HomeCauseWhat Causes Chest Pain If Ecg Is Normal

What Causes Chest Pain If Ecg Is Normal

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Possible Causes Of Chest Pain

What causes chest pain with normal ECG report? – Dr. Anantharaman Ramakrishnan

Your chest includes the area on the front of your body, from your stomach to your shoulders. It contains lots of bones and muscles, and the two main organs in your chest are your heart and lungs.

A few common vascular conditions that may cause chest pain include:

Different conditions cause different types of pain, but you shouldnt try to self-diagnose your condition.

Normal Blood Test And Ecg

My name is Charmaine and I am 33 years old. I have been having symptoms on and off since October of last yr.

I have been having pains and burning in my face, pains on and off in my chest and dizziness. I have had all the routine blood work done and they all came back normal except my folate which was low. I have taken medication for this.

My chest pains were investigated and ruled as acid reflux again which i take medication for. However I have been dizzy all week and the pains in my chest are still present. My ECG came back normal.

I am so stressed over it and constantly checking Google for reasons to my symptoms. I have 5 children I am scared to not see grow up. I’m super scared there is something wrong with me my doctor can’t see . Help!

Thank you so much for your advice.

I have been seeing the same gp since october, she has suggested that it could all be anxiety related.

She has just recently refered me to neurology, but seems to think they will not see me as I am not presenting with enough symptoms to cause any concern.

I think, with having young children and other people relying on me, and using Dr Google I have made my anxiety about my health sky rocket. Now I think I have every condition under the sun.

It doesn’t help that I cant talk to my partner or family as they seem to think it’s all in my head.

Again thank you for your advice.

Hi I feel your pain,

I suffer bad with chest pains iv had ecg bloods stress test

How Do I Know If I Have Heart Problems Or Anxiety

The most accurate way to determine if you have anxiety or heart problems is to visit your doctor.Anxiety or Heart Problem: Signs and Symptoms Chest Pain. Difficulty Breathing or Shortness of Breath. Intense Feeling of Doom. Lightheadedness or Feeling Faint. Rapid Heartbeat. Weak or Tingling Feeling in Limbs.

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Making A Doctors Appointment For Chest Pain

If you notice mild-to-moderate chest pain without any other symptoms, schedule a cardiology appointment to have an exam. At NJ Cardiovascular Institute, we offer comprehensive diagnostic testing, including stress tests and echocardiograms, to identify any irregularities in your hearts function.

Regular doctors appointments are important, even if you arent bothered by chest pain. High blood pressure, high cholesterol, and heart disease are very common health issues that can cause heart problems – but they dont have noticeable warning signs.

Dr. Patel and our team want to make heart health part of our patients lives. Our Heart Smart Program makes it easy to implement healthy lifestyle changes and improve your heart health one step at a time.

Heart Attacks Aren’t Always Obvious

Dr. Smith

Not everyone experiences the “chest grabbing” drama shown on TV. Symptoms can be subtle and not overly painfuland women’s symptoms may differ from men’s.

All cardiac symptomsincluding chest tightness shortness of breath pain in the jaw, arm, or backneed to be taken seriously, even if you think you couldn’t possibly be having a heart attack. Sure, it might be embarrassing to take action and discover it was just indigestion or stress. But despite the cliché, nobody has ever died of embarrassment.

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How Is Noncardiac Chest Pain Diagnosed

If you experience chest pain that resembles cardiac chest pain, you should go to the emergency room. On arrival, you’ll receive a complete physical exam that measures all of your vital signs, including blood pressure and heart rate. Then youll be screened for heart attack or heart disease. Tests include an electrocardiogram a noninvasive test that records your hearts electrical activity and blood tests. Your heart releases certain proteins when a heart attack occurs that will show up in a blood test. Only when cardiac factors have been ruled out will you be diagnosed with noncardiac chest pain.

Once a cardiologist or your primary care provider has ruled out cardiac causes, youll likely be referred to a gastroenterologist next. Theyll test you for esophagus-based causes, starting with GERD. One way of testing is to send you home with a proton-pump inhibitor , a highly effective medicine for GERD. If the PPI relieves your symptoms, it can also confirm their cause. Other tests may include a PH study of the esophagus, an esophageal motility test, an upper endoscopy or ultrasound. In addition to physical tests, your healthcare provider will take a medical history and ask about your stress and emotional factors.

Can Chest Pain Be Caused By Stress

How anxiety causes chest pain. When youre anxious, your brain sends a surge of adrenaline and cortisol through your body. These hormones immediately trigger a rapid rise in your heart rate and blood pressure. As a result, many people experience chest pain and sweating, or have a hard time breathing.

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Can Blood Tests Show Heart Problems

Blood tests

When your heart muscle has been damaged, as in a heart attack, your body releases substances in your blood. Blood tests can measure the levels of these substances and show if, and how much of, your heart has been damaged. The most common test after a heart attack checks levels of troponin in your blood.

