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Forum Name: Miscellaneous Chest Diseases

Question: Chronic Stabbing Pain Under Left Breast


 RLR - Sat Mar 28, 2009 1:15 pm

Hello,
I am a 23 year old female who smokes 1 pack of cigarettes per day since about the age of 16. I'm not very physically active and my diet isn't very good, and I am overweight. I started having chest pains back in October 2008 when I tried to quit smoking and was on the nicotine patch. (not sure if that has anything to do with it, or just coincedence) The pain is a sharp shooting pain right under my left breast it almost feels like it is right behind the breast. The pain comes when I am literally doing nothing such as sitting on the couch watching television. My heart seems to flutter and race and my breathing becomes very irregular. The pain often comes if I take a deep breath in or out. The entire left side chest and back area are sore and achy all the time. I have problems breathing but I suspect its because it hurts when I breathe sometimes so I have trained myself to breathe irregularily to prevent pain. I also have dizziness and light headedness (possibly due to anxiety from pain so close to my heart?
The following is a chronicle of the medical tests and medications prescribed:

October 2008
-Started having chest pains after being on patch for 1 ½ weeks, started smoking again.
-Went to ER , had ECG and bloodwork, all fine. Diagnosed me with Panic Attack/Anxiety. Prescribed Ativan.
-Went to family doctor , Said it is most likely Anxiety. Prescribed more Ativan.
-Ativan did not work, saw doctor again prescribed Prevacid for GERD.
-Prevacid did not work. Saw doctor she said Chest Wall Pain (costochondritis). Prescribed Naproxen.
-Chest X-Ray done. Fine.
-Naproxen did not work. prescribed Indomethacin.
-Found lump on breasts. Had breast ultrasound. Came back fine.
-Indomethacin did not work.
-Had ECG done in January. Fine.
-Went to ER again. Has ECG done and Chest X Ray. Came back negative. Gave Heartburn meds. Did not work. Gave Toradol IV-seemed to work. Prescribed Tylenol 3.
-Tylenol 3 made me vomit. Went back to doctor who prescribed Tramacet.
-Went to another doctor and told it was Costochondritis. Prescribed Zytram. Zytram made me vomit.
-Went to doctor again, prescribed Elavil and Extra Strength Tylenol.
-Went to chest disease specialist. He performed a breathing test and said my lungs were good.
-Sent for a bone scan, still waiting for results.
All blood and urine came back fine.

I am still having these pains and I suspect that the bone scan shows nothing as I have not heard from the specialist in a few weeks. I am still very concerned because if this truly is costochondrtis, it seems to be going on too long especially considering I did not have an injury to cause this. I am still quite concerned that it may be my heart or possibly lungs. Are there anymore tests I should request? Any medications I should suggest to my doctor? Anything? I am currently off of work and have been for the past 2 months due to this. Thank you for your attention to this matter.
 John Kenyon, CNA - Sun Mar 29, 2009 9:56 pm

User avatar Hi there -

The sort of chest pain you describe is extremely unlikely to be cardiac related, but one test you don't appear to have had, which could utterly rule out at least structural heart disease (usually it would be something bening like mitral valve prolapse -- MVP) would be an echocardiogram. While I don't believe this pain is heart-related, it seems reasonable to want to eliminate every more potentially serious thing first in order to help reduce your anxiety as related to the symptoms. (Anxiety can be a disorder or it can be situational -- caused by a real or perceived danger; remove the perception of danger and the anxiety should subside).

Unfortunately this sort of pain is also often part of a clinical anxiety picture. The good news is that once serious concerns are ruled out, anxiety has less traction and starts to become better as a rule, even if it is a separate disorder. You may or may not have such a problem. Either way, ruling out the really troublesome stuff should reduce your anxiety level, maybe even eliminate it.

It's interesting Ativan didn't help. Sometimes it doesn't, since it isn't going to remove the source of your concern (pain) and anxiety can often override this particular drug. The pain meds may not have been appropriate either, since only toradol seems to have helped at all (a pretty strong non-steroidal anti-inflammatory related to other NSAIDs like Advil and Aleve).

The fact that you feel your heart flutter at times during this as well as some faulty breathing patterns (even you have noted this, which is very insightful) suggests the possibility of mitral valve prolapse, which is a benign abnormality, usually mild and difficult to visualize, which for unknown reasons is often accompanied by a syndrome consisting of chest pain (usually sharp and stabbing in nature), fatigue, dizziness, anxiety, etc.

