns or triggers related to your chest pain, which can be useful information for your healthcare provider.

In summary, while it is reassuring that serious cardiac conditions have been ruled out, persistent chest pain can stem from various causes, including musculoskeletal issues, gastrointestinal problems, and anxiety. A comprehensive approach that includes further evaluation and possibly a multidisciplinary treatment plan may be beneficial in managing your symptoms effectively. Always consult with your healthcare provider for personalized advice and treatment options.

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