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Date of last update: 10/20/2017.

Forum Name: Cardiology Symptoms

Question: Left chest and arm pain, elevated CRP, EKG fine

 salorl - Thu Nov 06, 2008 4:26 am

In 2001 I went to the ER with heart attack symptoms, including a dull ache or slight burning in the extreme upper left chest, and a tingle or slight burning in the left forearm and the heel of the left hand. EKG was okay, some subtle aspect of the timing resulted in an echocardiogram and a cardiac catheterization, which were fine. Symptoms persisted all 36 hours I was in the hospital. I went home, took Ibuprophen and an antihistamine, and the problem went away.

This spring the exact same symptoms arose, accompanied by a brief hot sweat, anxiety, and occasional heart flutter (to be expected, I suppose). I went back to the ER, and the EKG was fine. Potassium was low. Neither mild exertion nor pressure affected it. Symptoms persisted a couple of days, Ibuprophen helped. I decided I had carried something heavy with my left arm immediately prior.

This summer I had a migraine, with the classic jagged lines, on the left side. It lasted only about twenty minutes, but I’ve never had a migraine before. An MRI looked fine, but blood work revealed a CRP of 28. Augmentin was prescribed.

Soon after, while traveling, identical left side and arm symptoms recurred. The doctor felt it might have been muscular, and after a couple of days of Paracetamol it went away.

Now it’s the fall, and it’s happening again. It certainly could be muscular, but it seems like there’s an occasional heart flutter or dizziness, but it could simply be anxiety. It does seem to be helped by Ibuprophen. My CRP is now 18.

The only other symptoms I can think of are I have a long-term history of a bad tooth on the lower left side that I really should take care of, as it occasionally aches. And I am overweight, and was once diagnosed with fatty liver, although my liver enzymes have been fine for several years.
 John Kenyon, CNA - Sat Nov 22, 2008 12:47 am

User avatar Hi there -

While your pain pattern should have sent you to an ER initially, you've passed most all the evaluations with flying colors, so it would seem heart involvement is pretty much ruled out at this point. Still the problem recurs periodically. While the palpitations and other ancillary symptoms probably are anxiety-related, the basic syndrome remains, and you are undertandably concerned.

The pain could be one of two things (just offhand): it could be a recurrent inflammatory problem, perhaps of a nerve, or it could also be one of the odd symptoms we sometimes see with mitral valve prolapse syndrome (MVPS -- the syndrome can exist even without any evidence of actual prolapse). Often pain similar to what you describe occurs in people with this problem, which is benign. What makes this slightly more likely is that MVPS is also frequently seen in association with chronic anxiety or panic disorder, with occasional palpitations and other autonomic misbehaviors such as flushing, lightheadedness, etc., and also in some patients there is also optical migraine. Since all these seem to be grouped in your case, this may well be the underlying problem.

I notice you're already taking a healthy dose of metaprolol, and wonder why that was prescribed, as it is often given to mitigate symptoms of MVPS.

Given your history and good cardio test results, not to mention the metaprolol, my best guess would be MVPS, with or without evidence of actual prolapse. It's benign, but it does carry with it the occasional cluster of oddball symptoms much such as you describe.

I hope this is helpful to you. Please follow up with us as needed. Best of luck to you.
 salorl - Thu Apr 02, 2009 1:28 pm

Thanks you for your response. It has taken quite a while to resolve this situation, and I wanted to update you on the combination of causes. In November and December I had complete cardiac workups including stress tests, nuclear imaging, and a carotid ultrasound. No problems were found.

CRP remained elevated, with occasional left side pangs, dull right abdominal pain on occasion. An MRI revealed nothing. A colonoscopy revealed diverticulitis, apparently not too severe. One benign polyp was removed. A CAT scan also showed diverticulitis, and a fist sized abscess connected to the colon. I was sent to the emergency room and admitted. The surgeon was astounded that I'd had no symptoms related to the colon. He suggested the right side pain was gallbladder related and had a sonogram done that showed two small polyps. So while I was opened up to remove several inches of colon and the abscess, he also removed the gall bladder. Everything was benign. It turned out the gallbladder was completely non functional.

I'm still recovering from the surgery, but it seems clear that some combination of these problems was causing the elevated CRP and certainly the gallbladder was causing the right side pain. Whether the left side pain was referential from the abscess, or caused by low potassium, I don't know. (While in the hospital I learned that one of my hypertension medicines, a diuretic, drains potassium.)

In the final analysis, I'm glad I stuck with the search and insisted upon the CAT scan, as although the problem was asymptomatic, I understand it was potentially very dangerous. Thank you for you help, and for maintaining this forum.

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