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1448936 tn?1363206346

Constant chest pains, no answers

I have been having chest pains for 2 months with no explanation. My pcp did two chest X-rays and an ekg which were normal. I was sent to a cardiologist who did an ekg and a stress test and both of those tests were normal. I also had bloodwork done that showed that my thyroid was normal but I had slightly high cholesterol but my dad does as well. He found that I have minor tachycardia but I have anxiety so he wasn’t worried about it. I’m still having the pains and have another appointment with my cardiologist this week.
I’m a 32 year old female. I’m not overweight, have low blood pressure, no family history of early heart problems, but I am a smoker. I’ve begun therapy to help with my anxiety so I can successfully quit smoking. So I am working on that.
I don’t know what this could possibly be. I’ve been so scared to do anything because of my chest pains. What could possibly be wrong if all my tests keep coming back normal?
5 Responses
20748650 tn?1521032211
Are they worse at night? Can you describe the pain better? How does it feel, where is it located.. What makes it better or worse?

Does it travel anywhere? How long does each "wave" or episode last? From the time you feel the pain how long does it take to start fading away?

Waxing and waning pain.. Which is basically loke a prolonged throbbing sensation.. With each "throb" lasting 5-15 minutes is a key indicator here.

You gave some good information so far with family history, hypercholesterolemia, smoking etc.. But i need more.. Alot more detail.. Including any and all illness to include common colds youve had in the past 6 months
20748650 tn?1521032211
Also include any other symptoms that come with your pain like, shortness of breath, racing heart, palpitations or fluttering sensations, fatigue, sweating, nausea.. Evaluating pain like this should literally take a doctor like.. At least 10-15 minutes of just question and answer.. Ideally this can be accomplished while staff draws labs, takes ekgs etc.. I really am not a fan of cutting corners on this one.
They’re a weird pain that’s hard to describe. Almost cramp like but sometimes sharp. It seems to be the worst in the morning but can last all day. It is usually located on my left side near my shoulder but can travel across my chest to my right side. I had bronchitis in September but I normally get bronchitis every fall and I’ve never dealt with chest pain like this. I notice that my upper back will hurt very bad too when I have the chest pains but not each time. The only time I was having shortness of breath was when I actually had bronchitis but I don’t have it anymore. I do have dizziness but I have low blood pressure that has always caused me dizziness and I do have nausea but have been dealing with nausea from ibs for about 7 years so these aren’t new symptoms. I do get palpitations but only notice them when I’m getting anxious over the chest pain. My cardiologist doesn’t believe it’s heart related and my pcp is exploring musculoskeletal causes but so far the prescription Motrin and muscle relaxers haven’t helped so I’m not sure it is muscle related but with normal tests I’m not sure what else it could be.
20748650 tn?1521032211
Front of chest on the left side? Or top of shoulder? Any pain in arms and neck? Numbness in finger?

I really need details about how long this lasts, could be a deal breaker..

Does it hurt when you move around.. Not necessarily when walking but like if you shift your body? How about if you push on it, does it hurt?

Im not in the business of disagreeing with your cardiologist... I think hes absolutely correct in ruling out SERIOUS heart disease.. And i think hes correct in muscle pain being most likely here.

Unfortunately so far it sounds like theres still very much a chance that maybe a less serious or less common cardiac cause is the culprit.

Is this pain worse at night? Does the chest pain trigger the nausea? Even if you already had these symptoms to begin with.. Is the pain making any of it worse?
20748650 tn?1521032211
When i say details about how long it lasts, i mean is it continuous all day or does it fade in and out?
20748650 tn?1521032211
From what Ive gathered so far the situation looks like this:

You're a younger female: -1 point towards cardiac issues

Normal stress test (the other tests are much less specific then this one.. Initial ekg and labs mean squat in comparison): -1 point

You got sick shortly before this happened: -1 point (viral illnesses have a tendency to cause inflamation at the joints and connective tissues.. Most common example being "costochondritis")

Pain lasts all day: -1 point depending on some additional details needed

Pain spreads toward the right side: -1 point (cardiac pain tends to spread left because the nerves that go to the heart and nerves to the left side are connected/ signals get 'mixed up')

No accompanying shortness of breath, sweating or fatigue attributed to the pain: -3 points

Anxiety: -1 point

On the other hand:

High cholesterol: +1 point

Family history of high cholesterol: +1 point (almost always accompanies familial atheroscleroris)

Pain starts on left side and is vaguely described: +1 point (cardiac chest pain almost always is difficult for patients to describe)

Nausea: +1 point

Pain does not improve with nsaids: +1 point

Smoker: +1 point

So far that gives us 6 points in favor of cardiac pain and 9 points against.

Of course this isnt any sort of scientific scale or scoring system but its a good way to illustrate the thought process here.

I think with a few more points against in going to agree completely with the cardiologist in terms of whether or not its the heart and maybe offer up some suggestions.
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