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Are Left-sided Shoulder Blade Pain And Dizziness Signs Of Heart Attack?
Question: If you answer questions on here frequently, you may have already answered a simliar question from me, but these symptoms keep coming back and I always feel like I should run to the ER. For a few months, I have been having left side pain (from near my shoulder blade that also goes down my arm into my pinky). I have had ECgs, blood work, chest xrays and finally a CT angiogram that was normal. As I mentioned, I am tempted to go back to the ER every time this happens because i think this might actually be a heart attack. I am so frustrated. I have been feeling somewhat normal and am back to my regular daily workouts (which are fine) but my back always feels very tight after I am done working out and it takes me a while to catch my breath. I came to work this morning and have been feeling dizzy at times and my left pinky and back feel tight again (the way they have in the past) and i feel like i am breathing harder than usual. I ran 5 miles (interval training) at lunch time and when I got back, my whole back felt tight when I used the foam roller, it popped in numerous places and feels "knotty". I have had testing done both in the ER and by a very good cardiologist (including a CT angiogram, ecgs, and bloodwork). I have had panic attacks but i can't help to fear that this is a real heart issue. Should i go to the ER? Could this be the time it is actually something despite over 5 visits in the past 3/4 months?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that your symptoms are not cardiac related.
All your performed tests have excluded any possible cardiac cause, including coronary artery disease.
There is no need to go to the ER, because all your tests will result normal. There is no serious cause underlying this symptomatology.
All your troubles seem to be related to anxiety.
You should just close your eyes, try not to think about it and take a deep breath. It will help.
Coming to this point, there is no need to repeat cardiac tests, because I can assure you that they will result normal.
The only thing that you should focus is your anxiety. I would recommend consulting with a specialist of this field to discuss the proper treatment options (an antidepressant would be helpful).
I would also recommend continuing your daily physical activity, practise Yoga and recreational sports, which are really helpful in the management of anxiety.
Meanwhile, I would recommend taking alprazolam 0.25mg 1or2 tablets. If your symptoms are relieved (chest and shoulder tightness), this would be another fact that would confirm anxiety as the main cause of your symptoms.
I would be happy to review your performed cardiac tests if you will upload them for another second professional opinion.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that your symptoms are not cardiac related.
All your performed tests have excluded any possible cardiac cause, including coronary artery disease.
There is no need to go to the ER, because all your tests will result normal. There is no serious cause underlying this symptomatology.
All your troubles seem to be related to anxiety.
You should just close your eyes, try not to think about it and take a deep breath. It will help.
Coming to this point, there is no need to repeat cardiac tests, because I can assure you that they will result normal.
The only thing that you should focus is your anxiety. I would recommend consulting with a specialist of this field to discuss the proper treatment options (an antidepressant would be helpful).
I would also recommend continuing your daily physical activity, practise Yoga and recreational sports, which are really helpful in the management of anxiety.
Meanwhile, I would recommend taking alprazolam 0.25mg 1or2 tablets. If your symptoms are relieved (chest and shoulder tightness), this would be another fact that would confirm anxiety as the main cause of your symptoms.
I would be happy to review your performed cardiac tests if you will upload them for another second professional opinion.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi. I feel like you have become my personal doctor.
I have an additional question. I have read a lot about my CT angiogram and it is my understanding that it finds plaque - and plaque that breaks off is what causes heart attacks. I was also reading that heart attacks can also be caused when the arteries contract or something. Could this
I didn't mean to submit yet. would this be found using this test as well?
I have an additional question. I have read a lot about my CT angiogram and it is my understanding that it finds plaque - and plaque that breaks off is what causes heart attacks. I was also reading that heart attacks can also be caused when the arteries contract or something. Could this
I didn't mean to submit yet. would this be found using this test as well?
Brief Answer:
You do not suffer from this disorder.
Detailed Answer:
Hello again!
I understand your concern and would explain something about this type of angina:
This is a specific situation called Prinzmetal or variant angina.
Unlike patients with typical angina, these patients characteristically have normal exercise tolerance, and their pain patterns tend to be cyclical, with most episodes occurring in the early morning hours without regard to cardiac workload.
