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Forum Name: Cardiology Symptoms

Question: longterm left side chest pain, lightheadedness, female - 29


 wrj - Thu Dec 25, 2008 11:24 pm

Hello -

This started almost three years ago (just before my 27th birthday.) I noticed chest pain on the left... it felt to be directly behind my breast. I also ended up with a sort of electric-feeling going down my left arm, plus it seemed that I could feel the nerves in my teeth. Ever since then I have had occasional dull pain in the same basic area, but it seems to migrate around, always staying on the left side and either above or below my breast area. I have noticed no connections to physical exertion, eating, and I don't think anxiety, but that one I wonder about.

About 3-6 months later I started to notice some dizziness, but it would ONLY happen after I would lie down for bed and had been still for 10-30 seconds. This comes and goes as well... I could go months with it not happening, then have it happen every night for 4 nights. In the last year or two I have noticed being lightheaded while awake and doing regular things, not getting up and down quickly or anything like that. I never have to steady myself, but I do purposely slow down a tad when I feel it.

Other things to mention that might help...

1) When I exercise and my heart rate gets above 180 for more than 5 minutes, I will develop intense pains that feel exactly like menstrual cramps that I get every month. I will have pain to the extreme that I cannot move or function for 10-20 minutes. When I have been to the ob/gyn they have said there is nothing wrong with me. Such exercise has not caused the above mentioned chest pains.

2) The only prescriptions I have been on in the last 10 years have been a couple rounds of antibiotics. No birth control or anything.

3) I have noticed occasional tingling of my big toe on my left foot for the last year.

4) I am 5'8" and 155 lbs. I have never smoked, I rarely drink, and have never done drugs. I am also a vegetarian. I have wondered about not getting enough iron, but other vitamins and minerals should be ok.

5) Around the same time that I developed the chest pains, I also seemed to develop a type of asthma. The house I was living in was right next to an interstate and I highly suspected mold in the house but was not in a position to find out for sure.

6) I am about average when it comes to how often I exercise (3 days a week, 1/2 - 1 hour)

Any input would be very appreciated. Thank you.
 John Kenyon, CNA - Fri Dec 26, 2008 9:58 pm

User avatar Hello -

The pain you describe (the chest pain, that is) doesn't sound at all like cardiac pain, which, along with a stable presentation for three years (no progression to further problems) makes it unlikely this is due to coronary artery disease. That said, it's well know women do tend, far more often than men, to present with atypical symptoms. Still, over such a long period of time and not exacerbated by exercise (which causes a whole different problem), it still seems unlikely this is due to coronary artery disease. However, the left chest pain you've been having should be investigated. One good possibility is mitral valve prolapse (MVP) which is extremely common and almost always benign (it's estimated 10-15 % of the general population has it and it is often referred to as a "variant of normal", but often people with it also have a syndrome that frequently includes sharp, stabbing, non-specific but usually left-sided chest pain, near the breast). The lightheadedness and dizziness sounds a great deal like benign positional vertigo (BPV) especially since it can be aggravated by lying down, something that normally would relieve lightheadness (faintness), not aggravate it. Then again, you also complain of lightheadedness while performing ordinary upright activities. It doesn't slow you down (as actual faintness would), so it may just be vertigo also. This is easy to check in the doctor's office without any special tests, just a simple "watch my finger move" and "close your eyes while standing with your feet together" usually will expose BPV. The MVP, if that's what's causing the chest pain, can often be diagnosed by resting EKG, oscultation (listening to the heart via stethescope), and sometimes also an echocardiogram. While positive findings using this triad are the "gold standard" for MVP diagnosis, it is often not found anyway, at least not the first time. It can be elusive. Other problems can, however, be ruled out via this same simple process. It might help ease your mind.

And at what age did your father suffer a heart attack? This is just a family history question, but it's important to know if he was relatively (or very) young when that happened.

As for the abdominal pain, that sounds like probable muscle cramping. I'd suggest, regardless of the ultimate diagnosis of that, that you try to keep your exercising heart rate below 180, since that seems to be the threshold for bringing on this phenomenon. It's odd, but once heart problems have been ruled out it will likely leave you with few other explanations than abdominal muscle cramping.

As to the tingling in your left big toe, no relationship to any of the other things in question, but also extremely common, usually due to a nerve being compressed somewhere between the lower back and the toe itself. Often due to a postural problem, shoes (heels in particular) or Just One of Those Things.

I hope this is helpful. Please follow up with us as needed.

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