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Forum Name: Chest symptoms

Question: Sudden onset of left side chest pain gradually decreasing


 Shiela - Sun Nov 01, 2009 10:15 am

I'm 53, female, 160 lbs. (post-menopausal)
Beginning of symptoms:
Onset: 10/4 3:00 a.m. chest pain rated:6 or 7 with all over body malaise, upset stomach. Never had chest pains or twinges before that. At some point, just prior or just after (can't remember when) I took a fall downstairs.

Woke up again at 7:00 a.m. All symptoms gone except pain in left chest. Next day very, very tired. Stayed in bed all day. Next day slept till 11:00 a.m. Pain reduced to about 5.
Next day and thereafter: Symptoms: chest pain on upper left chest. Feels like I was punched in the chest. Pain level at 3 next day and has gradually subsided (now 11/1) to .5 during the day and 2 in the morning. At first, couldn't sleep laying down. Now I can but it always hurts more laying down. Pain is dull, sometimes burning, ripping. I'm hoarse. I am tired. It always feels 'wrong', a few times a day the pain will come up to a 2 for 5-10 seconds. Stress exacerbates it.

Only since and because of the onset of these symptoms have I taken meds.

Have had: EKG, Blood tests, Stress Echo, CT Scan. All show nothing.

Any insights you may have or resources you could point me to would be extremely appreciated.

I DO NOT have: Difficulty swallowing, breathing, coughing or moving. Pain does not become worse with deep breaths. Pain is not triggered by pushing on areas of my chest. I do not have heartburn or notice any change in symptoms after a meal. I do not have gas, burping or abdominal discomfort or pain. I do not have heartburn, acid reflux or taste stomach fluid. I am not vomiting, not anorexic or jaundiced or anemic. I don't do drugs. I do not have a burning tongue, sore tongue, sore throat, red tongue. I do not have diarrhea, fever, unsteadiness, or general muscle pain. I do not have trouble swallowing. The pains are not sharp or shooting. Pains do not seem to be connected to heart rate. I do not feel that 'something bad is going to happen' or that I'm going to die. I don't (and didn't) feel 'out of control, sweaty, clammy, panic. I don't have chills. I didn't feel anxious before this happened. I don't think I have arthritis or any more joint pains than anyone else who is 53. I have not had any respiratory infections lately. I do not have high blood pressure, chills, night sweats.
 Shiela - Sun Nov 08, 2009 2:08 pm

CT Scan was of my head (no stroke)-not my chest.
 Shiela - Mon Nov 09, 2009 5:42 am

11/09 Pain has now moved mostly to the center of my chest and has gotten worse at night. It is now a combination of pain (about 3) and a feeling like there is unusual activity in my heart rhythm. The burning is now primarily in the region of the ascending aorta. I am getting about 4 - 5 hours sleep now and getting extremely fatigued since this happens every night without fail and seems to be getting worse over the last week. Although the pain is different (doesn't feel so unorganized) I am not able to lie down to rest during the day because every time I do the chest pain gets worse (from about .5-1 to 1-2). My family practitioner has me on a beta blocker and has increased the dose but it doesn't seem to give me any relief. I have been wondering if this is Prinzmetal's or maybe PVC. I read that PVC's can be a complication of stress cardiomyography. What are your thoughts on what is happening? Should I see a cardiologist instead of my family practitioner?
 John Kenyon, CNA - Sun Nov 15, 2009 10:29 pm

User avatar Hi Sheila -- I find this very troubling, even though the fairly thorough workup revealed nothing. This definitely does not sound like anxiety-related symptomology (although it could be inferred in many other cases); it does sound like something possibly heart-related, even though all those tests came up negative. You have several major risk factors for heart disease and even though you've had a fairly decent rule-out, I'd like to know what a followup EKG might look like even though you've had a very reasonable ruleout thus far. Women often have downright peculiar (by textbook standards) presentations of both ischemic heart disease and acute coronary syndrome (ACS). The latter can often resolve without damage showing on a resting 12-lead EKG, and your description of initial and subsequent symptoms just sounds way too much like the newly-classic female ACS to just assume it's not that. You may have dodged an initial bullet -- and I may be totally wrong about this -- but with your family history, being post-menopausal and having had such classic atypical symptoms, sometimes a woman requires a more aggressive workup to expose the disease that might well be obvious in a man. Why this is so is still being debated, but we know it can happen.

There are a few other potential problems this also could be, and those would include a pulmonary embolism (PE) and aortic aneurysm (the latter seeming less and less likely as the symptoms subside). I would want to have PE ruled out (the CT may have cleared up any question about an aneurysm) and coronary issues very thoroughly eliminated. There has to be an explanation for this event and your family history just screams for a second look at the heart. There is such a thing as microvascular disease in women also (not exclusively but overwhelmingly for sure) in which the smaller vessels are involved and it is often difficult to visualize damage or even frank ischemia. There is also the possibility of spasm of a coronary artery, which doesn't last more than 20 minutes initially, and usually resolves spontaneously without having caused any damage. It can be detected by EKG while it's happening, but rarely afterward.

This could well be something utterly unrelated to the heart, but something keeps gnawing at me, given the family history and your description of the symptoms. I'd want every possible, feasible test done to try and provoke the symptoms and located the problem. Also the potential for PE is still up in the air. Also, something of an afterthought, but hoarseness and "ripping" sensation associated with the pain could suggest, again, aortic aneurysm. A CT aimed directly at this (not certain where or how specific your CT was done) could help clarify.

