Pain in the heart

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Submitted by Dr T on September 4, 2010 – 8:25am

Question: 
For 3 months now I’ve been having health issues.It started with mild pain in the middle of the breastbone and when after a few days I had constant palpitations.When to the doctor,had an ECG, the results came back fine.Also had a 24hr heart monitor, the results was fine again. Since the palpitations has settled but the pain is still there at no particular time of the day.Sometimes I feel the pain in my heart and my ribs and back.The pain is only on the left side of my body and sometimes I feel like my left arm is weak.The pain can be here for a few days then disappear for a few days and then come back again. Went to the doctor again, did a series of blood test and all came back fine.I am really desperate,it’s affecting my life,it’s always in the back of my mind that I am going to die… I am 33 female with no other health issues and I don’t smoke and drink only occasionally.Thank you.

The combination of chest pain and palpitations should be further evaluated. Although it is possible these are a result of anxiety or stress, or Gastro-Esophageal Reflux Disease (GERD, unlikely), what needs to be ruled out first is whether these complaints involve your heart.

Women with coronary artery disease (CAD) often have atypical symptoms, like unusual fatigue, shortness of breath and only mild “chest discomfort”. Women wait longer than men to go to an emergency room when having a heart attack and physicians are slower to recognize the presence of heart attacks in women because “characteristic” patterns of chest pain and EKG changes are less frequently present. If you want, you can check your risk for CAD here: https://www.cardiachealth.org/cardiac-risk-assessment

I suggest you ask for a stress ECHO, as neither EKG nor blood tests will be positive unless there has been damage to your heart.

From that perspective the negative results are good news, but they do not rule out the presence of CAD. Although less common at your age, it is still possible, especially if you are  a Diabetic, overweight and/or have problems with cholesterol and smoke, or have a family history of heart disease.
Although I don’t want to minimize the impact of stress and anxiety, I recommend CAD ruled out of the equation of what may be wrong with you.

If, as I hope for you, heart disease is not present in your case (not disproved yet with these tests), your doctor will need to focus on other possibilities.

If you want to learn more about CAD, take a look at my website:
https://www.cardiachealth.org. I think it has useful information.

Hope this helps,

Pain in the heart
Question: For 3 months now I’ve been having health issues.It started with mild pain in the middle of the breastbone and when after a few days I had constant palpitations.When to the doctor,had an ECG, the results came back fine.Also had a 24hr heart monitor, the results was fine again. Since the palpitations has settled but the pain is still there at no particular time of the day.Sometimes I feel the pain in my heart and my ribs and back.The pain is only on the left side of my body and sometimes I feel like my left arm is weak.The pain can be here for a few days then disappear for a few days and then come back again. Went to the doctor again, did a series of blood test and all came back fine.I am really desperate,it’s affecting my life,it’s always in the back of my mind that I am going to die… I am 33 female with no other health issues and I don’t smoke and drink only occasionally.
Thank you.
Answer: Hi Jen,
The combination of chest pain and palpitations should be further evaluated. Although it is possible these are a result of anxiety or stress, or gastro-esophageal reflux (unlikely), what needs to be ruled out first is whether these complaints involve your heart. Women with coronary artery disease (CAD) often have atypical symptoms. I suggest you ask for a stress ECHO, as neither EKG nor blood tests will be positive unless there has been damage to your heart.

From that perspective the negative results are good news, but they do not rule out the presence of CAD. Although less common at your age, it is still possible, especially if you are  overweight and/or have problems with cholesterol, or a family history of heart disease.
Although I don’t want to minimize the impact of stress and anxiety, I recommend CAD ruled out of the equation of what may be wrong with you.

If, as I hope for you, heart disease is not present in your case (not disproved yet with these tests), your doctor will need to focus on other possibilities.

If you want to learn more about CAD, take a look at my website:
https://www.cardiachealth.org. I think it has useful information.

Hope this helps,
Dr T

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