Should I go back to my doctor?

I am a 26-year old female. In July I began having occasional chest pains which I attributed to heartburn - although I have never experienced them before in my life - or stress from my job.  Last month I saw my physician for a complete physical and he discovered that I have a heart murmur.  I am scheduled to go back in another month or two to have my heart listened to again, but in the meantime, I continue to have chest pains, usually underneath my right breast.  Sometimes they are sharp and quick but other times they are dull and last for a short period of time. I'm not sure if it is attributed to stress, heartburn (although I have not changed my diet) or..?? Should I be worried now that my doctor thinks that I have a heart murmur?

[Cleveland Clinic, MD]

Dear  Stacey,

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.