Chest tightness

  : : :    For the past five months, I have been troubled by a tightness in the middle of my chest. The discomfort isn't severe, but is sometimes accompanied by light-headedness and a slight tingling in the left hand. I have seen several doctors and had an EKG and sonogram test on my heart, but haven't had anyone be able to tell me what is causing the tightness. One of the EKGs showed a bundle branch blockage, but the rest of the tests were normal, according to the doctors.
  : : :    Occasionaly (once every 2-3 weeks) I will experience a severe pain in the middle of my chest (so severe I can hardly breathe for 10-15 seconds), but that pain only lasts 1-2 minutes.
  : : :    I have also noticed that when the tightness in my chest is most noticable, I also have a spot in my chest (just below the sternum) which is tender to the touch. When the chest isn't tight, the tenderness is also absent.
  : : :    This has been a very frustrating experience and my physician hasn't been able to provide me with any answers. Are there any other problems which could cause this pain? I know have also had some breathing tests and chest x-rays, all normal.
  : : I forgot to mention in my previous post that I am 28 years old and have been in good health until this inncident. Also, the chest tightness isn't brought on or made worse by physical activity. Thanks.
  :

[Cleveland Clinic, MD]

  : Dear  Troy,
  : There are many causes of chest pain.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out the work-up can proceed at a more leisurely pace.  
  : Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
  : Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
  : Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
  : Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
  : Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
  : As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.  Hope this helps.  Feel free to write back with any additional questions.
  : Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.
  Are any of the above mentioned problems associated with the "tenderness" below the sternum?
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Dear Troy,
One may consider more GI causes of chest pain if they orginate from the stomach area.
  : Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.