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- Wed Feb 16, 2005 10:03 pm
My boyfriend is from Africa and has been in the US for 5 years. He is 32 years old. He has had a history of chest pain since the age of 10. Being from an area that's very behind with technologic advances, his condition has never been treated properly. He does not take his condition seriously. He refuses to see a doctor. It is frustrating me because I am a nurse and know he is ill. How common is it for someone so young to have severe chest pain and it not be lethal. He is dyspeic at time, his hands/upper extremities are always clammy and diaphoretic, and experiences right arm numbness about once a month. The extreme chest pain happens several times a year. I know this case obviously seems like ischemic heart disease, but are there other rare conditions out there that may be the cause? This is hurting me terribly because I care about him a lot and I don't want to lose him.
- Thu Feb 17, 2005 12:22 pm
Your friend's symptoms may or may not be of cardiac origin . . . but that should certainly be ruled out. The symptoms you mention could easily be panic disorder also, OR many other conditions (hypoglycemia, for another). There's no way to tell without a workup. As a former ER nurse I can tell you I saw many, many patients with apparent cardiac symptoms that turned out to be panic attacks (either stress, hormone, or psychologically induced), or something else.
Has he ever had any significant disease, for example, that may have long-term residual effects? The fact that your friend has had these symptoms for some 22 years and apparently they have not worsened, and are intermittent, I would be more hopeful that it is not cardiac in origin, but again a complete physical examination and medical evaluation is needed.
You might try, and perhaps have, exploring with him any fears or concerns about seeking medical help. Get him to talk about these, and gently educate him with references on his symptoms, to help dispel his fears, if any.
You're a good, caring nurse, but as you know "You can lead a horse to water . . ." People's beliefs, as you know, have much to do with how they fare.
| Dr. Yasser Mokhtar
- Thu Feb 17, 2005 5:30 pm
Chest pain has many causes besides coronary disease.
To decide whether or not chest pain is related to coronary disease, risk factors for coronary disease in the patient suffering from chest pain and the characterisitics of the pain are looked at and the probability of this pain being related to coronary disease is then determined. If the patient has many major risk factors for coronary disease (these are hypertension, diabetes, smoking, drinking, family history, advanced age, male and hypercholesterolemia) and the characteristics of the pain are typical as compared to characteristics of the pain caused by coronary disease, the probability of the pain being caused by coronary disease is very high. If the patient does not have any risk factors and the pain is atypical, the probability is low.
Taking into consideration the age at which your boyfriend started to have the pain and assuming that he was otherwise healthy then (as you did not mention him having any other disease), the probability that the pain that he had then was not due to coronary disease.
If the pain that he has now is the same as the one that he was having back then, most probably, he does not have coronary disease now as well.
As Holly said, your boyfriend needs to be evaluated by a health care professional to decide what is going on with him and whether or not it is serious.
Having said that, however, this is not most probably related to heart disease as it sounds that your boyfriend has led an active life despite these chest pains.
Chest pain in the young age can be caused by a condition called mitral valve prolapse that needs an echocardiogram to be diagnosed. Being of african origin means that he might also have suffered from rheumatic fever when he was a child.
One's beliefs, past experience and culture can sometimes be a barrier in changing people's behavior and reaction to every day's events.
Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.
Yasser Mokhtar, M.D.