Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Pain Under The Left Chest?
Question: Hi
i already did stress test and ECHO , was normal. do i need to do CT Angio. i feel pressure some times under the chest in left side of the lung . i am concern if i do CT Angio because i already exposed to to 35 radiation when i did stress text, x ray, two time radiology and all were normal. and if i do this test it will be 45 mvs radiation. i mean if i have problem in the heart i couldn't ride stair or do sport, because i see the pain now become under the chest . the hospital told me they will call me to schedule an appointment but i am not sure if i cancel
i already did stress test and ECHO , was normal. do i need to do CT Angio. i feel pressure some times under the chest in left side of the lung . i am concern if i do CT Angio because i already exposed to to 35 radiation when i did stress text, x ray, two time radiology and all were normal. and if i do this test it will be 45 mvs radiation. i mean if i have problem in the heart i couldn't ride stair or do sport, because i see the pain now become under the chest . the hospital told me they will call me to schedule an appointment but i am not sure if i cancel
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
Regarding your concern, I would explain that as you have a normal cardiac ultrasound and a normal nuclear perfusional cardiac stress test, there is no any need to perform a coronary angio CT.
As your clinical symptomatology is non specific for coronary artery disease (the pain is more pronounced at rest than during physical exertion, it has a migrating nature), and your nuclear stress test has resulted normal, the probability for the pain to be due to cardiac ischemia is quite unlikely.
Furthermore, you are right about the cumulative radiation exposure. Coronary angio CT uses a high resolution imagine and hence a very dense multi-slice scanning.
This means that radiation is considerable and could not be justified considering the fact that you have not an intermediate pretest probability for coronary artery disease (which is in fact the ideal situation for undergoing coronary angio CT).
In my personal professional opinion, coronary angio CT would not be the suitable medical test for evaluating the nature of your chest pain, which seems in fact to be of extra-cardiac origin.
Hope you will find this answer helpful!
In case of any further uncertainties, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
Regarding your concern, I would explain that as you have a normal cardiac ultrasound and a normal nuclear perfusional cardiac stress test, there is no any need to perform a coronary angio CT.
As your clinical symptomatology is non specific for coronary artery disease (the pain is more pronounced at rest than during physical exertion, it has a migrating nature), and your nuclear stress test has resulted normal, the probability for the pain to be due to cardiac ischemia is quite unlikely.
Furthermore, you are right about the cumulative radiation exposure. Coronary angio CT uses a high resolution imagine and hence a very dense multi-slice scanning.
This means that radiation is considerable and could not be justified considering the fact that you have not an intermediate pretest probability for coronary artery disease (which is in fact the ideal situation for undergoing coronary angio CT).
In my personal professional opinion, coronary angio CT would not be the suitable medical test for evaluating the nature of your chest pain, which seems in fact to be of extra-cardiac origin.
Hope you will find this answer helpful!
In case of any further uncertainties, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much
Do you recommend me not to do coronary angio CT . And what should i do for this discomfort . do i just ignore it. when i go to the general doctor he said there is no much i can do and he sent me to cardiology and cardiology want do more test with angio CT without justifying like you mention and this concern me with exposing to radiation even though i went to ER already 4 times and every time they said EKG is normal and they did many tests include radiology 2 times, x ray for chest, blood test and they mention also about anxiety . the general doctor said we want make sure the heart is fine first than we see if you have anxiety and he sent me to cardiology now , he gave me propranolol 20 mg and it help when i need it and ativan 0.5 mg help too . i also take baby aspirin 81 mg and amaldopine 5mg and i have little high blood pressure, please let me know what should i do
Do you recommend me not to do coronary angio CT . And what should i do for this discomfort . do i just ignore it. when i go to the general doctor he said there is no much i can do and he sent me to cardiology and cardiology want do more test with angio CT without justifying like you mention and this concern me with exposing to radiation even though i went to ER already 4 times and every time they said EKG is normal and they did many tests include radiology 2 times, x ray for chest, blood test and they mention also about anxiety . the general doctor said we want make sure the heart is fine first than we see if you have anxiety and he sent me to cardiology now , he gave me propranolol 20 mg and it help when i need it and ativan 0.5 mg help too . i also take baby aspirin 81 mg and amaldopine 5mg and i have little high blood pressure, please let me know what should i do
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
As I explained you before your chest discomfort doesn’t seem to be cardiac related.
