Heart & Cardiology/Left arm pain


QUESTION: Hello Dr. David,

I have recently experience left arm pain that make me worry as soon as it trigger.... it come and go with intervals vary from seconds to several minutes. I have no other symptoms.

I have notice that the pain come while i am at rest and my heart rate approx 60 PPM. I have done small test to see if this pain is related to threat where i have walk my bldg stairs (5 floor bldg) and my heart rate went to 150 PPM and i did not develop any other symptoms and the arm pain did not get worst.
My questions:
1- is the left arm pain only related to heart issue like CAD.
2- In the case the pain is related to heart problem, does it get worse when my threat rate goes up.
3- how to tell if the left are pain i have is related to heart issue.
4- Does heart related symptoms get better or worse when the heart rate goes up.
5- If some one has a left are pain that is not related to exercise, i.e. come when heart rate is 50 and doesn't get worse when heart rate goes to 150 ppm, can this r/o heart problem.



ANSWER: Hello Saed,

1 - Very unlikely
2 - Yes.
3 - If  pain gets worse with exercise.
4 - Worse.
5 - Very unlikely.

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QUESTION: Thanks dr.
I have preformed heart test (Heart Echo/ Doppler - Stress test monitored by ECG) about 2 years back and all come back normal.
1- Does these test r/o heart structure disease like CAD?
2- Shall i re do them now or when do you recommend me to re do them.
3- Are these test accuret in detecting heart issues. IF not, why doctors still request them

I would also as you to be kind and have a look at these tests sum and let me know your feedback as a heart expert in the most advanced country in this field. Thx

1. No a stress test monitored by EKG is not very sensitive and can miss CAD
2. Since you have that arm pain, maybe get a stress test monitored by echo or radioisotopes
3. Echo very accurate in seeing heart structure and function at rest.  Stress test useful in seeing how much exercise you can tolerate, and about 50% accurate about CAD.

I can't add anything to the reports you already have about echo and stress test by looking at the reports.

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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