stomach pain radiating into left arm.

[lesmark]

My husband has been having epigastric pain that radiates into his left arm for 3 or 4 years.  He has had cardiac work-ups and been told that pain like this has to be his heart because "stomach pain does not cross the shoulder."  He does have a cardiac history with a VSD at birth and repair at age 5, cardiomyopathy in 2001, and an MI affecting the apex of approximately 4% of his heart at some time.  He has had his gallbladder removed because "some people are wired wrong with referred pain to the left side instead of the right side."  This has not helped.  He gets yearly EGD's due to Barret's esophagus.  He chronically has gastritis, duodentitis, esophagitits, and usually a sticture and is stretched with a #5 malloney.  He takes Carafate QID, Bentyl TID, and Nexium QD.  Can you recommend anything they are missing.  He is so leary of doctors at this point.  Thank you for your help.  Leslie.

[boron]

Both cardiac conditions (angina pectoris) or bowel conditions may cause the pain in the left arm.

Cardiac pain typicaly goes along the whole arm to the end of a little finger. This pain would be worse during an exercise, heavy meal, low outside temperature...A sublingual tablet of nitroglicerol relieve the pain within few minutes.

Stomach pain radiating into an arm is more likely limited to upper arm, shoulder and upper back.

Two suggestions:
1. control the stomach pains - if there are any pains there
2. detailed heart investigation, maybe 24-hour ECG monitoring to find eventual angina pectoris

[lesmark]

Pain not relieved with SL nitro.  Pains in stomach unrelieved with gastric meds.  Pains do at times radiate the full length of left arm to the tips of the fingers.  Husband has wore 24 hour holter monitor with no effective tracings noted.  He does have a RBBB otherwise he is basically a NSR without any ectopy noted.  There seems to be no correlation to his stomach pain and his diet or his stress levels.  He just has an episode that will put him on the couch for a few days after work with pain and then he will be fine again.  This is a man who had C4, C5, and C6 plate, screw, and fusion done and returned to work in 1 week without taking any pain meds.  He has a very high tolerance for pain.  We are out of ideas.  Thanks for your help.  Any ideas are appreciated.  

[CalGal]

Has he been checked for esophageal spasms? They can feel very similar to heart problems and some people report jaw and arm pain when they hit.

[boron]

Nerves for the arm originate from C4 - T2. So...there is an investigation called mielography, which shows, if any part of the spine pressures on the nerves.

http://www.patient.co.uk/showdoc/40001858/