Pain in left arm

       I had a heart attack 15 months ago. When I did, I had a place in my left arm about 3 inches above my wrist then about 4 or 5 inches long that I described as having a hot poker stuck in my arm in that location. I have been told that having a burning sensation  happens with a heart attack sometimes. Now when I exert myself I hurt in this same spot, If I rest or take a nitroglycerin pill it  goes away. If I continue with what I'm doing the pain extends to my left shuolder, so I use this hurt as an indicator of when to rest.
       My Question's are
  1.Is this angina?
  2. Is there a reason for the hurt starting where the burning sensation was?
  3. Are there certain motions, like reaching overhead, shoveling motion, and etc. that can cause more strain on the heart than normal. Walking in the level doesn't seem to bother me, but walking uphill or lifting does, especially if its overhead..
  4.If you don't have medical insurance and want to be tested after a heart attack how often should you be tested and what test will give the best results.
      I check this forum usually once a week. I find it very interesting and informative.                                                                                            
                                                                                                       Thank you all very much.
                                                                                                                          James

[Cleveland Clinic, MD]

_
Dear  James,
Q: Is this angina?
A: Angina is due to a lack of blood flow (ischemia) to the heart muscle.  It is typically pressure like and in the center of the chest.  It may radiate to the left arm or jaw.  It is often accompanied by shortness of breath and a cold sweat (diaphoresis).  It is often precipitated by exertion or cold but may occur at rest. It may last for as short as 10 to 15 minutes or longer than several hours.  Pain that lasts only a few seconds is almost never angina.  In may sometimes be only in the arm or jaw.  Your symptoms certainly could  be angina and I would recommend further evaluation.
Q:  Is there a reason for the hurt starting where the burning sensation was?
A: The heart "shares" innervation with the chest, arm and jaw.  Thus heart pain can be in any of these areas.

Q:  Are there certain motions, like reaching overhead, shoveling motion, and etc. that can cause more strain on the heart than normal. Walking in the level doesn't seem to bother me, but walking uphill or lifting does, especially if its overhead.
A: Generally things that require more effort are more likely to precipitate angina.

Q: If you don't have medical insurance and want to be tested after a heart attack how often should you be tested and what test will give the best results.
A: The work-up for chest pain usually includes an ECG, chest X-ray, blood tests and often times a stress test or echocardiogram.  The definitive test for blockages is a heart catheterization.  If one doesn't have insurance the local University hospital or county medical center are usually willing to work out some kind of plan.    

Other potential causes of chest pain are musculoskeletal, pericarditis, pulmonary problems, gastrointestinal problems and anxiety.  The best course of action is to have all chest pain evaluated by a physician.  Pain that lasts only a few seconds can be evaluated as an outpatient.  Pain lasting for more than 20 minutes should be evaluated in an emergency department.
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.