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Forum Name: Valvular Heart Diseases

Question: 28 year old with chest pains-


 khailey - Fri Jul 23, 2004 4:01 pm

doctor--

i am 28 year old female that has been having chest pains. also i have episodes where my heart rate will be around 115-120 while i am sitting and it seems to me that it could be running this high becuase i feel sometimes like i cant get a deep enough breath. i have gone to the doctors and i had an ekg done that was normal-- i will going for a echocardiogram in august. my question is that i truley have been living an unhealthy lifestyle most of my life, i grew up in a very chaotic family and i have alot of lingering stress in my life. although i am aware that i need to be accountable for my own actions at this point the habits that i have picked up have been extremely hard to change. i am overweight, i have been smoking since i was 15, and i am badly addicted to caffeine. now that i have given you some info on my lifestyle, i just wanted to know if these chest pains that i am having, along with fatigue and shortness of breath, could actually be a true heart condition or could stress be a reason? the only thing though is that i don't have these symptoms at the times i feel most stressed out , so i don't feel they are related. i also have what i think are heart palpatations where i feel like i skip a beat , and then have a few quick catch up beats. can you just give me a little insight on these symptoms. also, i saw you replied to other messages saying that hormones at my age normally protect you from heart problems this early but i did want to say that i have been diagnosed with polyocystic ovarian syndome and i have not had a period now for almost 3 years. i have been given glucophage to try and help, yet no luck -- i have high testosterone levels--so i thought maybe i am not as protected as others my age might be --do you think that would be correct? thanks for your response ahead of time .
 Dr. Tamer Fouad - Sat Jul 24, 2004 1:04 pm

User avatar khailey,
A study (June 2003) has indeed linked PCOS with increased risk for coronary heart disease. It was published last year in the Journal of Clinical Endocrinology & Metabolism (JCEM). Your smoking and stressful lifestyle increases your risk further.
My question to you is: does this chest pain occur during physical activity or can it happen while sitting down? Is it related to your palpitations?
The fact that you are at increased risk does not mean that you necessarily have a heart disease but what it DOES mean is that you need to change your lifestyle in order to minimize your risk of developing heart disease.
 khailey - Sat Jul 24, 2004 11:21 pm

Doctor -

I really appreciate your response so quickly. In reference to the questions you had for me, i have a few situations. I have had chest pains while being active, but i have also had them while sitting down watching tv. I have to say also that i have not had any chest pains in the last week or so. Concerning the heart palpitations, im not sure if that is what i am actually experiencing, the few times that i have felt them. If you could clarify whether the symptoms i had given you ( skipping beats) is heart palpitaions, i would appreciate it. I havent ,that i know of , had the palpitaions at the times i have had the chest pains, atleast to my awareness. My doctor had said that the ekg was fine, but that she said at my age the normal thing to look for would be ( i think) mitral valve prolapse-- i thought that was something that most people are born with , am I wrong? I wanted to ask was, I have been addicted to pepsi for so long, there is normally no other liquid that i take in, in a days time. i realize the habit is horrible, but it has been something i have been doing for years. Does caffeine damge the heart ? Is there any other reason that is not related to the heart , that could cause a person to have chest pains?Thank you very much.
 Dr. Yasser Mokhtar - Sun Aug 01, 2004 5:53 pm

User avatar Dear Khailey,

Thank you very much for using our website.

Chest pain has lots of reasons. It is not easy sometimes to differentiate between them or decide for sure whether the cause is indeed related to the heart.

First thing that would lead us down the correct path is the character of the pain itself and its associated symptoms in addition to the risk factor that the patient has for heart disease.

Polycystic ovarian syndrome is part of a metabolic symdrome where the patient usually has predisposition to being diabetic and having high lipids in addition to obesity.

At a young age such as yours and being a female, you should be protected by your female hormones, but since you don't have enough of your female hormones then this protecting effect is doubtful to say the least.

The most feared cause of chest pain is usually a heart attack, that's why whenever a patient comes complaining of chest pain, our first concern is to make sure that this is not a coronary event. And the process starts by analysing the risk factors of the patient (for developing coronary disease), chest pain characteristics, do an ekg and some blood tests (to detect heart muscle damage) and of course the possibility that this might be secondary to other causes.

The risk factors for coronary disease are:
1. Family history of early coronary disease.
2. Hypertension.
3. Diabetes.
4. Being a male.
5. Age.
6. Hyperlipidemia.
7. Smoking.
8. Sedentary life style.

As you can see, smoking is on the list, coffee or caffeinated beverages are not on the list.

You did not mention anything about coronary history in your family so, this is negative, you don't have hypertension, you are not a male, you are young, don't know about your lipid profile (but should be checked), you smoke and from what you said one can conclude that you have a sedentary life style.

Back to the pain characteristics, the pain that is typical to coronary disease occurs usually behind the breast bone, patients can sometime feel the pain in the left shoulder or arm, the back and the neck. The pain is usually described by patients as sharp, pressure, stabbing, etc..., usually lasts a few minutes, usually brought up by some kind of activity and relieved by rest. It is sometimes assoicated with nausea, vomiting, shortness of breath, dizziness, sense of suffocation amongst others.

In most cases, after analysing the data, the health care provider can say whether or not the pain is of coronary disease. If a decision can not be made then other tests are usually done, like stress tests.

In your case, it looks like your doctor voted against this pain being of coronary origin. i would recommend that you wait for the results of the echocardiogram as mitral valve prolapse is a well known cause of chest pain and palpitations.

To reduce your risk of coronary disease, you need to live a healthy life style. Stop smoking immediately, check your blood sugar and your lipid profile and try to lose weight and exercise.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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