Seeking Help for Persistent Chest Pain: A Patient's Journey

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Hello, I would like to inquire about my symptoms.
I have been experiencing chest pain since the year before last.
I have visited Kaohsiung Ruann General Hospital, Chang Gung Memorial Hospital, and the 802 Military Hospital, consulting specialists in cardiology, neurology, pulmonology, and even rehabilitation, but none of the doctors could identify the cause.
They all said there was no issue and suggested I see other specialists, but after those visits, there was still no diagnosis.
However, I continue to experience pain in my chest, sometimes quite severely.
I have undergone chest X-rays, electrocardiograms, exercise stress tests, and echocardiograms, all of which showed no problems.
Yet, the pain persists.
I have read about cases of misdiagnosis in the news; could my situation be similar? What should I do? Is there a possibility for further testing or alternative options? The ongoing chest pain has been affecting my ability to work, and I feel helpless.
Should I consider paying out of pocket for more detailed examinations or seek better medical expertise? I would greatly appreciate a detailed response.
Thank you.
Sincerely, Mr.
Hsieh from Kaohsiung.

Xie, 30~39 year old female. Ask Date: 2005/03/02

Dr. Huang Jianling reply Family Medicine

Dear Mr.
Hsieh,
Mr.
Hsieh has been experiencing chest pain for over a year and has consulted various specialists who have all indicated that there are no issues.
Due to the insufficient description of symptoms and examination data, I am hesitant to speculate on the underlying condition.
However, it is understandable that Mr.
Hsieh may have concerns about whether this could be a heart attack.
Below are some explanations and recommendations for Mr.
Hsieh:
Typical chest pain caused by the heart may present as a dull ache lasting about ten minutes, often accompanied by shortness of breath and sweating.
This type of pain may be relieved by rest or sublingual nitroglycerin (NTG).
If the pain persists for more than half an hour and is severe, it could indicate a myocardial infarction.
If there are symptoms of fainting or near-fainting, it is crucial to seek emergency medical treatment promptly.
(An electrocardiogram (ECG) during chest pain is the most effective way to diagnose heart-related issues.)
However, the majority of chest pain is attributed to neuropathic pain, muscle spasms, or previous injuries.
Additionally, lung issues (such as pneumothorax), asthma, and gastrointestinal diseases can also cause chest discomfort and pain.
Chronic cough can also be a cause of chest pain, and not all chest pain is indicative of heart disease.
I recommend that Mr.
Hsieh consult a well-known cardiologist at a medical center to rule out any cardiac issues or undergo a comprehensive health examination to check for gastrointestinal, cardiopulmonary, or neuromuscular conditions.
Sincerely,
Dr.
Huang Jian-Ling
Department of Family Medicine, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2005/03/02

More Info

Dear Mr. Hsieh,
I understand that you have been experiencing persistent chest pain for over two years, and despite consulting multiple specialists—including cardiologists, neurologists, and thoracic surgeons—no definitive cause has been identified. This situation can be incredibly frustrating and distressing, especially when the pain significantly impacts your daily life and ability to work.
Chest pain can arise from a variety of sources, including cardiac, gastrointestinal, musculoskeletal, and psychological factors. Given that you have undergone numerous tests, such as chest X-rays, electrocardiograms (ECGs), exercise stress tests, and echocardiograms, and all have returned normal results, it is essential to consider other potential causes that may not be immediately apparent.

1. Musculoskeletal Issues: Sometimes, chest pain can stem from musculoskeletal problems, such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain. These conditions can mimic cardiac pain and may not show up on standard cardiac tests. A thorough physical examination by a specialist in musculoskeletal medicine or a physical therapist may help identify any underlying issues.

2. Gastrointestinal Causes: Conditions such as gastroesophageal reflux disease (GERD), esophageal spasms, or even peptic ulcers can cause chest pain. If you have not yet consulted a gastroenterologist, it may be worthwhile to explore this avenue. Tests such as an upper endoscopy or pH monitoring can help diagnose these conditions.

3. Psychological Factors: Anxiety and stress can manifest as physical symptoms, including chest pain. If you have been under significant stress or anxiety, it may be beneficial to speak with a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can be effective in managing pain that has a psychological component.

4. Further Diagnostic Testing: If you feel that your current evaluations have not been exhaustive, you might consider requesting more advanced imaging studies, such as a CT scan of the chest or a cardiac MRI, which can provide more detailed information about the structures in your chest. Additionally, a Holter monitor (a portable ECG device) can help capture any intermittent arrhythmias that may not have been detected during your previous tests.

5. Second Opinions: If you feel that your concerns are not being adequately addressed, seeking a second opinion from a different hospital or a specialized center may provide new insights. Some centers have multidisciplinary teams that can collaboratively assess complex cases like yours.

6. Pain Management: In the meantime, managing your pain is crucial. Consult with a pain management specialist who can offer various interventions, including medications, physical therapy, or even alternative therapies such as acupuncture or chiropractic care.

7. Lifestyle Modifications: While you pursue further evaluations, consider lifestyle changes that may alleviate symptoms, such as dietary adjustments, regular exercise (as tolerated), and stress-reduction techniques like yoga or meditation.

In conclusion, persistent chest pain can be challenging to diagnose and treat, especially when initial tests return normal results. It is essential to remain proactive in your healthcare journey. Keep advocating for yourself, and do not hesitate to seek further evaluations or alternative opinions. Your health and well-being are paramount, and with persistence, you can find the answers and relief you deserve.

Best wishes for your health and recovery,
Doctor Q&A Teams

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