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Forum Name: Chest symptoms

Question: Intermittent chest pain in upper left chest


 mhgilbertlpn - Thu Sep 18, 2008 6:37 pm

I am a 23 year old female. I do smoke about 1/2 pack a day. Last summer I had I had a tragedy in my life. For about 9 months now I have had intermittent chest pain in the upper left area of my chest. It only lasts for a few seconds. And sometimes after it hurts then I have some gas. I am a nurse but like all people we are scared to know what is really wrong with us. And sometimes I have realized that the chest pain happens when I am really stressed. I have went weeks and days without any chest pains. So what should I do? What could it be?
 John Kenyon, CNA - Sun Oct 19, 2008 8:01 pm

User avatar Hello -

Your concern is certainly not unreasonable, and by writing here you're taking a big step toward getting past the avoidance part which is so common (especially in the healthcare profession, oddly enough).

Your linking the pain with stress is telling, one way or another. Either the underlying physical cause is aggravated by stress or, given recent events in your life, it may be that you're experiencing somatic transference symptoms -- just as real, if not necessarily life-threatening, and often more diffcult to deal with.

While I would never jump to the latter (somatic transference) conclusion, it is something that should be considered as part of the differential diagnosis. It is extremely common.

For potential physical causes, very brief, left-sided chest pain, especially when sometimes followed by evidence of gas (eructation or bloating), is rarely cardiac-related, and this should be the first and simplest thing to rule out (via resting EKG at least). Other potential causes of this pain, given its fleeting nature, are (as already noted) gas, which even if its origin is the splanchnic flexure of the colon, can be cause pain to be radiated to the left upper chest or even the shoulder or arm. (This is equally true of gas trapped in the hepatic flexure, but that happensless often). If there is any way to duplicate the pain by manual pressure/palpation, then you may well have some inflammation of the cartilege between the ribs on that side (Tietz's syndrome). This can be managed with OTC NSAIDs.

All of that is speculation, and a very basic physical should help determine the cause, if there is a physical one. If that turns out negative, which I suspect it will (and please do have one, because otherwise you'll carry the worry around with you indefinitely, and there's just no point in that), then somatic transference, related to the recent tragedy in your life, would be a major consideration.

In any event, there is the matter of the half-pack of cigarettes per day. That's all I'm going to say about that. You know what you need to do where that's concerned, so I hope you'll do it. I hope you'll also get yourself checked up, more for your own peace of mind than anything else, as what you describe honestly sounds most like stress-related somatic transference, but we don't go there first, but rule out physical causes first.

I hope this is helpful. Best of luck to you. Please follow up here as needed.

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