Women should not ignore chest pain

Dear Dr. Roach: I have been having pains and discomfort in my chest area for over a month now. I am a woman and in my early 30s. My doctor says my heart is OK. The pain is mostly in the right side of the chest but will stretch to the left and recently, I feel like the muscles in the left side of my chest are vibrating.

R.H.

Answer: Any kind of pain or discomfort in the chest should make a physician concerned about blockages in the coronary arteries. They can cause angina, a sensation of discomfort, usually on the left side of the chest, but sometimes in the inside of the left arm, the jaw, the back or the upper abdomen and are often (but not always) associated with shortness of breath, sweating and palpitations. These blockages may lead to a heart attack, where heart muscle cells die. Symptoms are highly variable one person to another.

Fortunately, coronary blockages are extremely rare in women in their 30s. That does NOT mean the symptoms should be ignored! Women unfortunately are more likely to have their angina symptoms written off by physicians, even though coronary artery disease remains the No. 1 cause of death in women.

A careful history, physical exam and often an EKG is adequate to be sure this is not heart disease.

Your doctor should then give you an alternative diagnosis. The most likely cause of chest discomfort in a 30-ish-year-old woman is within the muscles, bones and connective tissue of the chest. Inflammation of where the ribs and breastbone meet the cartilage (costochondritis) is one common cause. However, the sensation of vibration in the chest muscle makes me wonder about fasciculation of the pectoral muscles. Fasciculations arise from the junction of the muscle and nerve, and although they can occasionally represent serious neuromuscular disease, are far more likely to be benign.

All adult medical doctors need to be expert in the diagnosis of coronary artery disease. Determining a precise cause of musculoskeletal chest pain requires considerably different expertise. A physiatrist or rheumatologist has the most expertise in diagnosing musculoskeletal problems.