Dr. Yash Kathuria
Family Physician
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Patient's Query
Hello doctor.
I have been experiencing hot flushes, tight achy chest pain, and tingling or ache-like tension in my left arm. This mainly comes on if I get very anxious or angry during argument. Sometimes if I run I get tingling in my left finger or hand. I had an echo one year ago and the results were normal. All ECGs have always been normal and the last ECG was done two months back. I have been diagnosed with generalized anxiety disorder and GERD. The MRI neck showed a bulging disc at C5 or C6. My blood pressure is 125/85 mmHg. But during a panic attack when I called an ambulance it went up to 168/100 mmHg but then came down to 130/90 mmHg within 10 minutes. I am seeing a counselor now. But the chest pain when I am angry is making me think again of heart disease. Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern regarding your chest pain. Chest pain may occur due to various reasons apart from heart disease like anxiety, panic attack, musculoskeletal pain, and lung disease. GERD (gastroesophageal reflux disease) can also cause chest pain. Cardiac disease is something that has to be ruled out first. If you feel chest pain or tightness while walking then I would suggest you get a stress echocardiography test done. You can confirm it by CT (computed tomography) and coronary angiography also. C5 to C6 bulge would not cause a tingling sensation in your fingers or hand. May I ask you a few questions. Do you have any family history of cardiac diseases? What about your vitamin B12 and TSH (thyroid stimulating hormone) level? Thank you.
Patient's Query
Hello doctor,
I have attached the MRI reports below. An MRI scan was performed last week, which I was able to view. It shows that the cervical spine is generally healthy, However, I do have a broad-based disc bulge at the C5 to C6 level which is causing mild contact of the anterior thecal sac centrally and narrowing of the left C5 or C6 neural foramen causing impingement of the left C6 nerve. I discussed the findings with a physician, which explains the symptoms I have been experiencing. I do not have a first-line cardiac family history. My grandmother had heart disease and died aged 80. Vitamin B12 is normal. Cholesterol tests are usually normal or borderline high but controlled with diet. There is no chest pain during walking and some days I walk for hours. It is more when I am very anxious, angry, or arguing.
Hello,
Welcome back to icliniq.com.
Thanks for the detailed history. Your upper arm pain can surely be explained by disc prolapse. Anger and anxiety may increase your chest pain especially if it is cardiac in origin. As such your chest pain complaint does not seem to be cardiac in origin still I suggest you get a stress echocardiography test done to rule out any cardiac disease. If it comes back normal then you need to relax, meditate more, eat well, and live a stress-free life. Thank you.
Patient's Query
Hello doctor,
Thank you for your reply. The doctor did a stress ECG test today. The result was normal and he got me to over 100 % of my target heart rate to push me. I had no chest pain during the test only a small amount of hand tingling which he thinks is related to the neck. They have reassured me it does not sound cardiac. What are your thoughts? Should I also do further tests?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. As you have gone through a good amount of exertion and still did not feel any chest pain, it does not seem to be cardiac in origin. You need not worry about your heart and no need for further tests. Only the spondylitis issue needs to be taken care of. Hope this helps. Thank you and take care.
Patient's Query
Hello doctor,
Thank you for your reply. I got the report today. It is saying 13.5 METs achieved. CONCLUSION: Patient asymptomatic. No chest pain or dyspnoea. The exercise ECG showed no obvious ischemic changes or arrhythmias on a high workload. Appropriate HR/BP response to exercise. Excellent effort capacity. It does say that if I have any further concerns I could consider coronary CT. But if echo and testing ECG is fine, is this clinically indicated? Hope this helps. Thank you and take care.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. I am pleased to see your reports as they are all normal. No, I do not think you need to go undergo CT angiography as far as medical opinion is concerned. I would say again, just relax and focus on your diet and lifestyle. Hope this helps. Thanks and take care.
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Family Physician
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