Persistent Left Chest Discomfort: Causes and Solutions

Prolonged discomfort and mild pain in the left chest?

At 32 years old, I have no bad habits such as smoking or drinking.
Currently, I am taking medication for high blood pressure.
Before starting the medication, my blood pressure was around 165/90, but now it is controlled to about 135/85.
Four years ago, I experienced a sensation of heaviness and dull pain in my left chest, and I went to a major hospital for tests including echocardiography, electrocardiogram, exercise stress test, and coronary CT angiography.
The results indicated no issues, with no calcified plaques, just high blood pressure, and I started taking antihypertensive medication.
However, the sensation of heaviness and pain in my left chest has not improved.
After stopping the antihypertensive medication due to the pandemic, the chest discomfort disappeared for a while, but recently the heaviness and dull pain have returned.
I went to a clinic to get prescribed blood pressure medication, but the discomfort in my left chest persists throughout the day, varying in location.
The sensations are similar to those I experienced four years ago, sometimes manifesting as soreness in the left upper back and shoulder blade, sometimes as heaviness and dull pain in the middle of the left chest with slight soreness in the back, at other times as pain in the left side of the chest (near the armpit), shoulder pain, or dull pain on the right side of the chest near the abdomen.
The discomfort varies in location daily, and it tends to occur when I am standing, sitting for long periods, lying flat, or sleeping on my side.
Interestingly, the symptoms tend to alleviate during walking, exercising, or jogging.
Recently, I noticed that drinking cold water triggers a dull pain in the middle of my left chest, which does not feel like the "heavy stone" sensation described by doctors.
The discomfort is not vague; I can pinpoint a specific area that feels somewhat like muscle pain, but I cannot press on the painful spot.
Given that my work involves long hours at a desk using a computer, could this be related to my posture? Which specialty should I consult for further examination? Additionally, how long can the results of a coronary CT angiography remain accurate?

Mr. Li, 30~39 year old female. Ask Date: 2024/03/13

Dr. Wu Xueming reply Cardiology

If coronary artery disease is suspected, an exercise electrocardiogram or a nuclear medicine myocardial perfusion scan can be performed for evaluation.

Reply Date: 2024/03/13

More Info

Persistent left chest discomfort can be a multifaceted issue, especially in someone with a history of hypertension and previous episodes of chest pain. Given your age (32 years) and the absence of smoking or drinking habits, it is crucial to consider various potential causes for your symptoms.

Possible Causes of Left Chest Discomfort
1. Musculoskeletal Issues: Given your description of the pain moving around and sometimes feeling like muscle soreness, it is possible that your discomfort is related to musculoskeletal problems. Poor posture, especially from prolonged computer use, can lead to muscle strain in the chest, shoulders, and back. This can manifest as pain that varies in location and intensity, particularly when sitting or lying down.

2. Anxiety and Stress: Anxiety can often present as chest discomfort, especially in younger individuals. The sensation of pressure or tightness in the chest can be exacerbated by stress, leading to a cycle of worry and physical symptoms. If you find that your symptoms worsen during stressful periods, this could be a contributing factor.

3. Gastroesophageal Reflux Disease (GERD): Sometimes, chest discomfort can be related to gastrointestinal issues, such as acid reflux. Symptoms can mimic cardiac pain and may be aggravated by certain foods or beverages, including cold drinks, which you mentioned.

4. Cardiac Considerations: Although previous tests (echocardiogram, ECG, CT angiography) have ruled out significant heart disease, it is essential to remain vigilant. Conditions like microvascular angina or other non-obstructive coronary artery diseases can still cause chest discomfort, especially if symptoms are recurrent.

5. Nerve Pain: Conditions such as costochondritis or intercostal neuralgia can cause pain that radiates across the chest and back. These conditions can be triggered by physical activity, poor posture, or even viral infections.

Recommended Actions
1. Consult a Specialist: Given the complexity of your symptoms, it would be wise to consult a cardiologist to rule out any potential cardiac issues, especially since you have a history of hypertension. A follow-up with a primary care physician or a musculoskeletal specialist (like an orthopedic doctor or a physical therapist) may also be beneficial to address any postural or muscular issues.

2. Posture and Ergonomics: Since you spend long hours at a computer, consider evaluating your workstation ergonomics. Ensure that your chair, desk, and monitor are set up to promote good posture. Regular breaks to stretch and move around can also help alleviate discomfort.

3. Stress Management: If anxiety is a contributing factor, consider incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive behavioral therapy (CBT). These methods can help manage anxiety and potentially reduce the physical symptoms associated with it.

4. Dietary Considerations: Monitor your diet for any foods that may trigger symptoms, particularly if you suspect GERD. Keeping a food diary can help identify patterns related to your discomfort.

5. Follow-Up Imaging: Regarding the CT angiography, while it provides a snapshot of your vascular health, the results can change over time, especially with lifestyle factors like blood pressure management. It is generally advisable to repeat such imaging every few years if there are ongoing symptoms or risk factors.

Conclusion
Persistent left chest discomfort can arise from various sources, including musculoskeletal issues, anxiety, gastrointestinal problems, and potential cardiac concerns. A thorough evaluation by appropriate specialists, combined with lifestyle modifications, can help identify the underlying cause and guide effective management. Always prioritize your health by seeking timely medical advice, especially when symptoms are recurrent or concerning.

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