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.
I could have written that post for the most part..I do not get alot of jaw pain..but I have arm pain..and what I call muscle spasms on my left side only..in the breast area...
it drives me mad..I have all the tests..I also have panic disorder...I have resorted to studiying the anatomy and there are so many things that make up that area...I have them frequently....
if you ever want to chat or need an e-mail friend..just let me know...
maybe we can help each other...
Dawn, have you had an EKG during symptoms? That could help ease your fears if it turns out normal. Some other tests that could help put your mind at ease is an echocardiogram where they can see the heart chambers and valves, and a catheterization where they see the arteries. I doubt you'd need a catheterization unless your EKG or echo turned up abnormal. Your blood pressure and pulse look normal. Also it's reassuring that a female of your age is protected by estrogen as long as you're still getting a period. The estrogen protects the arteries from plaque build up. The way I know this is I just went through the whole work up with all those tests I mentioned, mine were abnormal though and I do get angina with tachycardia now treated with cardizem. I'm 37, female. Something interesting, my angina besides my chest, left arm/hand, and upper back, can go up the left side of my neck, jaw, and even my left ear. So when you said about your neck and jaw, I thought you possibly could have angina. Also remember that women present differently than men with angina, mine is described as atypical. I also get nausea, sweaty, breathless and lightheaded. My husband and other people could tell when I was not feeling well, they'd comment on how white I was. Mostly I would just lay on the couch and hold a pillow tight against my chest. I was given nitrostat and it helped most of the time. I'm just grateful I had the catheterization because they prescribed the cardizem afterwards to prevent the angina and bring down the heart rate that was running 120-140 at rest. I just tested it at the grocery store the other day and it was 91! I couldn't believe it. It hasn't been that low in a couple of years. One more thing before I quit rambling, exercize is GOOD for you and will strenghten your heart. Get your doctors ok and then start a program of walking or similar activity. I walk 30 minutes 3 times a week plus do some yoga every day. If your tests come back normal and your doctor says you're ok, try not to dwell on your symptoms or worry about your heart. Life is too short to waste any time worrying. Worrying doesn't change or help anything, and in your case it's actually crippling you.
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),
I have coronary artery spasms, this is only found with a heart cath. test called ergotivine challenge test. My heart dr. did this test on me in the heart lab three times and all three times my heart went into spasms. now i take nitrates, carry nitro and take channel blockers. However, it is rare but i sure was surprised when i found out i had it. iam 42 i have had these symptoms for couple years the angina symptoms..this was jan when i was diagnoised and its now march, and it took that long to get the meds correct. But i was in the er couple times before with same symptoms and had normal ekg's, until the last eposide where i had a real bad spasm, ended up in hospital 4 days. So keep after your dr.s until you find the answer to your problems, ps my primary dr. told me it was anxiety!
Best of luck to you
I don't believe i was tested for coranary artery spasm when i had my catheter in February. I was wondering ig you could tell me if coranary artery spasm is due to blockages or if it happens in clear arteries. Is it dangerous or more a benign (by that I mean not life threatening) pain and spasm that needs treatment to ease symptoms. I hope you don't mind me asking. I thought maybe my Dr. didn't test me for this because my arteries were clear. Thanks so much. Briane
Briane, I like Lynn get coronary artery spasm as the cause of my angina.This is NOT a benign condition and can cause a heart attack as surely as a blocked artery. What happens is the spasm blocks the blood flow through the artery. It happens in clear or partially blocked arteries, mine are clear. It would show up on EKG the same as blocked arteries, my EKG's show ST segment depression and lack of oxygen to the heart.
Does anyone know if the pain you get from coronary spasms feel like a sudden charlie horse type pain and they only last a few seconds and then its gone?It hurts so bad it doubles me over for a second and then when its gone I am completly fine.
I am afraid that if I add more comments to my earlier thread about muscle spasms they will go unnoticed, and since I cannot get in to ask a new question, I will post here a report on my tests ' see below thread for the background).
i chose CHARLIE HORSE because this seems to be the closest description to MY pain. BTW, this word is not medical, right? What is a medical description of Charlie horse, since Drs. here in Japan give me blank looks when I use it? Even the Japanese word for NUMBNESS can be understood as both pins and needles and lack of sensiation, which to me are two totally different things.
Anyway, here is my report...if there are any doctors, fellow
hypochondriacs, heart patients or people who found out it was NOT the heart, I welcome your comments.
As I said....
I am the guy in Japan who may have something heart related or
may have something muscle/nerve related. Testing was set up
for two weeks after initial consultation, and I was wondering about
exercise. Advised to wait. Here is what I have learned so far,
along with comments, obervations, questions.....
Past two weeks--I have taken 1 baby aspirin, 1 heart beat regulator
(itorol 20 mg, plus other normal medications for moderate asthma:
intal inhaler, theophylline 200mg, singulair, furotide).
Also 20 mg Paxil for stress, and 1 mg Proscar for hair
I avoid coffee and tea. Do almost no exercise, other than walking,
although walking can be 30-40 minutes at a time.
My symptons are less severe--and less frequent than initially.
The worst attacks of pain in the chest/rib area were three weeks
earlier. Now shorter attcks.