Wish I could give you a better answer, but this is a really difficult one. Please follow up with us here as needed, and especially if anything new comes to light. Good luck to you.
 John Kenyon, CNA - Fri Nov 20, 2009 4:47 pm

User avatar Hi again: Your subsequent posts showed up here after my initial response. At this point I do believe you should see a cardiologist because all the things you describe are at least consistent with potenial heart problems and especially with aortic dissection. An MRI (or CT, I personally favor MRI) of the ascending aorta and arch would likely disclose any funny business in that area, and this is important to rule out/in ASAP, so you can either leave the worry behind or get things repaired right away, depending on what shows up.

At this point (and the beta blocker was appropriate but isn't curative) it's important to know just what's happening. If heart and vascular problems can be ruled out that's great. If one or the other are ruled in, that's extremely important, and the sooner we know, the better. Cardiologist is the next logical step. Please don't hesitate and please follow up with us here as needed, and keep us updated also. Good luck to you.
 Shiela - Sat Dec 05, 2009 6:08 am

My FP has put me on Valium and that is helping the pain. Does Valium minimize the effect or alleviate resting arrhythmia? I haven't gone any further with the cardiologist who did a stress echo and is dismissive of resting cardiomyopathy even though my symptoms happen between 1:30-3:00 in the a.m. and even though the stress echo showed ischemia.
 Shiela - Sat Dec 05, 2009 9:51 pm

I am suspect of Printzmetal's angina.
 John Kenyon, CNA - Mon Dec 07, 2009 11:53 pm

User avatar Hi there -- Somehow half the posts you put up on the same date showed up after I'd replied to the first two. In response to the rest, yes, Valium (and other similar benzodiazapine drugs) can often reduce the frequency of palpitations, since they are very often increased by anxiety and/or stress. So that's one thing that sometimes does help to partially relieve them.

As for the Prinzmetal's angina suspicion, I can see why, now that I know your episodes tend to occur regularly during the night. This is very common among those with Prinzmetal's. This can be tested for via chemical stimulation during angiography, so if it becomes more than just a suspicion this could be checked out that way. If you do have that problem it is often amenable to calcium channel blocker drugs.
 Shiela - Sat Jan 09, 2010 3:25 pm

This is what is happening now: If I work a full day, the next day, I have fatigue, chest pain, and hoarseness. I do not speak loud or a lot. The hoarseness seems to correspond with just doing too much--which isn't much--I'm careful to stop when I start feeling tired. There is still chest pain--Two different kinds. I've noticed that pain on the left and right are relieved with Valium and/or aspirin and wondering if the hoarseness and left and right pain may have anything to do with vasospasms. Then there is substernal pain in that is not relieved by either aspirin or Valium..only by rest. I am now sleeping most nights, although fitfully in the early mornings.
 Shiela - Sat Jan 09, 2010 3:28 pm

FP took my off the beta blocker as that seemed to be making things worse.
 Shiela - Thu Jan 14, 2010 7:38 pm

Mr. Kenyon, Thank you so very much for your replies. I have read your replies to others and am so touched by your intelligent, well thought out and caring answers.
Once again, I am writing with an update on my condition. I had an event monitor but gave it up after ending up in the ER and told there was nothing wrong with my heart. But I did go to the hospital and retrieve the even monitor report myself along with a copy of the event monitor printout. The interpretation says:

"The patient is a 53-year-old female who underwent event monitoring for a history of chest pain and palpitations" [by the way, as I mentioned earlier - the 'history' started abruptly one day in October 2009]. "A total of 9 events were recorded. Each event was associated with sinus rhythm with occasional changes in QRS configuration consistent with an ectopic focus or wandering atrial pacemaker. There was no evidence of ventricular dysrhythmias, artrial fibrillation, or atrial flutter. IMPRESSION: Nine events associated with normal sinus rhythm with occasional ectopic atrial focus". [end of report]

The QRST segments in some cases look like a kindergarten kid just scribbled all over the page.

Can you tell me anything about what this report suggests? I will of course follow up with a cardiologist but a different one than the one I once saw who told me that there was nothing wrong with my heart and that once I was assured the symptoms would go away....well, they haven't. I know that atypical signs of impending heart attack are very often (80%) missed in women and I need to find a cardiologist that is going to take my symptoms seriously and don't feel that one did.

I am not one to quickly rush to the doctor. In fact, more the other way. At 53 I have only had 2 mammograms and 2 pap smears my whole life and I think 2 physicals. I know that is not recommended but I am only saying that to point out that if I didn't really believe something was really wrong I wouldn't be going to the doctor. My symptoms have changed since the day this started in October 2009 but my life is still upside down. I can't work a full day without getting hoarse, tired, chest pains and PVCs for two days afterward. I had a vibrant, full life before October. Something changed dramatically in one day. I am still taking Valium but aspirin helps just as much with chest pains on the left and right but doesn't seem to affect the pain that is substernal. I have never taken Valium before and only had morphine once in the hospital. I am afraid of getting addicted to it if I can't get to the bottom of this. Thankfully I am sleeping better, not being woken by pain in the early hours---maybe because of the Valium--since I started taking the Valium--but still wake up feeling like my chest is heavy sometimes. The substernal pressure which is better now is constant in varying degrees throughout the day, depending on the level of stress and also depending on the amount of activity/stimulation the day before. I am constantly tired--that never changes. I am off the beta blocker and the cardiologist took me off the Coreg. My BP is 147/81 and HR 85 around 2:00 p.m. Last night my HR was 58 with 3,5 and 7 PVCs in a row. Any other information, suggestions, etc. would be appreciated. Thank you.

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