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Dr. R. Bora
Dr. R. Bora, Doctor
Category: Health
Satisfied Customers: 5233
Experience:  14 years experience in the emergency room.
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I would like to get some guidance on a plan of action for

Resolved Question:

Hi, I would like to get some guidance on a plan of action for chest discomfort...
Submitted: 4 years ago.
Category: Health
Expert:  Robert Fernando replied 4 years ago.
Welcome to and thank you for your question.
I am going to assist you with your question. First I need a little more information-
Do you have pain in right or left side of chest, please explain in little more detail.
Do you have breathing discomfort or numbness in arm/shoulder?
How long has this been going on for?
Are you suffering from any medical condition or on any medication ?
Do you suffer from nausea/ acid reflux disease?
Do you suffer from severe emotional stress or anxiety issue?
Kind Regards,
Dr. Robert
Customer: replied 4 years ago.
Hi, Dr. Robert!

Thanks for the quick response. My "case" is a little weird, because I am not a typical heart patient. So let me give you some details:

- Mainly it's discomfort/pain in the left arm right now, I feel it slightly in the chest. lately, it has been going on, on and off, for a week or a bit more... But more long-term, it goes on and off for a few years now.
- what concerned me is that before this almost never turned on during exercise (mainly at rest), but on Saturday I was doing a hard running work-out and in one of the rest periods, my heart starting skipping beats - for abour 30 seconds it was arrythmic and then calmed down.

About me: I am actually an athlete (runner) and running coach. Technically, I am in great shape. But this week (and last) I have trained a lot - I got rid of my car and biked every morning in addition to running, to training a client, to calisthenics, etc. Also, I love coffee and I can't kick it easily, so maybe that contributes.

The "heart" thing started a few years back (also when I was working a lot, sleeping little, and training a lot). I have had innumerably tests- EKG, UltraSounds, even of angiogram. Most came out normal. My EKG always looks abnormal and the angiogram showed (supposedly) that one artery was narrowed (but all were clean). However, I have not done these tests in a while now.

That's about it. So I am sure there is a large psychosomatic component, but the pain and the physical manifestations are real. I am just frustrated, because I don't know what to do.

Cardiologist suggested medcation - I don't want to do it. I do have nytroglycerin handy and use at times - seems to help.

My plan tomorrow is to see my cardiologist and repeat ultra-sound and/or stress test (it's been a few years, I think). Though, heart monitor at the beginning of this year showed all ok.

About reflux - not sure, maybe. But that does not cause left arm pain, nor arrythmia, if I am not mistaken...

About stress - yes, at times. After all, in dealing with women... (joke).

I would love to have a solution of how to deal with this without doctors - I try to take hawthorne, pomegranate, garlic, etc...But I with I could do away with this once and for all...



p.s. shortness of breath - not now. I thought I noticed some when training a client earlier today. But not too bad.
Customer: replied 4 years ago.
why is it, actually, that the left arm hurts when it's heart related?

And what can I do on an immediate basis? because worrying does not help much:)
Expert:  Dr. R. Bora replied 4 years ago.
Hello Vladimir, I am DR. BORA.

The previous expert has opted out after reading your reply.

What confuses me is that even after your cardiologist has told you about a narrowed artery in an angiogram and an abnormal EKG, have you not followed that up with appropriate treatment.

Have you done a carotid doppler to exclude "plaques" in the internal carotid artery?
This can be dangerous as it can travel down your arm causing the "arm pain", your heart causing heart pain and even to your brain resulting in a stroke!!
Customer: replied 4 years ago.
I see. Maybe I did not put enough details. The cardiologist who did the angiogram said that it was normal, except one artery was spasmed (not narrowed). She said nothing had to be done, except "relieve stress." But when my cardiologist (whom I go to now) reviewed the test, she did not even see the narrowing. She said- maybe.

Also, the "abnormal" EKG could be simply a variance for athletes. I don't know.

I did not do any treatment, because I don't know what treatment. The only thing they offered was Beta blockers, etc, and from what I know that makes one dependent and has side effects...

I don't know what a doppler is... But the angiogram showed all arteries clean...Does is now show up the plaque you're talking about?

Customer: replied 4 years ago.
oh, and thanks for picking up the question...

And when it was spasmed (during angiogram), she said it unspasmed as soon as they put in some nitro...
Expert:  Dr. R. Bora replied 4 years ago.
Thanks. And yes, the doppler shows the plaque clearly.

The narrowed artery is likely to be causing the pain in your arm due to "cardiospasm".where the pain occurs when the artery narrows spasmodically.This is a transient phenomenon and the spasm may come and go periodically.

You should get another angiogram or even a cardiac CT scan asap to get an overall idea about the status of that artery .
Get the carotid doppler as well to exclude"plaques". This will tell you if you need medicines for it like anti thrombotics besides beta blockers, if there is any "immature / non calcified plaque on the arterial wall.

