Chest pain.... still

[nickie420me]

After about a week of center chest, left arm, left shoulder and left sided neck pain I went to the urgent care. They did an EKG and a chest x-ray both of which were normal. Does anyone have any idea if this should be a reassurance that these pains aren't heart related?

[kinikia95]

I don't think any of us can tell you better than a doctor can? If they felt okay to let you go I would say you're ok. I know it's hard though, I don't trust doctors either, but every time they've told me I was okay it turns out I was.

[michaelagjess]

Hi Nickie, you should be feeling a lot better already knowing that they found nothing wrong. The chest, arm, and neck pain are all caused from tensing up your muscles when you're worrying, most of the time you wont even notice yourself doing it. Try relaxing your muscles and do some deep breathing and you can rest assured that you're heart is perfectly healthy and that the chest pain is just your muscles tensing and your heart is normal and will be okay.

[nickie420me in reply to michaelagjess]

Thanks! I appreciate the reply and reassurance. The doctor didn't really give me any information other than "Your EKG is normal"

[michaelagjess in reply to nickie420me]

If there was something really wrong they would tell you, you do not need to worry about it anymore and anytime!

[sunnyg]

The pain I felt in my center chest and left shoulder and neck were gallbladder related. If the doc checked your heart, then it's fine. Keep on eye on what you eat and see if certain things set off or intensify the pain. Fat made my pain worse and so I had to cut out eating it.

[nickie420me in reply to sunnyg]

My shoulder hurts a bit with movement and a few places are tender to press on in my neck, arm and chest. Was that the case with you?

[sunnyg in reply to nickie420me]

No, food was the only culprit. If you have pain or tenderness on your arm, chest, neck or shoulder when you press on the sore area, then it is muscular in nature. Your tension has built up lactic acid in those muscles and they are tight and sore. They're all connected, so the pain can run through the whole system. Can you get a massage? A hot tub would help too. You could also take a warm bath with Epsom salt and drink a lot of water and relax as much as possible. Stretching will help too. Anxiety makes everything hurt so much and it sends our nervous system into a roar. Yuck. But, you're OK and you can get rid of this with some TLC toward yourself.

[LDS32 in reply to sunnyg]

Good post. Many people don't realize stomach and gallbladder issues can mimic heart issues. Could even be a heital hernia. None of these are fun but less scary than a heart issue.

[Sadiedog12]

They could have tested your blood for treponin levels. Levels are raised if you have had a cardiac event. In this case I would consult "Dr Google " on treponin levels.

[Katlinma78 in reply to Sadiedog12]

I wouldn't consult Dr Google if. we're you, you will just get yourself anxious. I used to be a doctor. Permanent chest pain for a week is unlikely to be a heart attack as if it was you would have been dead. A normal ECG when you have chest pain is very reassuring that the pain is not heart related. It is most likely anxiety related muscle tension - so don't worry about it any more and go and do something that help you to relax

[Sadiedog12]

Agree, it is probably unlikely after a negative ECG and the time frame but they should have taken blood for treponin levels with these symptoms.

My opinion only.

[Katlinma78 in reply to Sadiedog12]

It's fine to have your opinion Sadie dog, but mine still differs.. I disagree that they 'should' have done a Troponin level. When I was a doctor, I would have done a Troponin if the pain has gone away, and I thought it sounded like it could be cardiac...to check they hadn't had a cardiac event, as the the ECG being normal when the pain had gone would not exclude it. But if the ECG was normal I wouldn't do a Troponin, especially if the clinical history suggested other causes. This was standard practice (in the UK) . Where do you practice?

[Katlinma78 in reply to Katlinma78]

Sorry, that should have said if the ECG was normal with symptoms present...

[nickie420me in reply to Katlinma78]

Am I to understand that if neck, shoulder, arm or jaw pain is being referred from the heart that those areas wouldn't be tender when pressed in areas?

[Sadiedog12]

Let's agree to differ Katlinma

[Katlinma78]

That would generally be the case Nickie.

[nickie420me in reply to Katlinma78]

Thanks. I did make the mistake of googling. It's just scary that ALL these areas are listed for heart attacks in women!

[Katlinma78]

Sadie Dog, I'd be happy to agree to differ except that your advice is likely to cause more anxiety and I'm not sure what you are basing it on. On a site where people have anxiety, I think you have be careful suggesting that people should have had tests that the doctors may have legitimately decided weren't necessary or that they Google Tropinin levels and interpret them themselves when they are not medically trained.

[Sadiedog12]

You are mistaken in your supposition that I am suggesting the lady should try and interpret treponin levels herself. I also do not appreciate your lecture regarding people with anxiety. I am well aqainted with this condition in all its forms. There would be no harm in carrying out a treponin test with these symptoms and might provide reassurance and therefore reduce her anxiety.