How Do You Rule Out Heart Chest Pain

The ECG in patients with chest pain: diagnostic picture tests (1 of 2)

Determining whether chest pain is anginal, atypical anginal, or nonanginal is recommended to help determine a patients cardiac risk. The Rouan decision rule is recommended to help predict which patients are at higher risk of MI. A Wells score of less than 2 plus a normal d-dimer assay should rule out PE.

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How The Test Is Performed

You will be asked to lie down. The health care provider will clean several areas on your arms, legs, and chest, and then will attach small patches called electrodes to those areas. It may be necessary to shave or clip some hair so the patches stick to the skin. The number of patches used may vary.

The patches are connected by wires to a machine that turns the heart’s electrical signals into wavy lines, which are often printed on paper. The doctor reviews the test results.

You will need to remain still during the procedure. The provider may also ask you to hold your breath for a few seconds as the test is being done.

It is important to be relaxed and warm during an ECG recording because any movement, including shivering, can alter the results.

Sometimes this test is done while you are exercising or under light stress to look for changes in the heart. This type of ECG is often called a stress test.

Seeking Emergency Care For Chest Pain In Children

Ravekes recommends going to the emergency department or calling 911 if your childs chest pain:

  • Gets worse over the course of a few hours
  • Happens during exercise or physical activity
  • Is accompanied by breathing problems
  • Is followed by fainting

Its also important to know your familys health history. If congenital heart conditions run in your family, or family members have died suddenly at a young age, monitor your childs heart health closely.

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Acute Pericarditis Can Be Missed

Oftentimes, lab tests, EKG, chest x-ray, echo are all normal, particularly very early in the course, says Dr. Sayeed.

The symptoms can be anywhere from mild and brief up to a day or two, to more severe and long-lasting up to several months.

The sharp stabbing pain may be in the middle of the chest and/or on the left side.

Of note, the pain isnt always of a piercing or stabbing nature. It may also be dull or aching.

In either case it may radiate to the left shoulder and even the neck. The discomfort, wherever it is located, may get worse when you inhale deeply, cough or lie down.

Other symptoms may be swelling in the stomach or a leg, weakness or fatigue, and shortness of breath which may be worse upon lying down.

If symptoms last longer than three months, the situation is considered chronic.

Noncardiac Chest Pain Is Defined As Recurrent Chest Pain That Is Indistinguishable From Ischemic Heart Pain After A Reasonable Workup Has Excluded A Cardiac Cause

A man with chest pain and a broad QRS complex tachycardia

Patients with NCCP may report squeezing or burning substernal chest pain, which may radiate to the back, neck, arms and jaws, and is indistinguishable from cardiac related chest pain. This is compounded by the fact that patients with history of coronary artery disease may also experience NCCP. Consequently, all NCCP patients should first undergo evaluation by a cardiologist to exclude cardiac angina.11,12 Differentiating on a clinical basis only between cardiac angina and NCCP has been shown to be a very difficult task.1 Furthermore, NCCP patients tend to report a higher rate of chest pain occurrence and greater pain intensity. They also more use commonly sensory and affective words than patients with ischemic heart disease.1 For the cardiologist, any two of the following clinical characteristics are suggestive of atypical cardiac angina and only one or none of these characteristics is indicative of NCCP: substernal chest discomfort, pressure or heaviness that lasts several minutes, pain induced by exertion, emotion, exposure to cold or a large meal and pain that is relieved by rest or nitroglycerine usually signify cardiac angina.3

We did not include frequency or severity of chest pain in our definition, because there is no clear spectrum or threshold of both clinical parameters in the literature. As a result, any attempt to limit the frequency and/or severity of chest pain may exclude many true sufferers with NCCP.

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Ecg Normal But Pain In Chest & Left Hand

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What Is Noncardiac Chest Pain

Noncardiac chest pain is defined as recurring pain in your chest typically, behind your breast bone and near your heart that is not related to your heart. In most people, noncardiac chest pain is actually related to a problem with their esophagus, most often gastroesophageal reflux disease . Stress, anxiety and depression can also manifest as chronic chest pain. Other conditions can cause short-term, acute chest pain, including lung problems and musculoskeletal injuries. But noncardiac chest pain is diagnosed as a chronic condition.

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Question : How Would The Decision Be Affected If Patient Had A Known Prior History Of Cad

Answer 6

For intermediate-risk patients with acute chest pain and known CAD, stress imaging is reasonable to guide decisions on optimizing medical management and/or need for coronary angiography and myocardial revascularization. Alternatively, CCTA can be useful to determine progression of atherosclerotic plaque and obstructive CAD.

Patients presenting with acute chest pain with known prior CAD, who fall under intermediate risk based on the described CDP do not need hospital admission as default. If they have a known nonobstructive CAD, with < 50% stenosis, CCTA may be performed in the ED and, if no change from prior known coronary artery anatomy, can be safely discharged from the ED. If obstructive CAD is found or extensive plaque burden noted, functional stress imaging, FFR-CT, or invasive angiography may be performed. With known obstructive CAD, CCTA may not be beneficial and functional stress imaging is indicated.

