Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am 34-year-old female with pain in the upper abdomen, left chest, left shoulder and mostly middle-upper back pain (although back pain has been all over) upon standing, walking and on any exertion. Healthy otherwise and not overweight. I went to the ER yesterday, and they did two ECGs (did come back with an inverted t wave on one lead. They were not worried), did a chest X-ray, d-dimer (I had a DVT 1.5 years ago when I was six weeks pregnant), bloodwork including cardiac enzymes. All are normal. The pain started about two weeks ago, but was just off and on and would go away fairly quickly. I tried working out about 1.5 weeks ago and made it a couple of minutes until the jumping jack warmup. The jumping motion brought on this pressure pinching pain (not the best description, I am sure), but it is subsided when I stopped. The last few months, I have had intense burning pain in my upper middle abdomen that the doctor suspected an ulcer and put me on Protonix. The pain did get better after that, but I still have many flare-ups of that pain. It seems like when I get the chest pains, and I have a lot of upper abdominal pressure. I have to push down on my upper abdomen to help relieve some of the pain, even though the pain is felt more in the upper left chest into my left shoulder and sometimes arm. The upper-middle back pain is new and is hot pressure pain. The chest pains were off and on but have been consistent for almost three days now, but mostly only when I get up to walk around or stand. Just standing still without exertion brings on this intense pain. Sometimes certain sitting positions will carry it on too. I do not feel short of breath, except when the pressure hits. In ER yesterday my stats were good. BP around 100/60 (my norm), HR around 65, and O2 100 %. My respiratory kept alarming though around 8-9 quite a bit.I cannot help be worried about a blocked artery since that seems to be what pops up with chest and back pain. Also PE, but they were pretty confident I did not have to worry about that with normal stats and a negative d-dimer.
Hello,
Welcome to icliniq.com.
Unlikely to be related to a cardiac cause. Firstly, cardiac pain typically comes on exertion and relieves at rest and should persist for at least a few minutes. And rest cardiac pain suggest acs, in which pain persists for few minutes, ECG changes and positive enzymes are expected, will not be related to movements and unlikely to persists for two weeks even without treatment. It is likely related to reflux, which can cause chest, back, and arm pain as well. Will come in bouts and persists for a few seconds. However, it is better if you can get a stress test like a treadmill test and echo done to be sure. You should avoid fatty, oily, and high-calorie diet. Have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any. Also, should have antacids prokinetic combination like Pantoprazole plus Domperidone instead of just antacids. May have syrup Sucral O or other locally acting antacids two teaspoon SOS for faster relief. Overall, unlikely to be related to the heart or blocked arteries, However better to get few tests done. I hope this helps you and get back if you have any doubts.
Patient's Query
Thank you doctor,
This pain almost entirely goes away when I am sitting or lying, but just standing up brings on the pain. The only exertion I have been able to do in the last 2.5 days is standing and walking to the bathroom. A couple of minutes after standing there and it all kicks in immediately. At first, it was chest pain (and left shoulder), but yesterday is when the back pain kicked in, and today it is my whole back and quite painful. When the pain started two weeks ago, it was very intermittent. Just every once in a while. Last 2.5 days have been constant, but it mostly goes away while sitting.
Hello,
Welcome back to icliniq.com.
So it is very unlikely to be related to the heart. Pain due to CAD (coronary artery disease) or blockages, will not resemble this pattern at all. So, the pattern is firmly against CAD. So much immediate relation to standing suggests the possibility of mechanical cause like spinal causes, which may be nerve compression or other mass lesions. Do you get any tingling, burning or numbness along with pain, if yes it points towards the spinal cause? Meanwhile, avoid heavy activities and rest as much as possible. Also, reflux possibility becomes less likely with such a pattern. So, it does not appear to be related to blockages, and you need to get other imaging done like chest X-ray and CAT scan for diagnosis.
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