Exhaustion, Chest Pain, Shoulder Pain. Clean EKG, Good BP. Is It Anxiety?

Posted on Thu, 4 Oct 2012

Question: I have extreme exhaustion for the past month. Two weeks ago chest pain woke me from my sleep. Last night my left shoulder ached all night. Pain was gone in morning. I have had two clean EKGs, good BP and cholesterol. 42 years old. My anxiety. I would be fine with that but I want to know for sure. What should I do?

Answered by Dr. Anil Grover (2 hours later)

Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist.
I read your mail with diligence.
Probably the pain was not cardiac if EKG was normal and I am sure the doctor would have done some blood test to exclude heart attack.
Considering your age and the family history, you ought to consult a cardiologist and find out your risk profile for coronary artery disease. Thereafter, a test like Tread Mill Test (should your cardiologist feel it necessary) can be a next logical step. On the whole it is good idea not to ignore symptoms like chest pain and be judgmental in labeling these "anxiety".
At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-

A: MODIFIABLE RISK FACTORS
Diabetes +/-
Hypertension+/-
Smoking+/-
Stress+/-
Obesity and Sedentary Life Style+/-
High Bad Cholesterol and Lipid Component +/-
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
B: NON MODIFIABLE RISK FACTORS
Family History of Coronary Heart Disease*
Increasing age*
Being a Man (as opposed to women) till the age 45*

If you have a follow up query, I will be most happy to answer.
Regards
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anil Grover (14 minutes later)

My chest pains have lasted 15 years now. I have also had irregular heartbeats for the same period of time. Last year I had a run of three months straight of PVCs and they were captured on an EKG at the time. Again my primary physician said they were harmless. Well they did. It seem harmless. My exhaustion is really bad last month like I need to sleep immediately when it hits. All those are, as you know, cardiac warning signs. But again my primary tells me they are anxiety. I just want to m is for sure. So what does all this sound like in your expert opinion?

Answered by Dr. Anil Grover (3 hours later)

Thanks for writing back.

Chest pains are not related to heart.
PVCs (if echocardiography shows normal structure and function of heart) can be benign or harmless as your doctor puts it. Holter that is 24 hour ambulatory ECG recording and correlation with your symptoms is an absolute must.

Both of these problems are harmless does not make the diagnosis of anxiety.

You have family history of heart disease and you are well advised to consult a cardiologist, you may not need any treatment. Secondly, TMT may show that PVCs decrease with exercise or otherwise. A Holter examination might be necessary. Therefore it is premature to reach conclusions on basis of, agreed a thorough physical examination your primary physician has done and read EKG accurately.
Regards
With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anil Grover (8 hours later)

Thank you Dr. XXXXXXX I have uploaded a picture of my latest resting EKG to my file. It shows no PVCs, as I was not having them for the few moments the EKG was reading me.

I will take your advice and see a cardiologist for a TMT. Because I have chest pain everyday it is worrisome. The shoulder pain I had was very dull and painful. Sometimes the chest pain will leave me sore in the morning and it also spreads to the back. I also get dizzy sometimes and a few years ago I fainted when standing up while having a PVC episode.

At one point, I was diagnosed with MVP. It is all very confusing. Please understand this.

My follow-up question to you is, have you seen all these symptoms happen in the same person before and if so what did it turn out to be?

Answered by Dr. Anil Grover (5 hours later)

Hi there,
Thanks for writing back.
Regarding PVCs (with echocardiography showing normal structure and Function) : human heart beats for about 72x60x24 approx 100,000 times a day about 1% PVCs are normal. If your EKG is fortuitously recorded while you are having PVCs it becomes source of concern.

mitral regurgitation is not a disease so your worry there is misplaced. I see not a cause for even concern there. It is reporting technician's problem unless echocardiographer is a specialist him/her self.

Heart is encapsulated in two lungs which are in bony cage surrounded by muscle nerves and then skin. Others can be source of pain for example you could be having cervical spondylosis, with similar pain. Hard bed no pillow, neck exercises and proper posture is the solution after x-ray or scan of cervical region has proven the anomaly. Your shoulder pain story makes me believe that it is musculoskeltal pain. It is definitely not related to heart. I have seen your uploaded EKG I do not find any problem there.

Therefore, none of your symptoms has probably related to heart so why not see a sub specialist and move on with life?

I appreciate your writing to me. Good luck.

Dr Anil Grover

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar