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Forum Name: Cardiology Symptoms

Question: Pain in chest, high blood pressure


 shb203 - Thu Nov 20, 2003 3:14 pm

3 weeks ago I was in the emergency room for pain in the middle of breasts,vominting ,chills and sweating my blood pressure was 220/146 they gave me nitro and it went away. Yesterday I was laying down reading and the pain in my chest started again my blood pressure went up to 189/127 and it was hard to breathe and lasted about 2hours. My doctors said i had a panic attack.I was wondering if this is right all I was doing was laying down and reading a book.How does this cause a panic attack I have never had any panic attacks or anything of that kind. Thank you very much for your help on this matter
 Dr. Russell M - Thu Nov 20, 2003 4:42 pm

User avatar Hi!

Since you've already had your emergency room visit, can I assume your ECG to have been normal? Are you on anti-anxiety medications? Has your doctor discussed with you regarding a treadmill stress test or stress echocardiography?
 Dr. Yasser Mokhtar - Tue Jan 27, 2004 1:32 pm

User avatar Dear shb203,

Thank you very much for using our website.

Chest pain is usually worrisome for coronary disease. Coronary disease has factors the presence/absence of which can usually predict fairly well the probability of the person complaining of chest pain having or not having coronary disease.

These risk factors include family history, smoking, hypertension, diabetes, high cholesterol, sedentary life style and obesity. You did not mention if your father had a heart attack (and if yes how old was he then) before having his bypass surgery, whether you smoke or not, whether you excercise regularly and how much do you weigh. You mentionned that you are being treated for hypertension and high cholersterol and since your mom is a diabetic, you are most probably prone to develop diabetes (were you ever tested for diabetes?).

Chest pain caused by heart disease usually has certain characteritics. The coronary pain is usually a sharp pain, but can be perceived by patients as pressure, burning or stabbing sensation. It usually occurs on exertion, lasts for a few minutes and is relieved by rest. Its location is usually behind the breast bone and can move to other places like the left arm, the back or the neck. If severe enough it can be associated with nausea, vomiting and sweating. So, the vomiting, sweating that you had the first time can be related to the pain, but unfortunately these symptoms are so non-specific and they are not an indication that the pain that you had is of coronary disease but just the pain that you had might be severe.

The answer to all these questions makes it most of the time easy on the physician to decide the origin of the chest pain and whether it is cardiac in origin or not (from the heart).

Obviously if the only source of chest pain was the heart, it would have been very easy for doctors to diagnose all patients who present with chest pain, but there are other sources and the symptoms are sometimes vague enough so that doctors resort to other resources to try to diagnose the source of the pain.

Your visit to the emergency department was a good step and my guess is that they thought the pain that you are having is most probably not heart related and that is why they did not admit you to the hospital. And you did not mention what they thought was the reason behind the chest pain.

You are being treated for hypertension by lopressor and lotrel but it looks that your blood pressure is not really well controlled. Where does it usually run?

We don't know which comes first, the high blood pressure or the chest pain. High blood pressure as high as the numbers that you mentionned is a high stress on the heart and so you can feel some discomofort or pain in the heart but the main problem is actually your blood pressure. If the pain comes first and it is so severe, you can so anxious and nervous that your blood pressure shoots up but it is rare that it reaches such high levels.

You have quite a few risk factors for coronary disease. My suggestion to you is to discuss this further with your primary care provider and try to have your blood pressure controlled better and see whether this makes a difference in the occurrence of the pain episodes. If this does not make any difference i think it would not be unreasonable to ask him/her if you could have a treadmill stress test with a nuclear scan to evaluate the reason behind your chest pain.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped and i will be waiting for your response.

Yasser Mokhtar, M.D.

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