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What Causes Left-sided Pain In The Chest?
Posted on
Fri, 7 Apr 2017
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 7 Apr 2017
Answered on
Thu, 4 May 2017
Last reviewed on
Question : Dear Dr,
I have this on going issue for a 4 years now and it has become worse.
I frequently get pain in the left side of my chest, under my left armpit and shoulder. When the pain / sensation occurs it is extremely difficult to get rid of. Not only is extremely uncomfortable, but I believe the pain is the cause of extreme anxiety as it is in the chest area and can be mistaken for heart related issues. Simultaneously, my whole body feels extremely weak and can sometimes feel ache in my jaw and head and often down my left arm including the wrist. I've had to call the ambulance on a few occasions as I thought i was going to pass out. Both times the ambulance did a ECG which both came out clear, which helped relieve some of the anxiety. On mutiple occasions I have pulled over on the motorway whilst driving, as I felt like I was going to faint / or even die, as I was feeling extremely light headed at the time. It is such a struggle to get to sleep at night as when i'm lying down the pain is at its worse. I often find that when I finally am on the brink of falling asleep after hours of sitting up, tossing and turning, I suddenly have a panic attack / fit ? where I quickly get up out of my bed gasping for air. This actually happens often mutiple times in a night.
A few things you should know
- I have been a smoker for 7 years (Im 31 now). I used to smoke around 10-15 a day but have now cut down a lot, unless I am out drinking with friends, then i tend to go through 20 quite easily. I have been through short period where I haven’t smoked for a few days and noticed an improvement but the symptoms still occurred. Today I have only smoked 1 Cigarette and the pain is unbearable and has been there for hours.
- Being honest, Id say I binge drink at least once a week, on occasions twice a week. I find that when I drink alchohol (Double Whiskey / Shots / Chaser) the pain goes. Wether that is because the alcohol works as a pain killer, I’m not sure. However, When I do drink I go through a lot more cigarettes. The next day literally feels like death. Not only do I have a hangover which I can take, but I also have the most extreme pain in my chest. I wish I could go back to the days it was just a hang over. I see all my friend who pretty much do the same as me, don’t suffer anywhere near what I do
- I do sometimes take 20 MG Omprezole, i don’t even know if that makes a difference as the pain is still there with to without.
- I frequently burp all the time. They are very big burps and it is constant throughout the day. I do a feel a slight relief for a minute or two when I burp what seems to be trapped gas, but then it comes back again. Hence why i am messaging you today as I think this maybe a gas related issue.
Whilst I appreciate the immediate response to this will be stop drinking / stop smoking, which I have cut down on massively, and trying my best to stop it all together. If I do continue to do this, is their any advice / guidelines you can give me to at least cut this pain by 50%. Remove the feeling of “Im going to Die”
I’d love to hear your overall thoughts on this and you advice is much appreciated.
Thank You
I have this on going issue for a 4 years now and it has become worse.
I frequently get pain in the left side of my chest, under my left armpit and shoulder. When the pain / sensation occurs it is extremely difficult to get rid of. Not only is extremely uncomfortable, but I believe the pain is the cause of extreme anxiety as it is in the chest area and can be mistaken for heart related issues. Simultaneously, my whole body feels extremely weak and can sometimes feel ache in my jaw and head and often down my left arm including the wrist. I've had to call the ambulance on a few occasions as I thought i was going to pass out. Both times the ambulance did a ECG which both came out clear, which helped relieve some of the anxiety. On mutiple occasions I have pulled over on the motorway whilst driving, as I felt like I was going to faint / or even die, as I was feeling extremely light headed at the time. It is such a struggle to get to sleep at night as when i'm lying down the pain is at its worse. I often find that when I finally am on the brink of falling asleep after hours of sitting up, tossing and turning, I suddenly have a panic attack / fit ? where I quickly get up out of my bed gasping for air. This actually happens often mutiple times in a night.
A few things you should know
- I have been a smoker for 7 years (Im 31 now). I used to smoke around 10-15 a day but have now cut down a lot, unless I am out drinking with friends, then i tend to go through 20 quite easily. I have been through short period where I haven’t smoked for a few days and noticed an improvement but the symptoms still occurred. Today I have only smoked 1 Cigarette and the pain is unbearable and has been there for hours.
- Being honest, Id say I binge drink at least once a week, on occasions twice a week. I find that when I drink alchohol (Double Whiskey / Shots / Chaser) the pain goes. Wether that is because the alcohol works as a pain killer, I’m not sure. However, When I do drink I go through a lot more cigarettes. The next day literally feels like death. Not only do I have a hangover which I can take, but I also have the most extreme pain in my chest. I wish I could go back to the days it was just a hang over. I see all my friend who pretty much do the same as me, don’t suffer anywhere near what I do
- I do sometimes take 20 MG Omprezole, i don’t even know if that makes a difference as the pain is still there with to without.
- I frequently burp all the time. They are very big burps and it is constant throughout the day. I do a feel a slight relief for a minute or two when I burp what seems to be trapped gas, but then it comes back again. Hence why i am messaging you today as I think this maybe a gas related issue.
Whilst I appreciate the immediate response to this will be stop drinking / stop smoking, which I have cut down on massively, and trying my best to stop it all together. If I do continue to do this, is their any advice / guidelines you can give me to at least cut this pain by 50%. Remove the feeling of “Im going to Die”
I’d love to hear your overall thoughts on this and you advice is much appreciated.
Thank You
Brief Answer:
Can be cardiac or gastric or panic attack.
Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concern.
As per your history there are three possibilities.
1)As you are a chronic smoker and alcoholic it can be cardiac disease.All the features of your chest pain are very typical of angina. You have mentioned that at various occassions your ecg was normal but E.C.G is just a baseline test of cardiology and can not help to diagnose case of unstable angina.It's just a basic test.
I would strongly recommend you to go for few tests of cardiology like-
2d echo- Motion of the walls of heart can be seen.In case there is coronary artery disease wall motion would be effected.
Tread mill test- You will run on a tread mill and your E.k.g's would be recorded.Any ST-T change is significant of cardiac disease.
If cleared from cardiac side-
second possibility is Gastritis with heart burn with overlapping peptic ulcers.Severe gastritis can mimic cardiac pain.However usually pain responds to omeprazole but in your case it does not which again drifts diagnosis towards cardiac problem.
The easiest way to differenciate is take your blood pressure.If systolic Blood pressure is more then 110mm of hg take isosorbide dinitrate sublinguallly(consult cardiologist for doses).If pain responds to it; Its cardiac.
Stable angina typically responds to nitrates.
Smoking makes you 10 times more prone to cardiac disease then a non smoker.
For burping i would advice you to shift from omeprazole to Nexium 40 mg twice a day. It will provide you immediate symptomatic relief.
Third possibility is Panic attack which can be precipitated by high levels of anxiety but only way to differenciate the three is to rule them out one after other.
As per your query about how to reduce pain.we can't reduce it unless we know the root cause of pain.Lamely advising you medicines doesn't makes any sense.
I strongly recommend you the following tests-
2D echo
Stress test
Upper g.i endoscopy to rule out peptic ulcers.
Once the tests results are there medicines can be started to reduce your pain.
Medicines that can be taken till time tests are done-
Antacid syrup 2tsf twice daily.
Tab Nexium 40 mg twice daily.
Advice
Follow up with reports.
Hope i answered your query well,In case you need more details i would be happy to help.
Regards.
Can be cardiac or gastric or panic attack.
Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concern.
As per your history there are three possibilities.
1)As you are a chronic smoker and alcoholic it can be cardiac disease.All the features of your chest pain are very typical of angina. You have mentioned that at various occassions your ecg was normal but E.C.G is just a baseline test of cardiology and can not help to diagnose case of unstable angina.It's just a basic test.
I would strongly recommend you to go for few tests of cardiology like-
2d echo- Motion of the walls of heart can be seen.In case there is coronary artery disease wall motion would be effected.
Tread mill test- You will run on a tread mill and your E.k.g's would be recorded.Any ST-T change is significant of cardiac disease.
If cleared from cardiac side-
second possibility is Gastritis with heart burn with overlapping peptic ulcers.Severe gastritis can mimic cardiac pain.However usually pain responds to omeprazole but in your case it does not which again drifts diagnosis towards cardiac problem.
The easiest way to differenciate is take your blood pressure.If systolic Blood pressure is more then 110mm of hg take isosorbide dinitrate sublinguallly(consult cardiologist for doses).If pain responds to it; Its cardiac.
Stable angina typically responds to nitrates.
Smoking makes you 10 times more prone to cardiac disease then a non smoker.
For burping i would advice you to shift from omeprazole to Nexium 40 mg twice a day. It will provide you immediate symptomatic relief.
Third possibility is Panic attack which can be precipitated by high levels of anxiety but only way to differenciate the three is to rule them out one after other.
As per your query about how to reduce pain.we can't reduce it unless we know the root cause of pain.Lamely advising you medicines doesn't makes any sense.
I strongly recommend you the following tests-
2D echo
Stress test
Upper g.i endoscopy to rule out peptic ulcers.
Once the tests results are there medicines can be started to reduce your pain.
Medicines that can be taken till time tests are done-
Antacid syrup 2tsf twice daily.
Tab Nexium 40 mg twice daily.
Advice
Follow up with reports.
Hope i answered your query well,In case you need more details i would be happy to help.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr. XXXXXXX XXXXXXX
Thank you for your detailed answer and breaking down the 3 possibilities of what it could be.
- I have just taken my blood pressure three times and the readings are:
SYS: 140 DIA: 96 PULSE: 60
SYS: 138 DIA: 99 PULSE: 63
SYS: 140 DIA: 98 PULSE: 59
Does this mean that is definitely, Cardio related? I do have a family history of heart disease.
I also must stress i'm extremely Gassy. I burp so much all day, so could it be that? or a mixture of both?
is there a difference between acid and gas?
Thank you for your detailed answer and breaking down the 3 possibilities of what it could be.
