Chest Pain and Arm Pain along with tingling.

Dear Ask The Doctor:  2 months ago I started having pain in my chest on the left side sometimes on my breast area and sometimes below it more on my rib cage. It also spreads to my left shoulder blade and down my left arm, sometimes to my right side of my chest as well. I thought I was going to have a heart attack so I visited the emergency room and they said it could be a chest wall strain. I followed up with a doctor and got a ultra sound of my heart done and they said it looked ok. Well a week ago I was still experiencing pain in my chest and feeling light headed along with tingling in my arms and jaw so I went to the Emergency room again. This time they said it was possibly anxiety related and it was all in my head and I might have stomach ulcers due to anxiety so they prescribed me with 25mg of Nortriptylin to take before I go to sleep each night. I have been taking it for a week and I don't seem stressed at all. I am still having pain around the left side of my chest and tingling in my arms and jaw. Sometimes its a sharp stinging pain and sometimes its a burning type of pain. When I go for a run it doesn't seem to bother me, only when im not actively doing anything or when im trying to sleep do I feel the pain. I'm 17 years old and not overweight. Please if you can provide any information it will be of great help.
 

Dear Patient:  It seems that your chest pain is non cardiac in origin ie it is not related to the heart. The other causes of chest pain may include chest wall muscular strain, herpes zooster of the chest wall, peptic ulcer disease, reflux problems. These are the most common other causes. You need to get checked up in detail to definately rule out cardiac disease which i see has been already done.However since you are getting arm pain too i would just advice you to get a stress test or stress echo done to definately rule out the possibility of cardiac involvement. You could talk to your physician about starting you on a proton pump inhibitor medication like pantolac which will help and improve the symptoms if it is due to a peptic ulcer or reflux disease. Anxiety can also cause similar chest pain. Please try the trial of the pantolac and also analyse the symptoms as to when during the day they occur. I hope this helps.

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