Irregular Chest Pain: Causes and When to Seek Help

Recent episodes of irregular chest pain?

Hello Doctor, I am 19 years old.
During my university entrance health check last year, I did not have any issues related to hypertension, diabetes, or hyperlipidemia, but I was diagnosed with Mediterranean anemia.
Recently, I have been experiencing intermittent chest pain, primarily a sharp pain in the middle-left area of my chest, which is not a persistent long-lasting pain.
Occasionally, I also experience dull pain in other areas of my left chest, shoulder and neck soreness, sharp pain under my left armpit, arm soreness, and tingling in my fingers (usually in my left hand).
These symptoms typically occur when I am at rest, with no apparent cause; I do not feel discomfort while exercising, but after resting for a while post-exercise, some of the aforementioned symptoms appear.
I am unsure if there is a connection to exercise.
Last week, I visited the cardiology department at Mackay Memorial Hospital in Taipei (at that time, I only had the sharp chest pain symptom with no other issues).
An electrocardiogram and chest X-ray were performed, and the doctor said there were no abnormalities.
However, the chest pain symptoms continue to occur intermittently, and I have even developed pain in other areas.
I would like to ask the doctor if it is possible that there is an underlying issue that has not been detected yet, and if there is a need for further testing? My father has mitral valve insufficiency; could this be hereditary? Are my other left upper body pain issues related to my heart? If my heart is indeed healthy, could the pain be caused by anxiety? What symptoms in the chest would require immediate medical attention? Thank you, Doctor, for taking the time to read and respond.

Alice, 10~19 year old female. Ask Date: 2022/10/01

Dr. He Dongjin reply Cardiology

Hello, at this age, the likelihood of heart issues is very low.
It is more likely to be caused by poor posture leading to musculoskeletal or nerve problems, or possibly mitral valve prolapse, which is usually not related to the heart.
The pain in the upper left side of the body is likely not related to the heart and could also be symptoms caused by anxiety.
If the symptoms persist without improvement, it is advisable to seek further evaluation from a cardiologist.
Changhua Hospital cares about your well-being.

Reply Date: 2022/10/01

More Info

Understanding irregular chest pain can be quite complex, especially for someone as young as you, who is already dealing with Mediterranean anemia and experiencing various symptoms. Your description of the pain—sharp, localized to the left side of the chest, and accompanied by other symptoms like shoulder and neck pain, as well as tingling in the left arm—raises several important considerations.

Firstly, it’s good that you have already sought medical attention and undergone tests like an electrocardiogram (ECG) and chest X-ray, which have shown no abnormalities. This is a positive sign, but it does not completely rule out the possibility of underlying issues. Given your family history of valve problems, it’s understandable to be concerned about hereditary conditions. While some heart issues can be genetic, many factors contribute to heart health, including lifestyle, diet, and overall health.

The symptoms you describe could be related to several potential causes:
1. Musculoskeletal Issues: Given your age and the nature of your pain, it’s possible that the discomfort is related to muscle strain or tension, especially if you spend long hours in a static position (like studying or using a computer). Poor posture can lead to muscle tightness in the neck and shoulders, which can radiate pain to the chest area.

2. Anxiety and Stress: Anxiety can manifest physically in various ways, including chest pain. If you find that your symptoms worsen during stressful periods or are accompanied by feelings of anxiety, this could be a significant factor. Panic attacks, for example, can cause sharp chest pain, shortness of breath, and other distressing symptoms.

3. Cardiac Issues: Although your initial tests were normal, if your symptoms persist or worsen, further evaluation may be warranted. Conditions like costochondritis (inflammation of the cartilage connecting the ribs to the sternum) can mimic heart pain but are not related to heart function. However, if you experience symptoms such as shortness of breath, dizziness, or pain radiating to the jaw or arm, you should seek immediate medical attention.

4. Nerve Issues: Sometimes, nerve compression or irritation can cause pain that feels like it originates from the heart. This could be due to a pinched nerve in the neck or upper back.

Given your symptoms, it may be beneficial to follow up with a healthcare provider who can perform a thorough evaluation, which may include:
- Further Cardiac Testing: If your symptoms persist, consider asking for additional tests such as an echocardiogram or a stress test to evaluate heart function more comprehensively.

- Musculoskeletal Assessment: A physical examination focusing on your posture and muscle tension can help identify if your pain is related to musculoskeletal issues.

- Mental Health Evaluation: If anxiety is suspected, discussing your symptoms with a mental health professional could provide insights and coping strategies.

In terms of when to seek help, you should go to the emergency room if you experience:
- Severe chest pain or pressure that lasts more than a few minutes or goes away and comes back.

- Pain that spreads to your shoulders, neck, arms, back, teeth, or jaw.

- Shortness of breath, sweating, nausea, or lightheadedness.

In conclusion, while your initial tests are reassuring, it’s essential to continue monitoring your symptoms and communicate openly with your healthcare provider. Keeping a symptom diary, noting when the pain occurs, its intensity, and any associated activities or stressors can provide valuable information for your doctor. Remember, your health is paramount, and seeking clarity on your symptoms is always a wise decision.

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