In such case coronary angio CT is not considered a firm indication.
It may add beneficial information in regard of other potential structures involved in the pathophysiology of pain (chest CT may reveal other extracardiac disorders responsible for your current complaints (such as a backbone disorder, a hiatal hernia, a chronic pleural inflammation, an articular disorder,etc.).
But, it is not justified for concluding a coronary artery disease, as long as you don’t have other medical evidence (the performed cardiac tests has resulted normal) and coronary risk factors that raise sufficient suspicions about any cardiac issues.
So, my personal opinion would not go in favor of a coronary angio CT.
Regarding the differential diagnosis of several extra-cardiac causes that may be involved in your recent chest discomfort, I would recommend discussing with your doctor on the possibility of performing a chest MRI, which doesn’t utilize X ray imagine, so it does not produce harmful radiation.
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
As I explained you before your chest discomfort doesn’t seem to be cardiac related.
In such case coronary angio CT is not considered a firm indication.
It may add beneficial information in regard of other potential structures involved in the pathophysiology of pain (chest CT may reveal other extracardiac disorders responsible for your current complaints (such as a backbone disorder, a hiatal hernia, a chronic pleural inflammation, an articular disorder,etc.).
But, it is not justified for concluding a coronary artery disease, as long as you don’t have other medical evidence (the performed cardiac tests has resulted normal) and coronary risk factors that raise sufficient suspicions about any cardiac issues.
So, my personal opinion would not go in favor of a coronary angio CT.
Regarding the differential diagnosis of several extra-cardiac causes that may be involved in your recent chest discomfort, I would recommend discussing with your doctor on the possibility of performing a chest MRI, which doesn’t utilize X ray imagine, so it does not produce harmful radiation.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
But i already did radiology in ER similar to CT for the chest while they put me on the machine and hold breathing and they said is normal and i also did chest x ray
But i already did radiology in ER similar to CT for the chest while they put me on the machine and hold breathing and they said is normal and i also did chest x ray
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Coming to this point, as an extra-cardiac cause has been excluded by the chest CT scan you have nothing to worry about.
The chest pain is probably related to a musculo-skeletal pain or gastro-esophageal reflux.
I would just recommend trying an antiacid. If it helps, it would indicate possible gastro-esophageal reflux.
Is the chest pain is triggered by deep breathing or body movements, I would recommend trying ibuprofen. If it relieves the pain, it would be indicative of musculo-skeletal pain as the main cause of chest pain.
But, I would not recommend performing a coronary angio CT scan, because of radiation and because your symptoms are not suggestive of a cardiac ischemia.
I would just recommend monitoring your blood pressure. High blood pressure can also mimic this clinical scenario.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Coming to this point, as an extra-cardiac cause has been excluded by the chest CT scan you have nothing to worry about.
The chest pain is probably related to a musculo-skeletal pain or gastro-esophageal reflux.
I would just recommend trying an antiacid. If it helps, it would indicate possible gastro-esophageal reflux.
Is the chest pain is triggered by deep breathing or body movements, I would recommend trying ibuprofen. If it relieves the pain, it would be indicative of musculo-skeletal pain as the main cause of chest pain.
But, I would not recommend performing a coronary angio CT scan, because of radiation and because your symptoms are not suggestive of a cardiac ischemia.
I would just recommend monitoring your blood pressure. High blood pressure can also mimic this clinical scenario.
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
the doctor already gave me Omeprazole 20 mg but doesn't seem help so far. but the cardiology told me if i do coronary angio CT scan and result is normal my heart is fine. if i do coronary angio CT scan is the radiation going to hurt me because i did many previous tests and i am concern about the radiation?
because i want make sure my heart is fine because the doctors so far didn't know why i have the discomfort.
because if the pain won't from the heart, i won't worry about it
and also the cardiology didn't confirm yet the pain is not from the heart that's why i am concern and want to do the CT test
.And this would be last test but i am worry about the radiation .
the doctor already gave me Omeprazole 20 mg but doesn't seem help so far. but the cardiology told me if i do coronary angio CT scan and result is normal my heart is fine. if i do coronary angio CT scan is the radiation going to hurt me because i did many previous tests and i am concern about the radiation?
because i want make sure my heart is fine because the doctors so far didn't know why i have the discomfort.
because if the pain won't from the heart, i won't worry about it
and also the cardiology didn't confirm yet the pain is not from the heart that's why i am concern and want to do the CT test
.And this would be last test but i am worry about the radiation .
