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Forum Name: Cardiology Symptoms

Question: Left chest pain under breast


 mary81 - Thu Jan 08, 2009 9:04 pm

For almost a month now I have had this sharp chest pain on my left side under my breast. When it first started 2 months ago it came after I had shortness of breath, sweating, feeling of vomit, dizziness, near fainting, racing heart. I went to the ER they did and EKG it came back normal and then sent me home. Went to a walk in clinic two days later for the same thing they ran a blood test all came back normal.

Now ever since this happened I have had this pain on my left side under my breast that started out dull but has now gotten really sharp and always there . It get worse when I twist left or right, taking a deep breath and when moving to a different position, stretching and lying on my left side is painful too. The pain goes from the center of my chest down under neath the left breast. Sometimes if almost feels as if something is moving almost like a contraction .There will be this intense squeeze and release which when that happens it stops me in my tracks because it is extremely painful.

I am 27 years old mother of four children. I have family history of breast cancer which I just had a mammogram in December and that came back normal.
My father was 56 when he died of a heart attach and my brother was 19 when he died from his heart stopping after a severe seizure.

I tried to make a appointment with my family doctor that I have now since I just got health insurance but he is on vacation and won't be back for 2 weeks in the mean time I am pain.

I have taken almost every over the counter medication to see if anything would relieve this pain and nothing has worked so I have no idea what these could be.

I hope some one has an answer to what this could be. I am about ready to just go to the local ER again.
 John Kenyon, CNA - Fri Jan 09, 2009 11:09 pm

User avatar Hi there -

What you're describing is almost certainly not heart-related. The reason I say that is that cardiac pain can't be duplicated by movement (such as twisting of the torso) or breathing in. Most often this is caused, instead, by either an inflammation of the cartilage between the ribs (costochondritis), but sometimes is also caused by chest wall irritation, inflammation of the pleura (the lining between the lungs and the chest wall), or of the chest wall muscles themselves. Since you also describe a sensation of a painful contraction, which would suggest possible muscle spasm. Otherwise it is most likely constochondritis. In any of these cases the treatment is the same, non-steroidal anti-inflammatory medications such as ibuprofin or naproxyn (Advil or Aleve over the counter). Since those haven't worked for you, you may require some prescription version or another prescription medication that does the same thing, only more powerful. It doesn't sound remotely like a heart-related problem.

You might ask why after onset of the first episode you had nausea, dizziness, rapid heartbeat, etc. While this could have been a coincidence, the more likely explanation would be an anxiety response to the chest pain you were feeling, especially since you have a family history of premature heart disease (your father). Most often people suffering from symptoms related to anxiety are the last to know that's what it is. It's not so much due to denial (although they will usually deny anxiety at the time -- because they are unaware that's what's going on), as that it comes up via a subconscious fear or concern.

While I am pretty well convinced you're not experiencing any heart problem right now (based on the symptoms as described), since you do have a family history of early heart disease you should be followed at least annually with an EKG and blood lipid checks. This is only prudent in anyone with this sort of family history, and especially for women, who often present with vague and atypical symptoms when and if they do develop problems. That being said, your current symptoms really don't even fit the atypical patterns often seen in women with heart disease.

I hope this is helpful to you. Please follow up with us here as needed. Best of luck to you.
 jaysingsurrl - Sat Jan 10, 2009 9:28 am

I am having the exact same symptoms. I was prescribed naproxen but it has done me no good. I am to the point where I must sit up straight to get any sleep at all. If you find anything other than naproxen that works for you PLEASE let me know.

Thank you
 John Kenyon, CNA - Sat Jan 10, 2009 3:14 pm

User avatar To jaysingsurri -

You say your pain is only relieved by sitting straight up in bed at night. While the sort of pain that mary81 has described is unlikely to be cardiac-related, there is an indirect possible relation to certain types of postional pain. Are you able to aggravate your pain by twisting of your torso or other movement? If so, then we'll wait to hear what mary81 has to say. However, if your pain occurs primarily when you lie down and goes away when you sit up, it could be due to inflammation of the pericardial sac around the heart, which usually also does respond to medications like naproxyn, but if there is significant fluid buildup along with the irritation, then the usual pain meds sometimes arean't as effective. So what I am asking is can your pain be aggravated by the same sort of motions as mary81 describes? If not, and if your pain only occurs when you lie on your back in bed, you probably should have pericarditis rule out. While it is not a heart pain per se, it doesn involve the protective sac around the heart and, if fluid buildup occurs, can affect the functioning of the heart. Just curious about this. Thanks for your help.
 looking4advice - Tue Feb 10, 2009 3:29 pm

I'm hoping someone can help me out here. My symptoms are very similar as stated in the first post.