Since you've had numerous tests to rule out a lot of the more serious potential causes, we're left with either MVP syndrome or a chest wall irritation, which could be costochondritis or, perhaps, pleurisy, which is more common n smokers than others, and causes increased pain (often radiating to the shoulder or neck) on deep breathing.

It's clear you don't tolerate opiates and opiods well, which is just as well, since NSAIDs are probably more appropriate for whatever is causing this, since it seems like an inflammatory problem rather than orthopedc, like costochonditis or pleurisy. Either one can become chronic, so six months really isn't too long to be having the symptoms if this is what's causing your pain.

The good news is you know a lot of things are not wrong, so those can be dismissed. MVP should be ruled out, since if present it would not only explain a lot but can be managed medically with different sorts of drugs.

You may also have a chronic anxiety problem or panic disorder. Again, there are certain more appropriate drugs that can help with this, along with cognitive behavioral therapy, whch is a short-term process that can be very helpful. Alll these things should be ruled out/in.

I very much hope this has been helpful. You'll notice I haven't dwelt much on your smoking. You know what you need to do regarding that and I don't need to browbeat you about it. Stopping could very well help eliminate the problem. That's all I'm saying about that. :)

Good luck to you and please follow up with us here as needed.
 RLR - Mon Mar 30, 2009 2:17 am

Thank you very much for your opinion. I will certainly ask my doctor to check for MVP and Pleurisy. I gotcha on the smoking, I am surely trying! I will certainly let you know the outcome. Thanks again Dr.Kenyon!
 The Blob - Tue May 12, 2009 7:46 pm

Hi,
I've been having similar problems for as long as I can remember. I'm a skinny 15 year old who is highly active but sometimes I get those terrible pains at random times. Most recently on mothers day when I was just standing around talking. It uccurs for me when I take a deep breath in or out and it doesn't allow me to finish the full breath because the pain can't be endured. I usually only get it for a few minutes and somehow it just disappears. I also get the pain when I lean back.
Most recently it lasted for over 10 minutes. I was getting annoyed because it's never lasted this long before. So after I was getting shortness of breath I tried to endure the pain. I took a deep breath in, slowly, as deep as I could, then I felt a sort of clicking, as if my lung was unhooking from something. It felt as if my lung was caught on my rib. It's odd how no doctor ever seems to find an explanation for this. Very interesting...
Best of luck! ..Tim
 cancerfamily - Sun Nov 15, 2009 2:55 am

I am 37 years old and have too experienced the stabbing pain in or under my left breast. I had most of the same test done. I was diagnosed too with costocondritis.
was given naproxin and subsided. again came back and I too altered my breathing to not at all and small breaths as I didnt know what would happen if I took a deep breath. I take anti inflammatories and try not to worry as I was told anxiety played a large role in all of this. I was given in ER. Lorazapam and that worked. Unforunately we moved and my new dr. prescibed clonazapam and I have been ER x3. Last was xanax .5 and to follow up with my dr. still short of breath, still feel that pain and now I am at a loss as to how drs do not communicate with each other better to help the patient obtain the best possible health results. I too will chk on the MVP. Thanks so much.
 John Kenyon, CNA - Fri Nov 20, 2009 12:11 pm

User avatar For cancerfamily: Quiet often something simple brings our attention to our breathing, and if anxiety prone to start with, this can often serve as a trigger for a vicious cycle of cause-and-effect causing more anxiety. Your point about communication among doctors is a very important one, and I hope doctors reading this will take note and remember a quick fax, phone call or note to a patient's other doctor/doctors can be hugely helpful in keeping things all in line. The patient is the center here, not the process.

Thanks for sharing this. Hope you're soon doing better.
 wannabewinner - Tue Dec 29, 2009 10:26 pm

2 days before Thanksgiving 2009, I was diagnosed with viral pleurisy at an urgent care facility. No x-rays were taken. I was perscribed steroids and a cough supressent. I am allergic to motrin.

The pain with breathing has gotten better. The dry cough and pain persists. It is now 2 days before new year, 2010. I am still having to hold my side when coughing. The pain is severe. Originally, the pain was under my bottom left rib. It is now more to the center and under my left breast.

I was never sick when this started, no cold, sinus infection, nothing whatsoever. This is still the case. Just the "chest pain" and dry cough.

Is this still pleurisy and if so, how much longer will it continue? If not, should I see another doctor or will this clear up on its own?

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