Chest Pain

“My doctor is not worried about my chest pain, what could be it?”

In case you ever get left-sided chest pain, or left shoulder pain, the first thing that anyone would tell you would probably be, “Oh my God! You probably have a heart disease!” Yes, a cardiac issue is always considered first, because there is a huge possibility that it can be fatal. Once the cardiac issue is ruled out, often with extensive testing, your cardiologist will probably say, “You are fine. Go home”. “Well, if it isn’t heart disease, what just happened?” is what you may ask.

Here are 5 possibilities that can explain what may have happened:

1. Cervical Spondylitis: The pain in the left arm in such patients is because of the compression of the nerves. Nerves in the body derive chiefly from the spinal cord. These may be getting compressed if there is some skeletal compression of the nerves. This may be resulting in the pain that usually radiates from the neck, down the arm, or to other parts of the body, simulating the heart conditions. Most doctors suggest an x-ray of the neck or preferably an MRI of the spine.
2. Muscle Strain: The muscles are all attached to the bones. Therefore, when you have left arm pain, it may be possible that there is an inherent muscle trauma that may be causing pain. Alternatively, the attachments of the muscles to the bone may be weak or traumatized and may therefore lead to pain as well. A Nerve Conduction Velocity (NCV) or an electromyogram (EMG) may help diagnose this.
3. Gastritis: The nerve supply to the heart and the stomach is the same. This supply is to the left arm also. Therefore, when you have severe gastritis, the nerve takes the signal to the brain. Now since the brain receives signals from all three portions, it misreads the signals as pain in those parts. Thus, we feel pain in left arm. Medically, this is known as referred pain. An endoscopy may help diagnose this.
4. Pleuritis: Chest pain may be due to some pleuritis. In fact the sharp shooting / stabbing pain in the chest on breathing is typical to pleuritis. Pleura are the covering of lungs that can sometimes get inflamed leading to such kind of chest pain.
5. Anxiety or Panic Disorder: Chest pain could be very much similar to the pain of a heart disease. It can present with anxiety, palpitation, sweating, trembling or fear of dying. Here, an ECG, chest x-ray and most of the other investigations are normal.

Although heart attack or a cardiac cause of left-sided chest pain is very dangerous, it should be noted that there are several other non-cardiac causes for the same, as mentioned above. These can be confusing, and careful consideration should be given to conclusively arrive at the cause of the chest pain. Management of each of these causes varies according to the duration, severity and presentation of the symptoms.