I'm 37 y/o female, 5 ft 6 in., 120 lbs and fairly healthy other than migraines. I'm currently on amitryptylene for migraine prevention (10 mg/day).

Since about the 2nd last week of November 2008, I've been experiencing chest pains. At first it started in the middle of my chest. Whenever I bent down to pick something up or lay down (as I was getting into bed), I would experience a tightening in my chest. About a week after I started noticing this pain, I started getting pain under my left breast. I called a medical health line and they suggested I go to the ER.

At the ER, I had an ECG and an x-ray done. Both came back clear and I was discharged with "A-typical" chest pains. The pain never went away.

I saw my family doctor just before Christmas. She had me do another ECG and some blood work. The ECG came back clear but the blood work showed I had low platelets and was anemic. Other than that, all other levels were good. My doctor walked me to a chiropractor who then proceed to crack my back. He suggested that my chest pain was caused by weak pec muscles and a blockage in my back. He said the back cracking should help and if not, I should return for more alignments. I have not returned to the chiropractor.

I am now approaching 3 months of chest pain and it's only getting worse. Another trip to the ER and another ECG showed that all was clear. Blood work was done and a special cardiac blood test was run. My protein levels came back OK. I have an appointment to meet with a cardiologist but that's not for another couple of weeks.

In the meantime, my chest pain is becoming worse. I'm getting sharp pains around my whole heart (not just the bottom) which is now finding it's way to my back as well. I have large palpitations while I'm sleeping. So strong in fact that it's awaken me from sleep. I just don't know what to do anymore. My doctor says it's stress but I really can't think of anything stressing me out other than not figuring out what's happening. My mid/upper chest pain is still there. Again, aggravated when I bend down or reach over for something, i.e. to turn off alarm clock. I have been avoiding sleeping on my left side.

Any suggestions? Could this be some type of a chest infection if not a cardiac issue?
 looking4advice - Tue Feb 10, 2009 3:42 pm

Almost forgot...I don't smoke, drink, or use any drugs. No family history of heart disease except for one grandmother (on father's side).
 John Kenyon, CNA - Wed Feb 11, 2009 12:23 pm

User avatar For looking4:

The fact that your chest pain is aggravated by certain positional changes would normally almost rule out cardiac involvement from the start; the fact that resting EKG and other tests have also agreed with that conclusion would seem to confirm this. Also, pain continuous over a period of months would usually not suggest cardiovascular disease, and that probably is not the cause. However, this could still be heart-related in a different way. The postural factor strongly suggests something inflammatory and the most likely thing, given the ways this can be aggravated, argue for costochondritis, but there is also a remote possibility this could be caused by pericarditis instead, and this should be ruled out. While I feel certain you've had at least one chest x-ray during this prolonged episode, and probably have had your heart listened to numerous times (all of which should have revealed pericarditis) it still should be definitively ruled out by an MD. The cardiologist will no doubt take care of that loose end right up front. If that's the problem it's usually fairly easily treated or managed.

If it's not that and there's nothing else that shows up on chest x-ray, the problem certainly would seem to be orthopedic/inflammatory in nature. I'm wondering, however, if it might not be somehow related to your taking amitriptyline, which can cause any number of cardiac symptoms -- and may well at least be the reason for the perceived increase and forcefulness of palpitations (this symptom, in itself, is generally inconsequential, but can at least serve as a clue to what may be going on).
It can also cause other cardiac problems. Amitryptiline can also cause muscle stiffness, which may, in your case, have invaded the chest wall muscles.

I am also curious as to why the ER staff discharged you with "atypical chest pain" when that term only applies to suspicious or confirmed heart issues causing the pain. If heart-related problems are ruled out as the cause, or if the pain would seem to be unrelated to a heart issue, then they are no longer atypical, but just plain pain of unknown cause. There is a huge difference, which leaves me thinking there may have been some uncertainty as to whether or not this could be heart-related. Again, it really doesn't sound like it.

While there is a remote chance this could be true atypical presentation of some heart-related problem (the most likely of the unlikely would be pericarditis), it is more likely orthopedic/inflammatory in nature; whether or not it's being caused by the amitryptiline is open to debate and the only way to know for sure would be to stop that drug and switch to something else less noxious to try and prevent migraine (such as a beta blocking drug, which would also have some cardiac benefits, even if not needed).

