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Forum Name: Cardiology Symptoms

Question: Young female with persistent chest pain


 dmwilmoth - Thu Mar 03, 2005 10:54 am

Hello,

I am a 30-yr-old woman, nonsmoker, not overweight with normal blood pressure (102-120/80-86), cholesteral levels (184 total), and rather healthy. Problem is, I've had persistent chest pain for 2 years. It started out of the blue one day while sitting at my desk at work. It was a dull ache under the breast bone that would radiate out to both armpits. I would have it every single day and it would last all day long.

I went to a cardiologist who gave me an EKG and stress echo ~ he said I passed with "flying colors." Well, the chest pain persisted. I started to get used to it because it was present all the time; however, there was always a niggling fear that I was going to drop dead of a heart attack.

My father had heart disease ~ he had a heart attack at age 42 (but he did smoke for about 30 years prior, believe it or not), then had another bypass at age 60 (to avoid 2nd heart attack), then had a stroke at age 66, then died of brain aneurysm last year at age 68. My father's brother also has had heart disease, but he is also a smoker (but still alive at age 70). This is the only history of heart disease that I know of, and since I am not a smoker nor overweight like my dad and uncle, I'm hoping that is in my favor.

Anyway, I took Lexapro for anxiety (I've had it all my life unbeknownst to me; in full swing since late 2000) and it really helped with the dizziness and panic, but not the chest pain. I am currently off the Lexapro (for a year now), but since I've been off, my anxiety has gotten worse, my hypochondriac has taken over my life and my heart fears have escalated.

My chest pain will now disappear for a few days at a time, but always comes back. Now, though, I get the chest tightness and the constant need to take deep breaths. I also cannot lie on my back without my chest feeling very heavy. I have left arm/armpit area pain that will throb on and off (and can even feel pain in my ring finger at the same time). I have zap-like pains in my neck on both sides. I have jaw pain, primarily on left side, but sometimes on right (but I also have TMJ, so this could be the cause). I have tooth ache pain all the time ~ all in my mouth, can't tell what tooth it is coming from and occurs on top, bottom and both sides simultaneously ~ dentist shows no problems. I also have back pain (will get chest pain that goes through to my back, as well as the left armpit area pain that goes through to my back). Also, if I talk for long periods of time, my jaw hinges will ache and I get an uncomfortable lump in my throat (like an ache).

I have had a CT Scan of my chest that was normal ~ thyroid and trachea normal, everything in proper alignment and size, lungs clear, bones ok, no lesions or tumors. Then I had x-rays of my cervical spine to see if I had stenosis that might be causing my neck/arm pain. They were normal. Doctor recommended an MRI but I have not done it yet because of the expense.

I am fearful all the time and not sure if what I have is truly heart related or anxiety/stress related or my hypochondria taking me for a ride. My mother is extrememly healthy and a non-basketcase (ha!), so I'm hopeful that I've taken after her in the health department.

Your comments will be greatly appreciated!!!
 Dr. Yasser Mokhtar - Thu Mar 03, 2005 10:10 pm

User avatar Dear Dianna,

Females of the child bearing age are naturally protected against coronary disease unless they have had major risk factors for coronary disease for a long period of time. You only have one major risk factor for coronary disease which is positive family history (and you are doing great by leading a healthy life style) and the characteristics of the pain that you are describing are atypical as compared to those of chest pain related to coronary disease. So, the probability of this pain being due to coronary disease (having a heart attack) is very low.

i recommend to have an echocardiogram (ultrasound of the heart) to look for mitral valve prolapse. This is a condition which is very common in young otherwise healthy females which is very notorious of causing atypical chest pain. It only needs to be followed if you have it and the pain can be controlled with some medications of the beta blockers type.

The symptoms that you are describing (pain under your arm extending to your chest) could be due to:
1. Neck problems. Your x-ray of the spine was ok. i think you can have a ct scan of the neck (which is less expensive than an mri) specially with the zap like pains that you get.
2. Shingles infection or a condition known as post herpetic neuralgia (pain after shingles) even if you did not have a typical case of shingles. The armpit area pain can be due to this.
3. Reflux disease. i would recommend you trying some over the counter anti-acids, as reflux can sometimes present with real strange symptoms (without even having heart burn).

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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