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Forum Name: Cardiology Diagnostics

Question: Unidentified chest Pain


 nephilim78 - Mon Jan 10, 2005 11:08 am

I'm a 26 year old Male, about 70 lbs overweight with moderatly high cholesterol. Since October I've been having mild chest pains on and off. My primary concern is that I occasionally get a burning pain in my left arm from the shoulder (under the armpit) to about the elbow. It also seems to spread up my neck under the jawline. (it feels as if I recently exercised that arm, but I haven't.) Predominantly this feeling comes shortly after strenuous work. For example, mowing the lawn, jogging up a steep hill, shoveling. though once it happened when I was just sitting down at work. On the occasion that it happened after shoveling 2 low strength adult aspirin and lying down for 10 minutes helped considerably. However sometimes this pain can linger for several days to a week with varying intenisity. There is rarely any pain in my chest around the rib cage and breastbone, and no tightness.
When the discomfort is in my neck I find myself feeling extremely tired, run down, etc. This again seems to clear up once the discomfort goes away.

I've been back and forth to the doctor's office and the ER. EKG test was completely normal, bloodwork was completely normal (aside from that pesky cholesterol thing which I'm working on). I was initially diagnosed with pluerisy. Symptoms went away then came back after about a week. Went back to the doctor's and scheduled a treadmill stress test. Completed that test and the results were again completely normal. Not even so much as a hint of a problem. Also the discomfort could not be reproduced on the treadmil (and I was on it a good 20 minutes). Chest X-Rays show no abnormalities in heart, lungs or liver. So I was diagnosed with Acid Reflux. This seems particularly strange since my stomach isn't upset in the least. And all my discomfort is centered around my left jawbone, neck, and arm. I've had my doctor listen to the arteries in my neck as well, and they don't hear anything that would give them an indication that something was wrong. It's getting frustrating to continually have these symptoms and yet be told there's nothing wrong, or that it's all in my head.

Other symptoms which may be directly or indirectly related are a ringing in my left ear, possibly from TMJ (I should also have my wisdom teeth removed). Also, I occasionally have blurred vision, which may or may not be due to my contacts.

Like I said, the whole thing is getting quite frustrating. Any advice?
 Dr. Yasser Mokhtar - Mon Jan 10, 2005 2:58 pm

User avatar Dear Nephilim78,

Definitely, your chest pain is not due to coronary disease.

Chest pain has so many other causes including reflux disease. Somtimes reflux presents with the strangest of symptoms, i am not sure whether or not your symptoms are due to reflux but the treatment for reflux is not that harmful and there are lots of medications for it that are not that expensive, so i am not against you trying the reflux treatment for a while and see whether or not it controls your symptoms.

Personally, i have a bias. If a patient complains of neck pain, arm pain or tingling, numbness, discomfort, etc... in addition to chest discomfort that proves not to be of coronary origin, the first thing that comes to mind is neck problems like arthritis, muscle spasms, overuse of neck and shoulder muscles. So, a neck x-ray, a neck ct scan would not be bad ideas if your doctor thinks either is indicated.

In your case, i think it would not hurt to rule out mitral valve prolapse, and this is done by doing an echocardiogram (ultrasound of the heart).

Even though this is a remote possibility, but a case of post-herpetic neurlagia might be considered (but this would be a very long shot).

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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