What causes left chest and shoulder pain with a normal ECG?

Question

Hi doctor,

For the past 40 days, I have had pain and heaviness on the left side of my upper body, including my chest, shoulder, and arm, along with mild chest discomfort. I underwent three ECGs, one echocardiogram, and a complete master health check-up. My blood sugar, cholesterol, and thyroid levels are normal. The only findings were that I am underweight and have mildly low hemoglobin (10 g/dL).

My echocardiogram was normal.

First ECG: ST and T wave abnormalities – nonspecific.
Second ECG: ST and T wave abnormalities – consider inferior ischemia.
Third ECG: Inferior or lateral ST and T wave abnormality – nonspecific or borderline ECG.

Please guide.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Chest heaviness and shoulder or arm pain on the left side for over a month can be worrying, especially when ECGs (electrocardiogram) mention ST-T abnormalities or inferior ischemia. The good part is your echocardiogram was normal, blood tests were mostly fine, and you’re not diabetic or hypertensive, which rules out several red flags.

Nonspecific ST-T changes on ECG can appear in many situations, such as anemia, electrolyte imbalances, stress, or being underweight. A hemoglobin of 10 g/dL is not dangerously low but can still make the heart work harder, contributing to discomfort or fatigue.

Terms like inferior ischemia or borderline ECG are not always conclusive; they indicate something looks off, but not necessarily dangerous or diagnostic of a heart attack. With three ECGs, an echo, and a full workup showing nothing alarming, cardiac causes are less likely, though a stress test or coronary evaluation may still be needed if symptoms persist.

Investigations to be done:

TMT (treadmill test) or stress echo to rule out exertional ischemia.
Serum ferritin, vitamin B12 levels (to find the cause).
Chest X-ray (to check for musculoskeletal or postural issues).
ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) if pain is persistent or inflammatory.

I suggest the following treatment plan for you:

Improve diet with iron-rich foods (green leafy vegetables, dates, jaggery, eggs).
Consider iron supplements for a few weeks (under doctor supervision).
Light physiotherapy/stretching for shoulder or back pain.
Follow up with a cardiologist for stress testing if symptoms worsen.

If symptoms persist after improving iron levels, get a stress test. Seek urgent care if pain worsens, changes location, or new symptoms like breathlessness or dizziness appear.

I hope this answers your query.

Thank you.