Heart Discomfort and Facial Nerve Issues: A Comprehensive Guide

Regarding heart discomfort and issues related to the face and head?

Hello, Doctor.
A year and a half ago, I experienced numbness in my chest, sharp pain in my jaw, pain in my left shoulder and left arm, and severe wrist pain in my left hand.
Subsequently, I developed numbness on the right side of my scalp and right cheek, prompting me to visit two major hospitals for cardiac and neurological evaluations.
Both cardiologists concluded that there were no issues with my heart; however, I continued to feel unwell, leading me to undergo an upper gastrointestinal endoscopy, which revealed gastroesophageal reflux disease (GERD).
I also experienced upper abdominal pain (I had a CT scan, and the abdominal specialist indicated that my internal organs were normal).
A nerve conduction study of my face showed abnormalities, which led to an MRI of my brain, and the neurologist also reported no issues.
My thyroid function was normal as well.
Although medication provided some relief, my symptoms did not completely disappear and occasionally recurred.
Last month, I was troubled by sleep issues, which I have had for a long time but worsened recently (I find it difficult to fall asleep and can only sleep for 3-4 hours).
A few days later, I began experiencing numbness in my left face, left scalp, right face, and right scalp, along with involuntary twitching in my left eyelid and left fingers.
My cheeks also started to feel sore, and then the numbness in my chest returned, accompanied by pain in my left teeth, left inner ear, left shoulder (where I carry my bag), and left wrist and fingers.
Should I see a cardiologist for further evaluation, such as a cardiac catheterization? I wonder if the pain on my left side is related to my habit of sleeping on my left side, which puts pressure on my shoulder and elbow.
Regarding my teeth and jaw, I have noticed that I tend to grind my teeth and press my tongue against them, and I am unsure if this is related.
Despite seeking medical attention, I have not received a definitive diagnosis, and the pain is quite distressing.
I apologize for the lengthy message and would greatly appreciate any guidance you can provide.
Thank you.
I have also attached my examination results.
I do not have diabetes, and my blood pressure ranges from 115-130/78-90, but I am slightly overweight.
My cholesterol levels are normal.
First cardiac ultrasound results:
M-Mode:
RVD (7-25): 32 mm
IVSD (6-11): 11 mm
LVDd (37-56): 40 mm
AoRoot (20-37): 30 mm
IVS excursion (6-11): mm
LVDs (26-34): 25 mm
AV opening (15-26): 19 mm
LVPWD (6-11): 9 mm
EPSS (<5): mm
LA (9-40): 38 mm
LVPW excursion (9-14): mm
EF (>53%): %
Structural abnormality:
Pericardial effusion: No
Ant: cm, Post: cm, estimated amount cc
2D-Structure analysis:
MV: Normal
TV: Normal
AV: Normal
PV: Normal
Others:
-Wall motion analysis: Normal LV wall motion
-EF: 72%
Color Doppler: Mild MR
Comments:
1.
Normal LV wall motion, LVEF 72%
2.
Mild MR
Second cardiac ultrasound results:
Clinical Dx: M-mode + Section Scan:
Aortic Root (20-37 mm): 30
LAD (19-40 mm): 38
LVIDd (35-51 mm): 44
LVIDs (28-35 mm): 28
VS (6-10 mm): 10
PW (6-10 mm): 10
Comment:
(M-mode, 2-D, Doppler & Color Flow Mapping)
● Normal heart chamber size.

● Preserved LV and RV systolic function, LVEF = 66%
● Preserved LV diastolic function: E/A = 1.1, Em/Am = 1.2, Em = 12.4 cm/s, E/Em = 7.4.

MR: Minimal.

TR: Minimal.

PR: Mild.

● Other: (V) Poor acoustic window.

Abdominal CT scan results:
Whole Abdomen CT with & without IV-contrast enhancement study plus CTU shows:
- Slight dilatation of the right pelvicalyceal system and partial ureter, no obvious hyperdense ureteral stone or soft tissue lesion identified.

- Diffuse mild fatty liver.

- No definite abnormal attenuation or enhancing mass lesion in the liver, spleen, pancreas, gallbladder, or kidneys.
Few right renal cysts.

- Normal appearance of the appendix and bowel loops.

- Clear peritoneal fat without obvious ascites.

- Maintained bony structure without definite fracture.

- Degenerative change with spur formation at the thoracolumbar spine.

- No definite enlarged para-aortic or mesenteric lymph nodes.

- No active pulmonary lesions noted in the included lungs.

Impression:
1.
Slight right hydroureteronephrosis, rule out occult stone or ureteral stricture in distal portion, or inflammation.

2.
Mild fatty liver.

Clinical correlation and follow-up recommended.