Never a problem with breathing. Taking nitropen when I get
an attack, which number about 4 in two weeks. Often on carrying
a heavy bag or on sudden movement, never when sleeping. Effect
of nitropen unclear (attack seems to subside in about 2 minutes
whether I take or not, whereas strongest attacks two weeks
ago lasted 10-20 minutes). Anyway:
March 19th 8:45 After all night fast, get some kind of IV
or blood test, or maybe just tube for
isotope. I was too nervous to notice. As usual, they
have trouble finding my veins (same when I give blood).
Have bicycle test with doctor and nurse monitoring.
Gradually incrase watts to 170 plus. About 25 minutes
or so. Keep asking me if I feel ok. No problem, just
normal aerobic mild sweating. Good workout! They
inject isotope (I ask if I will glow in the
dark) near end of workout. Heart beat near 150 or 160.
Cardiogram and bloodpressure measured at intervals I think.
Cooldown period of 10 minutes. Check blood pressure.
Doctor says all is within normal range.
BUT there are PVCS. Says could be nothing or could be indicative.
Still, he stresses that otherwise normal. Feel reassured.
Also, he laughs at my jokes.
Says such test has accuracy of 90 percent (I worry about other
10 percent). He says other tests help to raise certainty).
All this is in Japanese. Since I teach Drs in Allergy section
of same hospital, I am comfortable with asthma vocabulary, but
heart stuff is too technical. He tells me about colours of isotope
test which indicate where, if any, a problem might be or not be.
Next test: 10 AM
Gamma ray (?) camera. I lie inside and camera moves
20 minutes. I hear funny flutterings--beep beeps, which make me
nevous. Technician (not dr.) says it is my beat plus another
patient's. But yes, some abnormal beats. That scares me.
She says this camera not only for heart, so ask Dr. later
as she is not expert.
Next test 10:20...ultra sound (echo?). Technician scares me,
says beats are irregular, asks me if I was told. She is young
and not aware how such talk can scare patients. I ask her
questions, but she says she doesn't know anything.
NOTE...5 years ago, had a health check at work, young
doctor hears murmur by stethespoic exam. Sent to
hospital, two technicians spend 30 minutes and
say that probably this doctor was erring on the side
odf caution. They hear nothing to be worried about.
Some murmers mean nothing, they say.
NOTE....10 and 20 years ago, due to stress related
panic attacks/culture shock, had bicycle test
whcih also measured oxygen (no isotope).
They found in both cases NOTHING. Lung
capacity was 30 percent above normal.
(though exhalation is poorer
due to asthma). I sing opera,
so maybe that is reason for good lungs.
Then have lunch--they tell me to eat relatively light.
Walk around for 2.5 hours. Go back to hospital
at 1:20. At 1:30 again gamma ray camera test
is repeated for 20 minutes. Still same wierd
flutterings make me nervous. In fact technician
tells me about it, which makes me more nervous.
Whole room is filled with those beep beeps.
Tech asks me if I have any pain or burning sensation.
I say no.
I ask about bones (ribs) or muscles or nerves as causes.
She says muscles in particular heard to diagnose.
Get bill. 180 dollars (which is WITH health insurance,
which is mandatory in Japan, but which is still notas
good as when I lived in Denmark as a student, where it
is all free). Worry that my wife will complain.
She already complains I will get fat because of not doing
Told to come back 11 AM on March 25 where Dr will evaluate all the
tests after taking an xray (one was taken two weeks ago
when I went to emergency room, also blood tests were done twice
at that time, as were EKGs).
Then--Wednesday, March 20, normal day, but have to carry heavy
bag again. That night, get an attack. Take nitropen. Pain
gone in about 40 seconds. Too soon to decide if Nitropen works
or not. One hour later on exiting subway, get again. It subsides by
itself. At home, sitting in chair 30 minutes later, again.
Again it subsides by self. Take aspirin regular size (have no other
pain medicine at home). Seems to be motion/weight related. Never
a breathing problem.
Now it is Thuesday
I go on 25th for report.
(1) What questions should I ask about test results and:
(a) hardening of the arteries/ability be be sure
(b) any current or previous damage to heart muscle
(c) blood clots
(d) other cardio vascular causes
(e) my blood results, blood pressure, flutterings, heart rate
(f) likelihood of other tests for other causes
NOTE I have cervical spondylosis, but orthopedist
said 1 month ago that there is no degeneration compared to
2 years ago, and this is unlikely causse of chest pain (I do
get pain in neck/shoulder area when carrying heavy bags or
pins and needles, but weight tarining has made this
less of a problem, presumably by building up muscles
that take some of the strain away from nerves and neck (I guess).
As doctors here seem to be clueless about causes outside
their speciality (and not particularly interested)
I wonder what can be tried if the heart cause
is eliminated? Sports medicine? Neurology?
I obviously don't want to risk further damage to muscles,
bone, nerves even if heart is ruled out, but want to get back
to physical activity that will protect my heart and other organs.
Drs themselves don't seem to be in great shape, so I want to make
sure that if it isn't heart, that I can keep myself in decent
shape as I enter my 50th year, My diet is already largely vegetarian,
with only weakness being chocolate.
IF IT IS THE HEART
Depending on what KIND of heart disease is found,
I assume that some exercises can strengthen the heart.
Since Japan seems to be conservative in these area, I need to know
what questions I can ask. I think I have been in decent aerobic shape
because of all the walking I do and various ski machines etc.
I don't want to be like the ulcer patients of many years ago who
were told to avoid ruffage. What should i specifically ask.
A related discussion, is it heart disease?