Occassional upper left chest pain

[2gayle]

I would experience occassional mild pain in my upper left chest (near the left collar bone), sometimes after a workout. EKG showed something abnormal so I was sent off for 2-D Echocardiogram. 2-D ECHO result came back all normal. Now, my Internist wants me to get a Stress Myocardial Perfusion (stress test). I told her that the occassional mild pain I felt in my upper left chest didnt start until she told me that my EKG was abnormal. It might just be anxiety as I got so worried when she told me that EKG showed abnormalities. Is it still necessary for me get a Stress Test when my 2-D Echo result came back all normal?

[Dr. A. Madia]

Hi.

Theoretically speaking yes you still do need Stress test even though the Echo is normal. Because Echo shows state of the valves, chambers, pumping power etc. Only if some damage has resulted from lack of blood supply, it will show.

Whereas stress test or stress thallium will show lack of blood supply to the heart even before any damage is done. In this sense it can "predict" future heart attacks or anginal pains.

Your clinical description though does not fit into the cardiac type of pain though. You have not stated your age, habits, (smoking etc).

But always, to evaluate a case of chest pain Echo and a stress EKG/thallium done in tandem are more informative and accurate.


Dr Apurva Madia

[2gayle]

Hi

Thank you for your reply. I'm female 36 yrs old. Non-smoker, not diabetic, total cholesterol is 164, HDL 54, triglycerides 58, LDL 96, no family history of coronary disease. The pain I experience is on upper left chest (almost on left collar bone). I would feel it when I'm nervous/worried. My internist is quite limited in her explanation other than telling me that the chest pain could possibly indicate blockage so wrote me a referral for stress test with thalium and left the office. I started to have anxiety which made my blood pressure go up.