Brain MRI results:
The supine position superconductive 1.5T brain MRI with surface coil was performed for this suspected trigeminal neuralgia patient.
The pulse sequences included axial T1WI, T2WI, SWI, and FLAIR, with coronal and axial thin 1mm slice thickness posterior fossa T1WI and T2WI studies.
No intravenous gadolinium was administered.
The axial functional brain images (DWI and ADC maps) were also performed.
Findings:
1.
No focal mass lesion, no abnormal signal intensity change, nor midline shifting seen within the brain parenchyma.

2.
No acute intracranial hemorrhage is seen.

3.
The intracranial vessels still show normal flow voiding.

4.
The ventricular size is normal.

5.
Clear appearance of bilateral paranasal sinuses and bilateral mastoid antri.

6.
Bilateral cerebellopontine cisterns and parasellar regions show no focal mass lesion; the cisternal segments of bilateral trigeminal nerves are well-seen.
No external compressive mass effect nor displacement occurs.

7.
The axial functional whole brain images (diffusion-weighted images and ADC maps) show no acute ischemic infarction, no acute inflammatory lesion, nor tumor mass lesion.

8.
The 3D intracranial T.O.F MR angiography shows no vascular malformation or saccular aneurysm.
No apparent focal vessel luminal stenosis or flow interruption occurs.

Impression: Bilateral cerebellopontine cisterns and parasellar regions show no focal mass lesion; the cisternal segments of bilateral trigeminal nerves are well-seen.
No external compressive mass effect nor displacement occurs.
The axial functional whole brain images show no acute ischemic infarction, no acute inflammatory lesion, nor tumor mass lesion.
The 3D intracranial T.O.F MR angiography shows no vascular malformation nor apparent focal vessel luminal stenosis.
Regular follow-up is suggested.

Niming, 40~49 year old female. Ask Date: 2024/05/18

Dr. He Dongjin reply Cardiology

Hello, the reports are all good, and the symptoms do not seem to indicate a heart problem.
It may be worth considering cervical spine issues or autonomic nervous system disorders.
It would be advisable to follow up with a neurologist.
Changhua Hospital cares about your well-being.

Reply Date: 2024/05/18

More Info

It sounds like you are experiencing a complex array of symptoms that are causing you significant distress. Based on your description, you have undergone extensive testing for both cardiac and neurological issues, and while the results have generally indicated no major problems, your symptoms persist. This situation can be incredibly frustrating and confusing, especially when the source of discomfort is not easily identifiable.

Understanding Your Symptoms
1. Chest Discomfort and Pain: The symptoms you describe, such as chest pain, left arm pain, and tingling sensations, can be alarming and are often associated with cardiac issues. However, since multiple heart evaluations (including echocardiograms) have shown normal results, it is less likely that these symptoms are due to a heart condition. Instead, they could be related to anxiety, muscle strain, or even gastroesophageal reflux disease (GERD), which you mentioned you have. GERD can cause chest pain that mimics heart pain.

2. Facial and Head Symptoms: The tingling and numbness in your face and scalp, particularly on the right side, could suggest a neurological issue, but given that your MRI results were normal, it might be indicative of a condition like trigeminal neuralgia or even anxiety-related somatic symptoms. Anxiety can manifest physically, leading to sensations of numbness or tingling, especially in stressful situations.

3. Sleep Issues: Your sleep disturbances are also a significant factor. Poor sleep can exacerbate both physical and mental health issues, leading to increased sensitivity to pain and discomfort. Sleep deprivation can also heighten anxiety and stress, creating a vicious cycle.

Recommendations
1. Follow-Up with a Specialist: Given the complexity of your symptoms, it may be beneficial to consult with a neurologist who specializes in pain management or a headache specialist. They can provide further insights into your facial symptoms and explore conditions like trigeminal neuralgia or other neuropathic pain syndromes.

2. Consider Psychological Factors: Since anxiety seems to be a recurring theme in your symptoms, it might be helpful to engage with a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing anxiety and can help you develop coping strategies for your symptoms. Mindfulness and relaxation techniques may also help alleviate some of the physical manifestations of anxiety.

3. Physical Therapy: If you suspect that your sleeping position and posture may be contributing to your discomfort, a physical therapist could help you with exercises to strengthen your shoulder and neck muscles, improve posture, and reduce strain.

4. Lifestyle Modifications: Incorporating regular physical activity, a balanced diet, and good sleep hygiene can significantly impact your overall well-being. Avoiding stimulants like caffeine and nicotine, especially close to bedtime, can improve sleep quality.

5. Medication Review: If you are currently on medication for anxiety or other conditions, it may be worth discussing with your physician whether adjustments are needed. Sometimes, the side effects of medications can contribute to feelings of discomfort or exacerbate anxiety.

Conclusion
Your symptoms are multifaceted and may involve a combination of physical and psychological factors. While it can be disheartening to receive normal test results without a clear diagnosis, it is essential to continue seeking help and exploring different avenues for treatment. Engaging with specialists who can address both the physical and psychological aspects of your health will be crucial in finding relief and improving your quality of life. Remember, you are not alone in this journey, and there are professionals who can help guide you toward better health.

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