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Date of last update: 10/20/2017.

Forum Name: Valvular Heart Diseases

Question: Chest/back pain (between the scapulas)

 michelle1982 - Wed Jun 30, 2004 12:48 am

I'm a 21 yr old female, non smoker, occasional drinker and I have been having (left side) chest/back pain (between the scapulas) for the last year. When these attacks occur they start in the middle of my chest (pain is simultaneous) with my upper back. The symptoms are continous tightness and pressure that will last for hours at a time 3-5 hours long. The pain can be unbearable and I find my self hyperventatling. Any type of movement makes the pain worse, the only relief I get is when I sit up but the pain is still there. Within the last 12 months I have been having these attacks more often..before once a month, then once a week, now every day for the past month.

I have gone to the emergency, my internal medicine doctor numerous times. I have had several chest x-rays, EKG, stress echo, and blood work up. Everything has came back negative except my chlosterol. They have referred me to a nutrionist already due to my elevated lipds. I have not had previous heart problems, I have not lifted and done anything streneous. The doctors say my heart and lungs are clear and are unable to refer me to a specialist because they can't diagnose me. They say that it may be my chest muscles and have given me motrin. I find myself taking these meds often due to my pain. I take these everyday but feel hopeless that I can't diagnosed. Please provide any suggestions or comments regarding my symptoms. Thank You
 Dr. Yasser Mokhtar - Wed Jun 30, 2004 4:01 pm

User avatar Dear Michelle,

Your chest pain appears not to be of coronary origin, because it has atypical features of pain of coronary origin, females of your age don't get coronary disease because they are protected by their hormones and you had lots of investigations that came back negative.

You never mentioned whether you had an echocardiogram (ultrasound of the heart) or not. The echo should show whether you have mitral valve prolapse or not. This is a condition that was found in about 15% of healthy females and was associated with atypical chest pain although the characteristics of the pain that you have, are not typical for the chest pain most of the persons with mitral valve prolapse experience.

Chest pain has so many other causes begining with skin causes and ending with the heart and other organs inside the chest like the lungs. If your chest pain is not of heart origin then i would look for other reasons. One of the common causes of chest pain is people confusing it with pain originating from the gastrointestinal tract like heart burn for example. If everything turns out to be negative, the most likely diagnosis although i don't like to pin anything on it is panic attacks.

At this point, i would suggest to start an over the counter medication for heart burn and see if it makes any difference. If it helps then most probably this is the correct diagnosis and you will need to use and may be have some kind of investigation like a stomach scope to make sure that there is nothing wrong.

The investigations that i would go for in your case is to check the gall bladder with an ultrasound and do a pancreatic enzyme check. Also, have liver functions tested.

Although it does not sound like it, and if this was not done, i would check an x-ray of the spine regardless or not you have a history suggestive of spine injury. Although it is a long shot, and surely it does not sound like it, some patients who develop shingles will get chest pain continuously and this is a nerve type of pain and treated with specific medications.

You can take these thoughts to your doctor and see what he thinks.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.

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