Question : Does This Patient Need Further Testing

Chest pain: how to distinguish between cardiac and noncardiac causes

Answer 4

This individual does not need additional testing beyond ECG and hs-cTn in the ED and does not need admission. For patients with acute or stable chest pain who are determined to be at low risk, urgent diagnostic testing for suspected coronary artery disease is not indicated.

The patient has risk factors that need further follow-up care with a primary care physician. Therefore, establishing good out-patient care and blood pressure monitoring will be of benefit. Furthermore, education and discussion about smoking cessation is important. However, at this point, offering any type of additional cardiac testing is of little utility and would increase economic burden on the patient and the healthcare system. Discussion of low probability of MACE at 30 day should be done with the patient along with importance of risk factor modification and primary prevention strategies.

Pretest probability of having obstructive coronary artery disease is based on age, sex, and symptoms. If coronary artery calcium score is available, it may be used to estimate pretest probability of obstructive coronary artery disease based on the coronary artery calcium score .

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Chest Pain And A Normal Ecg


What is your interpretation?
Both formulas predict LAD occlusion, even with the most conservative values for STE 60 V3 used.

Side note: contemporary troponin drawn 1 hour after acute LAD occlusion should usually be negative, unless the event has been going on longer than the patients symptoms. The assay at my institution, for example, is frequently negative until 4-6 hours after acute coronary occlusion.

Not much change. Maybe even improvement in the reciprocal changes in the inferior leads.
No caption needed!
Although this is often erroneously called “Torsades ,” it is really ventricular fibrillation. It should have been shocked at least 10 seconds ago.
Bradycardic escape/agonal rhythm, with large ST deviations. Beats 4, 6, and 7 are narrow, as the rhythm is trying to resume from above the ventricles.
Obvious anterolateral wall STEMI.
There are also hyperacute T-waves.Smith likes to say: “Hyperacute T-waves occur ‘on the way up,’ and ‘on the way down.'”This means that they occur shortly after onset of occlusion, but also may be the last remaining sign of ischemia after ST elevation resolves .
T-waves less hyperacute, though ST elevation remains
There is large anterolateral STE with hyperacute T-waves, and reciprocal STD in III. This is diagnostic of re-occlusion. This ECG cannot be present 7 days after a single persistent acute occlusion.

Can Ecg Detect Angina

Diagnosing angina

Your doctor can suspect a diagnosis of angina based on your description of your symptoms, when they appear and your risk factors for coronary artery disease. Your doctor will likely first do an electrocardiogram to help determine what additional testing is needed to confirm the diagnosis.

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Chest Pain That Isnt Caused By A Heart Attack

You feel a pain in your chest and left arm. You immediately start worrying that you’re having a heart attack. At what point do chest pains equal a heart attack? Emergency room physician Dr. Troy Madsen shares what chest pains can mean. He also discusses the symptoms and feelings of a heart attack versus “regular” chest pain.



Chest Pain In Children: Is It A Heart Condition

A man with chest pain and a broad QRS complex tachycardia

Chest pain tends to be associated with heart attack or other acute heart conditions in adults. But what about chest pain in children? Parents should know that childhood chest pain is actually a fairly common complaint and its rarely an indication of a heart condition.

“Only about 1% to 4% of chest pain in children will be cardiac. The vast majority95% or moreisnt related to a heart issue, explains William Ravekes, M.D., Medical Director of Pediatric Heart Transplant at Johns Hopkins Childrens Center.

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What Disease Can Ecg Diagnose

When an ECG is used

An ECG can help detect: arrhythmias where the heart beats too slowly, too quickly, or irregularly. coronary heart disease where the hearts blood supply is blocked or interrupted by a build-up of fatty substances. heart attacks where the supply of blood to the heart is suddenly blocked.

Here’s A Rundown Of The Likely Chain Of Events After You Call 911

For a suspected heart attack, paramedics can often perform initial testing in the ambulance while the patient is en route to the hospital. Image: Thinkstock

Every 43 seconds, someone in the United States has a heart attack. If one day that someone is you or a loved one, it may be helpful to know what’s likely to happen, both en route to the hospital and after you arrive.

For starters, always call 911 to be transported via ambulance rather than going by car. Contrary to what you might assume, speed isn’t the only rationale. “If you’re having a heart attack, there are two reasons why you want to be in an ambulance,” says Dr. Joshua Kosowsky, assistant professor of emergency medicine at Harvard Medical School. One is that in the unlikely event of cardiac arrest, the ambulance has the equipment and trained personnel to restart your heart. Cardiac arrest, which results from an electrical malfunction that stops the heart’s pumping ability, is fatal without prompt treatment. However, most heart attacks do not cause cardiac arrest, Dr. Kosowsky stresses. “It’s rare, but it’s certainly not a risk you want to take while you’re driving or riding in a car.”

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