My symptoms resemble cardiac pain. I am confused and need help.

Q. My symptoms resemble cardiac pain. I am confused and need help.

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and medically reviewed by iCliniq medical review team.

This is a premium question & answer published on Feb 12, 2018 and last reviewed on: Oct 09, 2018

Patient's Query

Hello doctor,

I have been having intermittent chest pain since two years. The first time I went to the cardiologist, he totally dismissed it as muscular pain due to bad posture and mild bronchitis. I had an episode of sinus tachycardia last year following which I visited the same cardiologist. He did my ECG, 2D echo, troponin, CP-MB and stress test. All tests were normal (Troponin was 1.5 ng/L and CP-MB was 14). I was however referred to a senior cardiologist for further assurance. He did not feel the need to investigate any further but put me on Nebicard SM 5 mg (now reduced to 2.5 mg/day). He attributed the problem to anxiety and described the chest pain as non-specific.

Mid last year, I was diagnosed with grade II GERD. The gastroenterologist who did my endoscopy said the chest pain is entirely because of GERD and it is not cardiac. I experienced major chest discomfort two months ago. The doctor repeated my ECG, troponin and CP-MB. Troponin was unchanged at 1.5ng/L and CP-MB was 5.

Despite all these investigations seeming to rule out a cardiac problem, my symptoms are extremely discomforting, and sometimes seem to resemble cardiac pain. I have to explain the symptoms in detail so kindly bear with me.

The chest pain mostly starts in the upper breastbone (left side or right side of the chest), then it radiates downwards and towards the side of the chest (below underarms). Sometimes it radiates to my left or right arm (not both arms at a time) and back. I have a stiff neck as well. When I press my neck on the sides, the pain radiates like a shock wave through my arm and breastbone. Chest pain lasts for minutes to hours. There are times when I do not feel any pain even after walking three to four kilometres and there are times when walking a few meters or climbing a few stairs worsens pain. Sometimes the pain goes away with rest sometimes it does not.

Sometimes it is stabbing pain, other times it is dull in nature. Many times the pain is triggered by eating. I recently checked my thyroid profile. TSH was low at 0.24 but T3 and T4 were within normal range. I have been experiencing clammy palms and increased sweating in underarms. I have lost 5 kg in the last three months. There is increased fatigue, brain fog, confusion, stress. I am really confused about my symptoms. Need help. Thanks.

Answer

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine

Hello,

Welcome to icliniq.com.

I have gone through your history and reports (attachment removed to protect patient identity). You have not uploaded the report of stress test here but you mentioned that it is done. So anyway, firstly I do not think this has any relation to the heart because your age is less, symptoms are not compatible with heart disease and also all your evaluation is also negative. So, I think you should not worry regarding a cardiac cause. Just for the sake of completion of evaluation (not absolutely necessary), you can get stress test (treadmill test or stress thallium) done if not done already.

The possibilities in you are certainly you have reflux disease and hiatus hernia and it is leading to pain. This is a very common mimicker of cardiac disease. In addition to reflux, another contributing factor could be cervical spine problem as you mentioned some of the symptoms. So, these two causes in combination giving you trouble.

You are already taking treatment for reflux. For cervical pain, which occurs due to compression of nerves between spine, you should get X-ray cervical spine AP/Lat view and further may need MRI. You need to visit physiotherapist after X-ray and also an orthopedician.

Meanwhile, I suggest tablet Neurobion forte once a day which is a nerve vitamin. If this is not helpful then you need to request your doctor for tablet Pregabalin 75 mg bedtime, which is a nerve stabilizer, relieves pain and tablet Myoril 4 mg two to three times a day whenever for neck stiffness. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.

Hope this helps you and get back if you have any doubts.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

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