- male
- 50 Years
- 20/02/2025
I've recently had a stress echo and it came back negative. Ten years ago, in 2011, I had an angiogram and it looked fine then too. In 2015, I went through a nuclear test, treadmill test, and some other checks, and they all turned out normal. Lately, Ive been having this dull pain in my neck that sometimes reaches up to my ear and jaw, and it also bothers my shoulder. My neck and upper back always feel stiff. My physiotherapist says my posture is pretty poor, mentions scoliosis, and thinks that might be causing this pain. I don't have issues when I'm walking and I can climb up to 12 floors without a problem but the neck and back pain, especially on the left side, really gets to me. Occasionally, I feel a sharp pain on the left side of my chest, but it fades away quickly. My chest is tender, and some spots are really sore to touch. Do you think it's safe to rule out any cardiac causes? Is there any other test I should consider doing?
Answered by 1 Apollo Doctors
Based on your history of negative stress echo, normal angio in 2011, and normal nuclear test and TMT in 2015, it is less likely that your current symptoms are related to cardiac issues. However, it is important to consider other potential causes for your neck, ear, jaw, shoulder, and chest pain. Given your description of neck stiffness and pain, along with the presence of scoliosis affecting your posture, it is possible that your symptoms are musculoskeletal in nature. To address your current symptoms, you may benefit from a muscle relaxant such as Cyclobenzaprine 10mg to help with the neck and back stiffness. Additionally, you can consider taking Ibuprofen 400mg for pain relief. Since you mentioned tenderness in your chest and certain points, it may be helpful to rule out any musculoskeletal chest wall pain. However, considering your history and current symptoms, further cardiac testing may not be necessary at this point. To improve your posture and alleviate the neck and back pain, regular physiotherapy sessions focusing on postural correction and strengthening exercises may be beneficial. It is important to continue working with your physiotherapist to address the underlying cause of your symptoms. If your symptoms persist or worsen, it is advisable to follow up with your healthcare provider for further evaluation and management.
Dr. Ranjith Suggests...
Consult a Cardiologist
Answered 04/07/2025
0
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View allI've recently come across my TMT results, which show a mildly positive reaction with horizontal ST depression up to 2mm in some leads, but it normalizes quickly in recovery. My echo came out normal, and I don't smoke, drink, or have any early CAD family history. My lipid profile reads LDL at 101, triglycerides at 139, HDL at 33, and a total of 157. I'm quite sedentary, and lately, I've noticed pinpoint pain and pressure in my chest, shoulders, and upper abdomen. It flares up intermittently during brisk walking and feels really localized. I've also been dealing with anxiety for the past four years, so I sometimes have breathing difficulties whether I'm resting or active. Is it possible to have CAD at this age without any obvious risk factors, or could this pain just be anxiety? I did have stress echo tests in the past, which were negative, just like a TMT back in 2016. Could you offer some insight?
Given your history of chest painpressure, especially with brisk walking, and the findings on your recent TMT showing mildly positive results with horizontal ST depression, it is important to consider the possibility of coronary artery disease (CAD) even in the absence of traditional risk factors. The fact that the ST depression normalizes within 15 seconds of recovery is somewhat reassuring, but further evaluation is warranted. Considering your symptoms and history of anxiety, it is also possible that the chest pain you are experiencing could be related to anxiety. However, it is crucial not to dismiss the possibility of CAD, especially with the new onset of localized chest pain and your TMT results. Given your overall profile and symptoms, I would recommend further evaluation by a cardiologist. They may consider additional tests such as a coronary angiogram to assess the extent of any possible blockages. In the meantime, it is important to continue monitoring your symptoms and seek medical attention if they worsen or become more frequent. In terms of medication, based on your lipid profile, a statin medication such as Atorvastatin (10-20mg) may be considered to help lower your LDL cholesterol levels and reduce the risk of CAD progression. Additionally, medications to manage anxiety such as Escitalopram (10mg) may be prescribed to help alleviate your symptoms. It is important to address both the cardiac and psychological aspects of your symptoms to ensure a comprehensive treatment approach.
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