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Vakul Aren
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 3403
Experience:  MBBS,DTM&H( Univ of Liverpool),34yrs experience in practice
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unexplained upper chest pain.

Resolved Question:

Hi, I have some unexplained upper chest pain. It has been with me for about 5 weeks now, off and on, but more frequent in the last 3 weeks. I am a female, age 47. I have been in stellar health for most of my life with no sick days from work in the last 9 years. I hardly ever get even a cold. The pain can be described as a tightness or heaviness, that worsens when I hold my breath and expand the chest cavity. It also hurts in my arms, upper back, occasionally in my jaw and ears. I had a chest Xray, a Chest CT with contrast, and an echo stress test, EKG and tons of bloodwork. All of this came back fine, and doctors don't think it's cardiac. I do not have shortness of breath or nausea or fever. But...it hurts and I am not anxious, under stress, or otherwise concerned about anything except of course this, because nobody likes to have chest pain. I know two women who had heart attacks in their 40s, and hate it when doctors say "you are too young for heart issues." Nobody is too young. While I am relieved at the good test results (forgot to mention my FSH was 126 so they tell me I am beginning menopause) I take really good care of myself and don't understand why this pain persists. I am a vegetarian, I take magnesium, Vit D, Vit C, Folic Acid, and B-complex vitamins. I am very frustrated because I just want to fix this and get on with my life. I am following up with my GP next week but has anyone heard of this sort of chest pain? It seems to be in the lung area yet my chest X ray and listening to my lungs shows they are clear. I do have a massage scheduled tomorrow and plan to see a chiropractor too in case it could be pinched nerves or out of alignment vertebrae, though I would be surprised. The holding my breath and feeling pain tells me that MAYBE it could be chest wall related, but I had no injury and this has gone on very long. I am baffled, but want to be sure nothing serious is missed.


 


Edit: I should add that my blood pressure is normal, usually around 117/72 give or take a few points at different times during the day. When the pain is there, it doesn't matter if I am at rest or moving. It doesn't change the severity of it. At times, I think that it gets worse in a sitting position (like driving) and possibly decreases a bit when I lean back or lie back, but I have had it during those times as well. It is not constant, but is there for several hours each day. Sometimes it seems a  hot shower makes me feel better, but not always. Adding this info so you have more to work with, thanks!


 


Any thoughts? Thanks for your time.

Submitted: 2 years ago.
Category: Health
Expert:  Vakul Aren replied 2 years ago.
The commonest cause of chest pain is musculoskeletal pain,related to the rib cage and muscles,of the chest.This may be secondary to muscle spasm or myalgia,costochondral joint pain/posterior chest wall syndrome or costoverteberal joint dysfunction syndrome.The pain may occur due to postural reasons like long hours at the computer or while driving,or be secondary to rheumatic disease or arthritis related problems like Rheumatoid Arthritis,Psoriatic Arthritis,Fibromyalgia.Post herpetic neuralgia or pain due to problems with the sensory nerves ,spinal nerve root compression and pain along the dermatome may need to be identified.
Cardiac causes as well as those of major vessels like aortic dissection need to be kept in mind.Radiation to the jaw , neck and shoulder is common in coronary artery disease,ischaemic heart disease pain may be relieved by rest,may occur for short durations and maybe accompanied by other symptoms like vommiting/nausea,presyncope,paroxysmal dyspnoea,post prandial epigastric pain,palpitations and lightheadedness.A cardiac stress test or a Tread mill test ,checking for atherosclerosis and hyperlipidaemia may be useful.Pain due to Syndrome -X with normal coronary arteries may need to be assessed,other causes would incl;ude valvular disease,myocardial inflammation and pericardial causes.
GERD,Oesophageal spasm,abnormal motility and achalasia,oesophagitis due to medication or other causes,hiatus hernia,rarely due to Gall Bladder disease and Pancreatitis should also be assessed.
Pulmonary causes including lung parenchyma infections and diseases,pleural inflammation,and lung vessel diseases like pulmonary embolism related pain needs to be looked for.
Atypical causes likechest pain associated with psychosomatic causes,panic disorders and anxiety related pains ,pains due to long standing diabetes,thyroid disease or other systemic diseases may also occur.
A detailed history,a thorough physical examination and investigations based on the findings of the examination and history by a good physician should help reach the diagnosis.The treatment will be specific to the disease found.
Customer: replied 2 years ago.

Hi, thank you for your reply. You did mention cardiac causes...As noted in my initial question, this was my primary concern so I have already had Chest X-ray, many hours of bloodwork, EKG, Chest CT scan with contrast to rule out aortic dissection and cardiac stress test, all negative. I have had no palpitations. BP has been normal. EKG was normal. Chest CT showed normal aorta.


 


The chest Xray and Chest CT scan ruled out pulmonary embolism according to the doctors. They did not find any lung issues except for one granuloma in the lung which they said is not significant. You did mention some other causes which I have not heard before so thank you, XXXXX XXXXX check those out. As noted, I am not having any panic attack. I have a very low stress job and am very happy in my personal life. I am usually a very calm person.


 


I have confidence in my doctors but am looking for as many medical opinions as I can get because of the strange nature of the pain. In your opinion, how confident would you be that cardiac causes are ruled out with all of the negative testing I have had? Do you feel any of this pain could be related to my entering menopause? Thanks!!

Expert:  Vakul Aren replied 2 years ago.
Menopausal/premenopausal phases do cause pains, especially related to musculoskeletal issues and other causes .I would suggest Holter Monitoring for 48-72 hours(this is a small mobile ECG recorder which is fitted on your belt with electrodes in place on the chest for continuous home ECG recordings)be done to rule out any cardiac causes.As mentioned earlier the pain is most likely to be musculoskeletal pain ,thus cardiac cause do seem unlikely.Having a good doctor will help you solve your problem with no untoward event.I wish you a early recovery and good health.God Bless!
Please do give a positive rating.Thanks.
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 3403
Experience: MBBS,DTM&H( Univ of Liverpool),34yrs experience in practice
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Vakul Aren
Vakul Aren
Consultant Physician
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MBBS,DTM&H( Univ of Liverpool),34yrs experience in practice