Tingling In Back And Chest. Done With EKG And Blood Work. Pain And Chest Tightness. Suggest The Treatment?

Posted on Sat, 26 Oct 2013

Question: I have had tingling in my back and chest for about three weeks now. My doctor did an EKG and blood work. Everything came back normal. She said it was stress related and sent me home for rest. I haven't been able to get much rest due to helping out with my newborn son and work. This past Friday I felt a pain in my chest and the pain stayed there for awhile, so I went to the E.R. They did a chest X-ray, blood work, and EKG. Everything came back normal and they told me to check with my primary. I am still having some pain and chest tightness, I'm worried about it. I'm only 32, and I don't drink or smoke. I try to maintain a physical lifestyle.

Answered by Dr. Jorge Brenes-Salazar (3 hours later)

Brief Answer:
Unlikely to be heart blockages

Detailed Answer:
Dear XXXXXXX

Thanks for your concerns. There are many causes of chest pain, and by your healthy clinical history and lifestyle I conclude that you dont have risk factors for heart disease, and given the atypical description of your ailments, it is HIGHLY unlikely that a heart issue is causing them. The doctors have done the right thing by ordering the basic tests, that is a chest xray and an EKG, which are normal. Then, there is a whole host of other causes of chest pain outside the heart: muscle and rib inflammation, esophageal pain, gastric pain, pain from lungs or skin itself... differential that can be addressed by your primary care to try to nail the specific origin of the atypical symptoms.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
Cardiology

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

Follow up: Dr. Jorge Brenes-Salazar (3 days later)

Since I talked to you last I set up an appointment with my primary. The night before I started to vomit and have diarrhea. She gave me some presciptions to help with the heart burn and upset stomach. I came home and rested and went back to work the next day. I have since then had shortness of breath, pain in my upper back,and constant pain in the upper abdominal. I have been looking up things online and now I am worried that it could be something related to the heart again cause of the chest tightness and back pain. I dont want to go back to the ER again, but I might have to if the pain does not stop. Could the Xray, EKG, and blood work being wrong? Do I have heart issues?

Answered by Dr. Jorge Brenes-Salazar (8 hours later)

Brief Answer:
Not impossible but unlikely

Detailed Answer:
Dear XXXXXXX

Thanks for the follow up. With the diarrhea and vomiting, it sounds like you have contracted an infectious gastroenteritis, and that could explain the upper abdominal pain and perhaps the back pain as referred pain. The shortness of breath indeed is unusual for gastroenteritis.

A reasonable step, to give you and your providers peace of mind, would be to obtain an echocardiogram, which is an ultrasound of the heart that tells you very accurately about the function of the heart itself and the valves. If it is stone cold normal, then paired up with the other normal results I would shy away from thinking about cardiovascular causes and explore other options (eg. reactive bronchial disease, GERD, etc).

Best regards

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

Follow up: Dr. Jorge Brenes-Salazar (5 hours later)

With the echocardiogram, can my general family physican order that or would I have a cardio doctor send me for that test? I have an appointment tomorrow at 9am, and would like the testing to be done tomorrow if possible.

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

Brief Answer:
Yes

Detailed Answer:
XXXX:

Your primary care physician is able to order the echocardiogram; it will come with a report from the cardiologist telling us if there are any abnormalities. If everything looks good, as I said, it would be quite reassuring.

Best regards

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

Follow up: Dr. Jorge Brenes-Salazar (39 hours later)

My primary said that since I have gone through the tests she believes there is no cincern for alarm with my heart. She did not want to send me for a test with no prior issues. She thinks its stress and a acid reflux issue. I am just worried still about the tingling. My family is also reassuring me that its all in my head. I'm not a doctor, so I should just trust mine since she has the schooling and knows the signs for heart issues correct?

Answered by Dr. Jorge Brenes-Salazar (32 minutes later)

Brief Answer:
Reasonable

Detailed Answer:
Dear XXXXXXX

If your primary believes that you are low cardiovascular risk (and thus no strong indication for the echo), then it may be reasonable to focus on the alternative explanations for your symptoms, and therefore these should be treated to assess response: the acid reflux with a proton pump inhibitor (PPI like omeprazole) and the stress ideally with a series of non-pharmacological techniques, including yoga, regular exercise, acupuncture, breathing exercises and so on.

Many times, after you undergo these therapeutic trials, the symptoms resolve and you confirm a non-cardiac origin of the symptoms.

Best regards

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

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