The age at which symptoms first appear is highly variable, but on average, patients are in their 50s at symptom onset, and it is more frequent in women in menopause.
The diagnosis is made based on the typical symptomatology and changes in ECG. ( But this is not your case, because all your repeated ECG have excluded angina and you have not typical characteristics of angina pain).
CT angiogramm is not the test of choice for the diagnosis of this disorder. But it can be diagnosed with repeated ECG, coronary angiography and provocative testing with ergonovine maleate, which induces vasospasm.
Anyway, I would not recommend performing any of these tests, because all your ECG have resulted normal and your symptoms are not compatible with this disorder.
So relax and do not think about it any more!
Hope to have clarified some of your uncertainties!
Regards,
Dr. Iliri
You do not suffer from this disorder.
Detailed Answer:
Hello again!
I understand your concern and would explain something about this type of angina:
This is a specific situation called Prinzmetal or variant angina.
Unlike patients with typical angina, these patients characteristically have normal exercise tolerance, and their pain patterns tend to be cyclical, with most episodes occurring in the early morning hours without regard to cardiac workload.
The age at which symptoms first appear is highly variable, but on average, patients are in their 50s at symptom onset, and it is more frequent in women in menopause.
The diagnosis is made based on the typical symptomatology and changes in ECG. ( But this is not your case, because all your repeated ECG have excluded angina and you have not typical characteristics of angina pain).
CT angiogramm is not the test of choice for the diagnosis of this disorder. But it can be diagnosed with repeated ECG, coronary angiography and provocative testing with ergonovine maleate, which induces vasospasm.
Anyway, I would not recommend performing any of these tests, because all your ECG have resulted normal and your symptoms are not compatible with this disorder.
So relax and do not think about it any more!
Hope to have clarified some of your uncertainties!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. I have some Xanex. I am just worried (of course) of becoming dependent on it. I have taken ativan a couple of times and it seems to make me feel somewhat normal .
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
I understand your concern and would not recommend taking it for a prolonged time (more than a month).
In such cases, when anxiety is the main cause of your symptoms, you should discuss with a psychiatrist on other long term therapies like antidepressants, which can be taken for a long time, in order to help you manage anxiety.
Alprazolam should be used only as a short term therapy, because it can cause dependence and tolerance (that the same dose will have no effect later).
So you should discuss with a specialist of the field on the proper treatment options.
Hope you will find this answer helpful!
Greetings,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
I understand your concern and would not recommend taking it for a prolonged time (more than a month).
In such cases, when anxiety is the main cause of your symptoms, you should discuss with a psychiatrist on other long term therapies like antidepressants, which can be taken for a long time, in order to help you manage anxiety.
Alprazolam should be used only as a short term therapy, because it can cause dependence and tolerance (that the same dose will have no effect later).
So you should discuss with a specialist of the field on the proper treatment options.
Hope you will find this answer helpful!
Greetings,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I felt fine all day Saturday. I went to work out on Sunday morning and ever since my upper back is sore and feels "knotty" again. This is the last question for now, but if this was a heart issue would the pain occur after the workout? I find it odd that i am typically fine until after my workouts .
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
I would explain that pain related to myocardial ischemia is typically exacerbated by physical activity and the chest pain is proportional to the exertion degree. So the more straining physical activity, leads to a more expressed chest pain. Stopping of physical activity, leads to chest pain relief.
So, you can see that your symptoms are not related to a myocardial ischemia, as they are not typical of this disorder.
I would also recommend performing a cervico-thoracic column X ray study to exclude a back bone disorder, which could lead to a similar symptomatology.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
I would explain that pain related to myocardial ischemia is typically exacerbated by physical activity and the chest pain is proportional to the exertion degree. So the more straining physical activity, leads to a more expressed chest pain. Stopping of physical activity, leads to chest pain relief.
So, you can see that your symptoms are not related to a myocardial ischemia, as they are not typical of this disorder.
I would also recommend performing a cervico-thoracic column X ray study to exclude a back bone disorder, which could lead to a similar symptomatology.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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