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To Your Good Health: Women shouldn't ignore chest pain or discomfort

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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, but I can't help but wonder. 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, and women are even more likely than men to have less typical symptoms.

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. Up to 70% of people will have spontaneous fasciculations, which can be in just one muscle (the eyelid is a common place) or widely spread. Relatively few cases are serious diseases.

All adult medical doctors — family physicians, internists and cardiologists especially — 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; however, these symptoms often go away by themselves, especially in young people.

DEAR DR. ROACH: Is it necessary to have a colonoscopy for acid reflux? — L.M.

ANSWER: A colonoscopy is not indicated as part of the workup for acid reflux. A screening colonoscopy IS recommended for anyone between the ages of 45 and 75, and if you haven't had one, your doctor may have wanted to do one at the same time.

The endoscopy typically done for acid reflux is called an esophagogastroduodenoscopy (EGD for short). A colonoscopy is a different type of endoscopy, since endoscopy just means "look inside." Sometimes the words used lead to confusion, such as when health care professionals recommend an "endoscopy," meaning colonoscopy, and the person expects an EGD. Physicians must be precise and explain ourselves better than we often do.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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