I hope the cardiologist will be thorough in order to put your mind more at ease about this, and at the same time help narrow down the possible causes.

One other potential cause of this (and should your cardiac consult come up clean, as I expect it will), would be thoracic outlet syndrome (TOS), which would require either a neurologist or orthopedist (or both) to rule in or out. This can cause diffuse chest pain at times, and since it is orthopedic with either nerve (and sometimes blood vessel) impingement causing the symptoms, can be influenced by position and, in fact, is often caused by faulty posture. Just something to think about once everything else is ruled out. (It's not life-threatening either, and often can be improved by physical therapy, home exercises, etc.).

I certainly hope this is helpful to you. Good luck with this and please follow up with us as needed.
 looking4advice - Thu Feb 12, 2009 9:47 am

Thank you so much! I have printed off your answer and will be taking it with me tomorrow to the naturopath and the cardiologist.

I will let you know of the outcome. :)
 jlnunes - Thu Apr 23, 2009 2:18 pm

I have also been getting extremely painful 8/10 sharp pains in my left chest/breast which come randomly and not related to any positioning or excersize. It is excruciating and I have to breath very shallow until it subsides because trying to take a deep breath is excruciating. I am a 27 y/o F also with a Hx of migraines since I was about 5 y/o. I also have some back pain (mostly lumbar) from a MVA but not taking anything for it. I've been considering talking to a doctor since I'm in nursing school and its distressing however I know that it so so so so unlikely to be heart related as menstruating young female of good health. So if anyone gives you any answers let me know. I haven't tried NSAIDS or anything since it comes so randomly and quickly comes and goes.
 Nichellealger - Mon May 04, 2009 3:27 pm

I just had a baby on March 16th of this year, i had some bleeding problems and they put me on methergonovine ... i was on it for two days and i started getting heavy chest pains and my heart rate was a little faster than it shouldve been, after they took me off the meds, my bleeding was fine until a week later i passed a clott the size of my palm, and since then i have been fine, now for the past couple of days i have been getting this really sharp,burning chest pains in the left side close to the middle but still under my breast every time i laugh, this does not happen when i breathe deeply or cough ONLY when i laugh, what could this be? should i be concerned enough to go to the er? and also would it have anything to do with nerve damage from having an epidural? ( I have also been having sharp pains that run from my butt down my leg on the right side and have had reoccuring numbness when i sit or lay on my arms or legs..also...at the injection site of my epidural it is very tender to the touch)


HELP!!!
 cwgregg11 - Mon May 18, 2009 5:56 pm

I was recently thrown from a ATV in early march.I landed on the left side of my body my left shoulder,knee ankle and foot. my shoulder started hurting really bad.I didnt go too the Dr. at first because i thought it would go away.After two weeks the pain had went down to my mid upper arm,arm pit,and shoulder blade.I went to the Dr.and he took two fingers and pressed between my left chest rib which was so painful.I told him that one night my pain was so bad it took my breath and made my chest hurt.He told me that was where my pain was all along in that nerve.He put me on naproxen three times a day which didnt help.Today he gave me a shot in my chest right where the pain was located.He told me that it was inflamation in my nerve or aorta not sure which and wanted to know all the details of this because i never heard of inflamation in a nerve of aorta it sounds kinda scarey.Could you give me more info on this
 gooniesgirl217 - Mon Jun 14, 2010 4:44 pm

Hello Mary and John,

Today I was diagnosed with Tietze Syndrome. I would like to describe how this may cover similar pains described by Mary. I have had sporadic spasms under my left breast while at rest my entire life. These spasms usually last about a minute and are always extremely painful. I cannot move. I have to take shallow breaths so as not to enhance the pain. I get lightheaded and my left arm will sometimes get soar. The most recent one was rather scary, about 5 minutes, and I returned to my doctor for advice.

Tietze Syndrome can last for years. It is characterized by pain left of the sternum in the chest. This sharp pain can be worstened by twisting or turning or expanding the chest. It is the result of an inflammation of the rib cardilage. The pain my radiate to other areas of the body and often mimics the pain of a heart attack. This is a combination of what I have researched and what my doctor told me.

My question is that Tietze Syndrome describes a pain that is closer to the center of the chest. My pain, although it has all the other symptoms I described, actually originates from deep under my left breast. Also, my doctor did not tell me how I may decrease the likehood of these attacks.

So I would like to know if I have an accurate idea of what Tietze Syndrome is. Do you agree that this is what I suffer from? What can I do to decrease the likelihood of an attack?

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