Chest Pain: When to Seek Help and Which Specialist to Consult

Pressing in the middle of the chest causes pain?

Hello Dr.
Ding: I have seen several doctors but none have been able to identify the cause of my symptoms.
I would like to ask you some questions, as I am unsure which specialty I should consult.
Thank you!
In mid-September, I suddenly experienced a sharp pain in my heart, but it went away.
However, I continued to have intermittent mild pain, which was not severe.
That night, I had difficulty sleeping due to chest tightness and some breathing difficulties.
I felt pain when pressing on a specific point in the middle of my chest.
I was very anxious and went to Yadong Hospital, where I first consulted a cardiologist, who found nothing wrong.
Despite the cardiologist's reassurance that my heart was fine, I continued to experience chest tightness and insomnia.
The cardiologist performed a resting electrocardiogram and a chest X-ray, both of which were normal.

I then consulted a gastroenterologist to check for gastroesophageal reflux disease, but again, nothing was found.
I was referred to a pulmonologist, who suggested that my symptoms were due to stress and prescribed muscle relaxants.
Blood tests were also performed, all of which returned normal results, but I still experienced pain.
Last Friday, after another follow-up appointment with no diagnosis, I decided to see an orthopedic doctor privately, who also found nothing wrong and attributed my symptoms to poor sleeping posture.

On that day, I felt somewhat better and managed to sleep well.
However, after 3-4 days, while the pain in the center of my chest subsided, I began to experience pain in my left shoulder, lumbar spine, and upper back, with the pain points being inconsistent.
My chest and throat felt very tight and uncomfortable.
I thought it might be due to lack of exercise, so I walked around the track, stretched, and asked family members to massage me.
After 3-4 days, I noticed improvement in my left shoulder and upper back, which felt less tight and painful.
However, my lumbar spine still felt sore, and I discovered a small, painful, round lump near the center of my left chest.
When lying flat, the lump was more noticeable, and I also found several small bruises on my left thigh, resembling minor ruptured capillaries.
Now, I am unsure which specialty to consult, as I have experienced back pain and chest pain, and currently have a small round lump in my left chest along with bruising on my leg.
I cannot distinguish which specialty to see, especially since previous tests have shown no issues.
I am considering whether I should check my breasts, but my back also hurts, which doesn’t seem related to breast issues.
I truly don’t know what to do.
I am very scared and worried that I might have cancer.
I fear that my body is sending me signals that I cannot interpret, and I don’t know which specialty to consult next.
Can you please help me? Thank you!

Ms. Hu, 30~39 year old female. Ask Date: 2015/10/31

Dr. Ding Xianwei reply Neurosurgery

It is recommended that you start with family medicine.

Reply Date: 2015/10/31

More Info

When it comes to understanding chest pain and determining when to seek help, it's essential to recognize that chest pain can arise from various causes, some of which may be serious. Given your symptoms and the extensive medical evaluations you've undergone, it's understandable to feel anxious and uncertain about your health.

Firstly, it's important to note that chest pain can stem from cardiac issues, gastrointestinal problems, musculoskeletal conditions, or even anxiety. Since you've already consulted with specialists in cardiology, gastroenterology, and pulmonology, and they have ruled out significant issues, we can consider other potential causes.

1. Musculoskeletal Pain: Your description of pain that radiates to your shoulder and back, along with the discomfort in your chest, suggests that musculoskeletal issues could be at play. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain can cause localized pain that may mimic cardiac symptoms. If your pain improves with movement or stretching, this may further indicate a musculoskeletal origin.

2. Anxiety and Stress: Given the stress and anxiety you've experienced, it's possible that these factors are contributing to your symptoms. Anxiety can manifest physically, leading to muscle tension and pain, as well as sensations of tightness in the chest. If you find that your symptoms worsen during periods of stress, it may be beneficial to explore stress management techniques or speak with a mental health professional.

3. Further Evaluation: Since you mentioned the presence of a small, painful lump in your chest and unexplained bruising on your thigh, it would be prudent to follow up with a healthcare provider. A general practitioner or an internist could perform a comprehensive evaluation, including a physical examination and possibly imaging studies, to assess the lump and any underlying issues. They may also consider referring you to a specialist, such as a dermatologist for the skin changes or an oncologist if there are concerns about malignancy.

4. Breast Health: Given your concern about potential breast issues, it may be worthwhile to schedule a mammogram or breast ultrasound, especially if you notice any changes in breast tissue or if there is a family history of breast cancer. Early detection is crucial, and discussing your concerns with a healthcare provider can help determine the appropriate next steps.

5. Holistic Approach: In addition to seeking medical advice, consider adopting a holistic approach to your health. Regular physical activity, a balanced diet, and adequate sleep can significantly impact your overall well-being. Mindfulness practices, such as yoga or meditation, may also help alleviate anxiety and improve your coping mechanisms.

In conclusion, while your symptoms are concerning, many potential causes are manageable with the right approach. Continue to advocate for your health by seeking further evaluations and expressing your concerns to your healthcare providers. Remember, it's essential to listen to your body and seek help when needed. Don't hesitate to reach out for support from friends, family, or mental health professionals as you navigate this challenging time.

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