Q. In what condition can on and off chest pain occur under breast?

Answered by
Dr. Ilir Sharka
and medically reviewed by Dr. Nithila A

Hello doctor,

I am attaching a word document detailing cardiac issue symptoms. I have been experiencing this for the past seven months of this year since I ended up in A and E. It outlines the issues and tests so far. At present, I have chest pain that comes and goes on the left-hand side under the breast, and it is not a tightness it feels more like an ache. Left-arm pain that comes and goes, lightheadedness and woozy sadness, especially when walking or standing. I want to get the thoughts, and some advice on what could be the possible issue, and any further tests recommended.

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Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome to icliniq.com.

I passed carefully through your concern and would like to explain that your recent clinical symptomatology seems to be related to THC (Tetrahydrocannabinol), alcohol, and cocaine use. They are potent stimulants, and apart from leading to blood electrolytes imbalances, heart rhythm disturbances, and central nervous system symptoms may also lead to coronary blood flow disturbance and cardiac ischemia. Not rarely, when taken in excessive amounts, they may lead to life-threatening cardiac arrhythmias and myocardial infarction.

That is why I strongly recommend you to be careful and to avoid those substances in the future, possibly. To clarify any potential myocardial damage, I recommend you to discuss with your doctor on the opportunity of performing a cardiac ultrasound test and if possible, a cardiac magnetic resonance imaging test. I hope to have been helpful to you. Let me know in case of any further questions.

Thank you, doctor,

Yes, it all seems to be related to the drugs mentioned since the symptoms did subside in the past only to be brought back after more alcohol or cocaine use. Currently, though it has been over a month since last drug use and I am still experiencing the chest pain or lightheadedness etc.,

Yes, I had a cardiac ultrasound test (echo) done already, and this did not find anything. However, when this test was undertaken back before two months, my symptoms had subsided (brought back again now, however, after alcohol or cocaine use). Do you think it is worth asking for a cardiac MRI? Or do you recommend any other tests?

All my symptoms point to a cardiac problem, but any test I have done does not find anything which is frustrating, this is why I am hesitant to return to my doctor as he has already referred me to a cardiologist and I am not sure what else he can do for me which is frustrating.

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

Considering regular previous cardiac tests is a good first step. They are a reference point when currently reviewing your cardiovascular conditions. In the range of a few days from the chest pain, checking cardiac enzymes (CK-MB, Troponin) would be a valuable tool for detecting any myocardial injury or damage. Also, a new cardiac ultrasound coupled with exercise or pharmacological stress could be more specific and sensitive in identifying areas of cardiac ischemia.

And regarding cardiac magnetic resonance imaging test, my response is yes. Cardiac MRI is the most sensitive and specific tool for the evaluation of even small myocardial and other cardiac structural lesions or abnormalities. I would highly recommend it in case the other tests do not confirm anything.

Thank you doctor,

Am I correct in saying based on your response you suspect my issue is cardiac ischemia? If that is correct, is there any possibility it would subside on its own? Considering these symptoms subsided on their own in the past. If cardiac ischemia is detected in tests, does it require a surgical procedure? Heart surgery at 26 seems daunting. Also, I have prescribed Metoprolol (but only take it on an as-is basis - before important meetings, presentations). Will Metoprolol help?

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

I do not think you are suffering from any clinically important cardiac ischemia syndrome. Anyway, as you are using dangerous substances, that may lead to severe cardiac disorders, including ischemia, we need to be sure that no such findings be present. That is why I suggested the tests mentioned above. The best strategy to avoid these cardiac issues would be to stop using those stimulants in the future.

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