On an immediate basis, medicines willbe prescribed by your MD or cardiologist only after these tests are done to confirm the current findings.

If you have any further question, I would be happy to help you.

I hope my answer has helped you.

Please remember to rate my service positive once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you!
Customer: replied 4 years ago.
I meant "does it not show" - not "does not now show", sorry. meaning would the angiogram not show the plaque you were talking of?
Customer: replied 4 years ago.
I see. would the angiogram not have shown the plaque the doppler would show?

I have had a CT scan of the chest in general - it was ok.

GEtting an angiogram is not really viable for me, as that takes me out of sports for about 3 weeks, and I am a running coach. I would only do that in a complete emergency.

What other tests would you suggest - what about stress echo? -

Do you know of any way to prevent spasms?

Just so you know what I am looking for is: what is causing my pain and the spasm? if that's it. What are the effects and possible consequences? and how do I fix it? - best without hard-core medication or invasive tests...

Customer: replied 4 years ago.
also, why is pain in the left arm associated with the heart? how are they related? And, are there any other reasons for the left-arm pain? quite often I would get it ONLY upon lying down - that does not sound like heart. or does it?
Expert:  Dr. R. Bora replied 4 years ago.
the angiogram will not show the plaque in the carotid artery of the neck, which can also cause arm pain resembling a coronary artery plaque. The transient spasm of coronary artery is a documented phenomenon and can definitely predispose to the formation of plaques.So, my advice to you is to get a cardiac CT scan done now. This is different from a normal chest Ct scan as it is a non invasive alternative to coronary angiography.

For the spasms, you may need nitro depending on the intensity of pain.

I hope my answer has helped you.

Please remember to rate my service positive once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you!
Dr. R. Bora, Doctor
Category: Health
Satisfied Customers: 5233
Experience: 14 years experience in the emergency room.
Dr. R. Bora and 3 other Health Specialists are ready to help you
Expert:  Dr. R. Bora replied 4 years ago.
One other reason for the left sided arm pain is a "pinched nerve" in the neck due to cervical spondylosis (degenerative arthritis of the neck bones).
Customer: replied 4 years ago.
ok. thanks. that all makes sense. I'll accept the answer in a sec. But last clarification: you think Cardiac CT scan is better than a function test like a Stress Echo?

will the cardiac CT scan show the carotid artery?
Expert:  Dr. R. Bora replied 4 years ago.

Good question!

No, the cardiac CT scan will show the coronary artery in the heart and not the carotid artery which is in the neck. The cardiac CT scan will tell you if the "spasmed artery has developed any "wall plaque that needs intervention.
The carotid doppler will show the "carotid artery in the neck" which can also produce plaques that could go and block your coronary arteries in the heart and cause pain.

You can also get an X ray of the neck to exclude cervical spondylosis which can often mimic cardiac related pain , when left sided. The X ray will tell you if you actually pain heart related pain or just cervical spondylosis , the latter easily treated with proper physiotherapy without the need for medicines, except pain killers.

I hope I am clearer this time!
Customer: replied 4 years ago.
It's all clear. I will ask about the tests. I am guessting they're quite spendy, though...

Are there also any "simple" remedies? If I were a doctor (which I am not), I would probably tell "me" to sleep more, quit coffee...

Are there any "functional" tests? - I mean, theoritically, the fact that I can run up a steep incline at sub 6 minute/mile pace should mean that all is ok with my heart, no?

I have run into two schools of thought: some doctors (like you) say to check it out, but most (even my cardiologist) say to just leave it alone and not think too much about it...
Customer: replied 4 years ago.
also, what about nutritional remedies? - I have heard that garlic, niacin, hawthorn, etc are natural vaso-dilators...

Also, can things change in 2 years? My Angiogram was two years ago, I think. Can anything build up that quickly? (it was clean then)


Customer: replied 4 years ago.
anyway, going to bed. will see your answer later. But thanks much for your help!
Expert:  Dr. R. Bora replied 4 years ago.
which school of thought would you like to follow? Doctors like me want their patients to remain "stress free" and healthy even though that means spending some money , being 100% sure that they have no fear of serious disease rather than being pre occupied with thoughts that put you under constant stress!

And if you could indeed sleep over your medical concerns, you would not me asking your question in just answer at this odd hour?! (no pun intended).

Yes, garlic as well as the others are natural vasodilators and they work best when no plaque has yet formed in the artery that otherwise.

Yes, two years is a lot of time and if your arteries are prone to plaque formation due to coronary vasopasm (which is a recognized phenomenon), you can develop plaues in that time.

Anyway, it was a pleasure assisting you!

I will sign off now.
Dr. R. Bora, Doctor
Category: Health
Satisfied Customers: 5233
Experience: 14 years experience in the emergency room.
Dr. R. Bora and 3 other Health Specialists are ready to help you
Expert:  Dr. R. Bora replied 4 years ago.
Sorry, I was offline.

I could not get back to you because the requested question was locked.

You can request me today again now.