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again,
I could not have any objection regarding your attending cardiologist’s recommendation, as he know more closely your clinical file.
Now, returning to your main point of concern: radiation risks from a coronary angio CT I would like to explain that an amount of radiation is inevitable.
But, you should know that radiation exposure has cumulative effects.
So the total radiation effects will depend on the number of medical tests (utilizing radiation) over a certain period of time.
Let me give some examples:
- A radionuclide cardiac stress test involves on average a radiation in the range of 8-16 mSv,
- A coronary angio CT involves on average a radiation in the range of 8-22 mSv,
- An invasive coronary angiography exposes the patent on a radiation in the range of 5-13 mSv
So, as you see coronary angio CT has a slightly higher radiation compared to the other two tests.
The radiation exposed by this test is equal to the radiation that an individual may encounter on average during five years of life.
So, if you decide to undergo coronary angio CT you should be careful to avoid radiation exposure for a few years thereafter.
That’s my opinion.
Hope to have clarified your uncertainties!
In case of any further questions do not hesitate to ask me again.
Regards,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again,
I could not have any objection regarding your attending cardiologist’s recommendation, as he know more closely your clinical file.
Now, returning to your main point of concern: radiation risks from a coronary angio CT I would like to explain that an amount of radiation is inevitable.
But, you should know that radiation exposure has cumulative effects.
So the total radiation effects will depend on the number of medical tests (utilizing radiation) over a certain period of time.
Let me give some examples:
- A radionuclide cardiac stress test involves on average a radiation in the range of 8-16 mSv,
- A coronary angio CT involves on average a radiation in the range of 8-22 mSv,
- An invasive coronary angiography exposes the patent on a radiation in the range of 5-13 mSv
So, as you see coronary angio CT has a slightly higher radiation compared to the other two tests.
The radiation exposed by this test is equal to the radiation that an individual may encounter on average during five years of life.
So, if you decide to undergo coronary angio CT you should be careful to avoid radiation exposure for a few years thereafter.
That’s my opinion.
Hope to have clarified your uncertainties!
In case of any further questions do not hesitate to ask me again.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks you
i already exposed radiation from previous test stress test, and radiology 2 times. is it safe if i do coronary angio CT test ?
i just want make sure my heart is right because the doctor didn't confirmed this.And i went to ER like 4 times before, so if the pain not from my heart i won't go ER any more. the cardiology also come to the room and go out less than 5 minute.And he seems doesn't care about patients. even if i have questions i can't ask him. before few month i tried left heavy thing, and i had short of breathing and tired and sit for 5 minute than breathing become normal. than didn't happened again. is that from the heart?
i already exposed radiation from previous test stress test, and radiology 2 times. is it safe if i do coronary angio CT test ?
i just want make sure my heart is right because the doctor didn't confirmed this.And i went to ER like 4 times before, so if the pain not from my heart i won't go ER any more. the cardiology also come to the room and go out less than 5 minute.And he seems doesn't care about patients. even if i have questions i can't ask him. before few month i tried left heavy thing, and i had short of breathing and tired and sit for 5 minute than breathing become normal. than didn't happened again. is that from the heart?
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Coming to this point, as all your previous cardiac tests have resulted normal and your symptoms are not typical of a cardiac disorder, I would not recommend performing coronary angio CT scan, because it would be just another dose of unnecessary radiation.
As your chest CT scan has resulted normal, other extra-cardiac causes have been excluded too.
So, in my opinion it is just anxiety or a musculo-skeletal pain. In my opinion your symptoms are not related to any cardiac disorders.
I would not recommend performing a coronary angio CT scan, because I find it unnecessary in your clinical situation.
Just try to relax and do not worry about !
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Coming to this point, as all your previous cardiac tests have resulted normal and your symptoms are not typical of a cardiac disorder, I would not recommend performing coronary angio CT scan, because it would be just another dose of unnecessary radiation.
As your chest CT scan has resulted normal, other extra-cardiac causes have been excluded too.
So, in my opinion it is just anxiety or a musculo-skeletal pain. In my opinion your symptoms are not related to any cardiac disorders.
I would not recommend performing a coronary angio CT scan, because I find it unnecessary in your clinical situation.
Just try to relax and do not worry about !
Hope to have been helpful!
Wishing all the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
