Recurring chest pains

[Melissa]

I am 29 years old.  I'm a healthy weight and I am not sedentary.  I started having chest pains yesterday that increase as I move.  They also get progressively worse during the day.  If I lie perfectly still, it only hurts if I breath deeply.  As I have 3 small children, lying perfectly still isn't an option!  My left arm feels weak, not numb.  Any excertion makes me short of breath, but I'm not really having trouble breathing.  My doctor's office told me to go to the ER, but I don't want to make a big deal out of nothing.  This happened a few years ago, but went away.  I'm wondering if it is possible that I have pulled a muscle or something?  I lift my 30 lb. two year old and my 40 lb. four year old frequently.

[Cleveland Clinic, MD]

I would agree with your doctor that you should go to the ER if you cannot get in to see him. 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 and coronary artery spasm), 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.