[Katlinma78]

In my opinion, doing an unnecessary Troponin for reassurance in anxiety does not help in the longterm. Because the next time they have anxiety and chest pain and chest and arm pain due to anxiety, they won't be able to relax until they have had a Troponin checked. And in time, even that might not be enough, they may think what if the test results got mixed up etc The problem is the anxiety and learning not to feed that anxiety with checking is part of the solution, at least that works very well for me. As you said above, just my opinion.

[Katlinma78]

Sadie Dog, I'm sorry if I have been a bit forceful in my responses to you, I know that we are both just trying to help. I just fundamentally disagreed with you on this one and wanted to explain why I felt your advice could be (unintentionally) harmful.

[nickie420me in reply to Katlinma78]

Sorry for all the questions! But I'm now on week 2 of these intermittent pains. At times I find the duration of these pains reassuring that it's not my heart. I've read so much about people having "warning pains" before a heart attack. Should the fact that it's still going on indicate that this isn't due to an upcoming heart attack?

[Katlinma78]

Hi Nickie.

The trouble with anxiety is that certainty about anything is impossible. So ultimately we all need to choose between possibilities that will have pros and cons either way and learn to live with the possibility that we might be wrong. The more we do this, our brains get reset to be less anxious. You might want to read my reply to another recent post about health anxiety where I explain a bit more about that.

With an a normal ECG, by far the most likely explanation is anxiety. However, I'll explain a bit more about how doctors make decisions about risk of heart attack and then I'll tell you my story too, to help you decide what you are going to do.

First of all, doctors will ask what the pain feels like, what brings it on and what makes it better, whether you have any risk factors for heart disease (high blood pressure, diabetes, high cholesterol, smoking, cocaine use, heart disease or stroke in close blood relatives before the age of 60). Based on that, they get an idea of whether it sounds like this is a heart attack or warning signs for a heart attack.

Then they'll examine you, again looking for things that may make a heart attack more likely such as a heart murmur. Again, a normal examination doesn't exclude a heart attack, but if they find a heart murmur then that is something that they will weigh in the balance and look into.

Then they'll do an ECG - if it is normal then a heart attack or warning signs for one is much less likely.

That at this point last time they sent you home is reassuring that based on your description of you pain, risk factors, examination and ECG they thought heart pain was unlikely. However, it is still possible that it is your heart, especially if you have some of the risk factors above.

As Sadie Dog suggested, a Troponin test could be also be done, especially if the doctors felt that the type of pain you were having, your risk factors and your examination meant that they still thought a heart related cause was a reasonable possibility. I may have given Sadie Dog a bit of a hard time about this, as it isn't an unreasonable thing to do. But I think it should be done in order to detect heart disease that might have been missed rather than to rather than to reassure someone who is suffering from anxiety - as ultimately that won't help their anxiety. If it is heart related and a little heart damage has already occurred, then the Troponin could pick that up, though a negative Troponin would again not completely exclude this.

If there was still a significant possibility of you having a heart problem but everything else was negative, they could do a stress ECG test, where you run on a treadmill. Or they could skip straight to other tests which are more accurate but more invasive and expensive.

But none of these tests are 100% certain. You need to consider them all together to get an accurate idea of risk. Importantly, they also carry the risk of side effects or being diagnosed with something you don't have. Which my story illustrates. I find it quite amusing now, but it wasn't at the time!

I was a doctor and I would get chest pain going down my left arm when I ran or got stressed. Other than that, I was healthy and had no risk factors. I was also a highly anxious person.

One day at work, I had to run to an emergency and I had chest pain. After the emergency was over I still had chest pain and so I got one of the nurses to do an ECG. It was slightly abnormal, though that could have been dues to lead position. I took it to one of my colleagues who was a cardiologist and he agreed to see me in clinic. I had a normal ECG in clinic and a normal examination. He did an echocardiogram just in case, which was normal. He sent me for a stress ECG, which came back as inconclusive. He then sent me for a CT angiogram, where they inject a substance which enables them to see the blood vessels around the heart on CT. Straight afterwards I had a reasonably serious allergic reaction to the injection. The result was normal - except they couldn't see properly one part of the heart (the bit where the stress ECG suggested there could be problems if there were any)! I was offered a full angioplasty, where they use a tube inserted through the blood vessels in the groin to directly put a substance into the heart blood vessels so that they show up on X Ray. After a long discussion with the cardiologist I decided not to go ahead - serious side effects of an angiogram are unlikely but possible but after my allergic reaction to the CT injection (also not common), I decided that I would take the very low risk of my having an undiagnosed heart condition over the low risk of a complication from having the angiogram. I don't tend to get pain when I run these days, I do a bit when I l'm stressed, but it is much better because I don't worry about it.

[LDS32 in reply to Katlinma78]

This is solid info thank you. I have some mild heart issues and the reality is all my symptoms are gone when I'm not anxious. I can workout go without sleep, drink beer and feel fine but if I'm anxious I can't do anything without palpitations. And two members of my family have major heart issues and don't get palptations or dizziness at all. Many people with heart issues don't have any symptoms of heart problems and many people with anxiety have several. Best thing we can to is get examined, monitored and just live our lives.