- I have just taken my blood pressure three times and the readings are:
SYS: 140 DIA: 96 PULSE: 60
SYS: 138 DIA: 99 PULSE: 63
SYS: 140 DIA: 98 PULSE: 59
Does this mean that is definitely, Cardio related? I do have a family history of heart disease.
I also must stress i'm extremely Gassy. I burp so much all day, so could it be that? or a mixture of both?
is there a difference between acid and gas?
Brief Answer:
Follow up answer.
Detailed Answer:
Hi dear,
Your blood pressure is in prehypertensive stage.Drastic life style modification should be followed to revert blood pressure to normal.
First and the foremost is try to change your smoking and drinking habits.Eat heathy food avoid all junks.
Incresed anxiety levels,Smoking,Binge alcoholism and strong family history are all risk factor of cardiac diseases.However just on the basis of history its not possible to give you the exact diagnosis.History can help in differentials but to reach a diagnosis atleast basic investigations are required.
Acid vasically used for gastritis and GERD. Reflux of acid back into food pipe irritates its mucosa and causes pain while gas is formed as a result of incomplete digestion of food.
It can be cardiac it can be gastric or it can be mixed.As expkained above i need results of investigation to give you a diagnosis.
Regards!
Follow up answer.
Detailed Answer:
Hi dear,
Your blood pressure is in prehypertensive stage.Drastic life style modification should be followed to revert blood pressure to normal.
First and the foremost is try to change your smoking and drinking habits.Eat heathy food avoid all junks.
Incresed anxiety levels,Smoking,Binge alcoholism and strong family history are all risk factor of cardiac diseases.However just on the basis of history its not possible to give you the exact diagnosis.History can help in differentials but to reach a diagnosis atleast basic investigations are required.
Acid vasically used for gastritis and GERD. Reflux of acid back into food pipe irritates its mucosa and causes pain while gas is formed as a result of incomplete digestion of food.
It can be cardiac it can be gastric or it can be mixed.As expkained above i need results of investigation to give you a diagnosis.
Regards!
Above answer was peer-reviewed by :
Dr. Raju A.T
Dr, I went to see my GP and I actually had a 2d Echo in July 2015. The results came back all clear. I asked for a Treadmill test, but the DR said because I play sports 4 times a week and don't feel the pain when I play, there would be no point taking this test, especially if the Echo has come back clear.
From the report:
Cardiac size appears normal. Hilar Shadow appears normal. Lungs appear clear. Costophrenic angles are clear. Visible rib cage appear intact. There is MILD SCOLIOSIS alone the upper dorsal spine. No other abnormality noted
The pain is still present and affects me on a daily basis.
From the report:
Cardiac size appears normal. Hilar Shadow appears normal. Lungs appear clear. Costophrenic angles are clear. Visible rib cage appear intact. There is MILD SCOLIOSIS alone the upper dorsal spine. No other abnormality noted
The pain is still present and affects me on a daily basis.
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
A pathetic reply on part of general physician.Stress test is done in accordance with a protocol developed by a scientist XXXXXXX You are required to run on a treadmill on a predefined speed with elevation of the tread mill increasing by 10 degree every 3 minutes along with change in speed. Stress test is designed to check ST-T changes in ecg during exercise and not to see if pain is there or not.
Almost 60% patients presenting with coronary artery disease never feel any pain in chest area. Classical angina is seen in less then 40% patients.
Secondly 2d echo is done when patient is at rest(lying on table) while stress test is done when you are running on treadmill.
Both these tests are equally important.
I don't think that when we have the tests and technology with us it's a good idea to assume that it's gastric and just wait and watch.
No doubts it can be gastric but what if it's cardiac?
Why not to go for test and make things clear?
Personally i don't believe in wait and watch policy. We should exclude all differentials to reach a diagnosis.
Regards.
Follow up answer.
Detailed Answer:
Hi again,
A pathetic reply on part of general physician.Stress test is done in accordance with a protocol developed by a scientist XXXXXXX You are required to run on a treadmill on a predefined speed with elevation of the tread mill increasing by 10 degree every 3 minutes along with change in speed. Stress test is designed to check ST-T changes in ecg during exercise and not to see if pain is there or not.
Almost 60% patients presenting with coronary artery disease never feel any pain in chest area. Classical angina is seen in less then 40% patients.
Secondly 2d echo is done when patient is at rest(lying on table) while stress test is done when you are running on treadmill.
Both these tests are equally important.
I don't think that when we have the tests and technology with us it's a good idea to assume that it's gastric and just wait and watch.
No doubts it can be gastric but what if it's cardiac?
Why not to go for test and make things clear?
Personally i don't believe in wait and watch policy. We should exclude all differentials to reach a diagnosis.
Regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I agree. I will get the Treadmill Test done too even if i have to pay for it.
Will come back to you when i have done this.
Will come back to you when i have done this.
Brief Answer:
Follow up advice
Detailed Answer:
Hi again,
Good luck once we are clear from cardiac side we can concentrate on gastric.
Regards.
Follow up advice
Detailed Answer:
Hi again,
Good luck once we are clear from cardiac side we can concentrate on gastric.
Regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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