Spinal cord is a busy neurological highway to brain .It runs 24/7 non stop with unlimited horizontal and vertical lanes .It is such a compact structure , it can easily get confounded when multiple signals converge, diverge, summate , deduct , reflect back, or cancel out .
A 64 year old women came to me for second opinion regarding chest pain . A cardiologist had just adviced her an emergency coronary angiogram and also suggested she may require an urgent PCI as well .
I listened to her history in my office . . . In her own words .
Doctor , I am getting sudden compressing type of pain which starts in the centre of the chest and soon transmits to the left shoulder and gradually reach the inner aspect of the hand up to the little finger . And occasionally it is very severe and some times i feel like sweating as well ! I am unable to predict when it comes doctor !
It was so convincing but one feature was not fitting In . She said , she used to walk daily and do all house hold work with no pain . She also recalled about the acid peptic disease , and neck pain periodically due to cervical spine problem.
Her resting ECG was normal .She was afraid to do a stress test . After thinking for a minute , I had no other option but to endorse my colleague’s view and asked her to go for coronary angiogram .
One thing I suggested differently was , I told her it was not an emergency , I also conveyed my gut feeling that it is unlikely to cardiac pain . One week later CAG through radial route was done . Both of us were happy to find a normal coronary angiogram !
Final message
Pain is a feeling . It can be perceived at multiple levels . The site of origin , spill over on transit and at the level of brain . A patient with multiple potential source for pain can either summate , deduct , reflect or cancel out .This can confuse the clinician in a dramatic fashion as it did to us ! . To complicate the matters further , gastric pain can trigger a cervical pain and vice versa . (Spill over effect)
Dr.S.Venkatesan MD 