[Katlinma78]

The short answer to your question is that if this is a new thing that is coming and going then if you are fit and healthy and even if not, anxiety related pain is by far the most likely explanation. Heart is still a possibility, especially if you have risk factors. You could have another assessment, another ECG and if the doctor thought it was warranted they could do a Troponin or further tests. But in terms of your anxiety around these symptoms, you will never achieve complete certainty the trick is to learn to live with that and the anxiety will decrease.

[nickie420me in reply to Katlinma78]

Thank you so much for taking the time to explain all of this!! I've been somewhat arguing back and forth with myself over this! For the past year-year and a half I've thought I had every cancer you can imagine! This is my first "heart" symptom scare. At times the shoulder and arm pain is made much worse by turning my head. The doctor I saw spent about 5 minutes with me. She said my EKG was normal and that my heart sounded strong. I'm 37 years old, 115 pounds and a non smoker (I quit 4 years ago) I don't drink, don't really know about my cholesterol. The chest pain isn't as persistent as the arm pain. My other problem is I don't have health insurance and can't afford all of those tests unless it was absolutely life and death. The pain on a 1-10 scale is probably a 2 at most. The physical pain is a 2, the mental pain from it is about an 8 or 9! My best friend is a nurse and paramedic and she said this doesn't sound cardiac to her. The doctor I saw basically pushed on a few areas and said "It's muscular" and that was about it!! As funny as this sounds, my husband had me stand up and said "Do 15 jumping jacks then jog in place." I did. And then he said "You have to believe if you were having heart problems this wouldn't have just been so easy for you to do!" Not sure how that will sound to a doctor! Crazy I'm sure!

[Katlinma78]

So, let's look at the evidence here:

- Doctor doesn't think that it is your heart

- Paramedic friend doesn't think it is your heart

- Worse with turning your head - definitely sounds muscular rather than cardiac

- Doctor didn't hear any heart murmurs

- Normal ECG

- Tender to touch - definitely sounds muscular rather than cardiac

- Only risk factor for heart disease is that you are an ex smoker (and stopping will have hugely decreased your risk)

- Able to do jumping Jack's with the pain, which doesn't make it loads worse (this made me smile by the way).

I'll let you draw your own conclusions

[nickie420me in reply to Katlinma78]

Ugh. I'd hate to have to tell my husband his jumping jacks test could possibly be smart! 🙂

[Katlinma78]

Lol 😁

[Katlinma78]

In terms of your anxiety, this is what I wrote in reply to another post about health anxiety, based on my own experiences with anxiety:

This is a normal effect of anxiety. When our ancestors lived in the wild, a rustle of grass would make them think 'lion' and they would be extra vigilant. Another rustle of grass and they would be prepared to run ('flight') or fight. Whether or not it was actually a lion, because assuming it was helped you to survive. We evolved that part of the fear response was to believe it was a lion even if we couldn't possibly know, even if it wasn't - because responding quickly helped you to survive. And that has consequences to us today that become a vicious circle if we don't understand them.

If we have an experience that triggers the fear response e.g. stress at work, an abusive relationship, a bereavement or even chronic subtle things, this acts like the first rustle in the grass or maybe like actually encountering but escaping from a lion. We become hypervigilant - which is what you are describing.

We then notices other 'rustles in the grass' e.g.bodily sensations, things people say... and our brain screams 'lion' heart attack, cancer, very ill. Even though it may not be at all, that possibility feels very real in the anxiety, because it used to be part of our survival to believe the possibility of 'lion' as fact. So we indulge in fight (checking our pulse, Googling, asking a friend, asking this forum, going to the docs) to try and kill that lion. Or we use flight - distracting ourselves with other things, avoiding the situation where we had those frightening bodily sensations. The trouble is that this reinforces to the brain that lion might be real, that there might really be danger. So the hypervigilance persists and becomes a vicious circle.

So the solution when your brain is screaming 'lion' is to say to it 'this may or may not be a lion, but I won't know until I calm down and think clearly without the fear response. So I am going to choose not to respond with a fight or flight behavior, I am going to do something productive or which is good for me. This is really hard when your brain is screaming 'lion'!! But if you keep doing it then the hypervigilance subsides. There are many things that can help you with this: mindfulness, breathing exercises, medication that reduces the anxiety response. I hope this helps

[nickie420me in reply to Katlinma78]

It's a tremendous help! Googling is a horrible habit of mine! Thanks SO much for all of your help!

[Katlinma78]

Some one else recommended these: Essential Help For Your Nerves by the late (great) Dr Claire Weekes and finding a website called Anxiety No More set up by Paul David

I've not seen either of these, but I have read 'Hope and Help for your Nerves' by Dr Claire Weekend, which is very insightful, if somewhat old fashioned in some of its attitudes (but the overall wisdom trumps this in my opinion).

I'm off to visit my Mum, sister and her husband for a week, so if I don't reply I'm not ignoring you

Plan something that you enjoy to take your mind off things maybe? All the very best.