Doctors Lounge - Cardiology Answers
Forum Name: Cardiology Symptoms
Question: chest pain, SOB on exertion
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|janedoe2009 - Wed Jan 28, 2009 8:34 pm|
I'm a 33 yr old female who has been having chest pain with SOB on exertion since around October last year. I am overweight but have been all my life and have been relatively healthy.
I had a stress echo in Oct which came back normal. Resting HR was around 80 and BP was 120/68. I stayed on the treadmill for 1 min 47 seconds and my HR was 153, BP was 210/82. Continuing to have symptoms including nausea, dizziness. I can't walk very far before losing my breathe and having to rest.
I've seen a pulmonologist and all pulmonary function tests came back normal as well.
Since then I have had 2 ekg's come back abnormal. The first showed a left atrial abnormality as well as a lasting QT syndrome (this was a 12 lead ekg). The second showed a T wave abnormality but my DR doesn't seem to be that concerned. He is sending me back to the cardiologist but I am unsure of what this means.
Blood work has come back normal. Last Chest xray in October was normal.
I need some answers and am wondering if I should be concerned. Please help!
|John Kenyon, CNA - Tue Feb 03, 2009 12:58 am|
Hi there -
I'd say that based on your family history and the too-short-to-be-conclusive stress test you probably have reason to be concerned, although I wouldn't go beyond "concerned" at this point. I do feel you should be worked up more thoroughly, however, preferably including a stress test with nuclear scan, and an echocardiogram.
The long Q-T on EKG could be a separate concern, but was probably transient (and should be rechecked to be certain); T-wave abnormalities are frequently seen in healthy people for various reasons, but when coupled with symptoms such as you describe they shouldn't be brushed off. However, you're a young, otherwise healthy woman, so it's difficult for a lot of doctors to accept that there could be a cardiac cause for the symptoms. This is an ongoing problem, because odds are the symptoms aren't cardiac-related, but they are caused by something, and heart disease is too often overlooked in younger women.
Since pulmonary hypertension seems to be ruled out I'm thinking possibly a structural abnormality of the heart's workings. It could be a thickened chamber wall, a malfunctioning valve, something like that. An echocardiogram would very likely rule this sort of thing out -- or in.
For the time being, I'd recommend not over-exerting, and to be very aggressive in seeing that you're followed up for this. Something is causing the symptoms and they are somewhat troubling. They could be due to something fairly minor, but until it's clarified it's not safe to assume there's nothing to this. The symptoms speak for themselves.
I hope this is helpful to you. Good luck to you. Please follow up with us here as needed.
Having seen a pulmonologist was a very good idea and happily things appear to be fine there. I was thinking possible pulmonary hypertension, but apparently not. Good.
The left atrial enlargement finding is also common and usually meaningless, but also can occur in conjunction with systemic hypertension. Since your blood pressure did get rather high very quickly during your stress test (and I'm assuming this is why it was terminated after less than two minutes, since you were nowhere near your maximum heart rate), your symptoms may be due to some sort of blood pressure abnormality. Do you know what your normal resting BP is?
|janedoe2009 - Tue Feb 03, 2009 1:54 am|
Normal resting is between 110/68 to 120/80. BP has never been issue for me until the past few months.
|janedoe2009 - Tue Feb 03, 2009 1:21 pm|
one more question - is it possible for the heart to enlarge since the last xray, which was done in October as well? That xray was 'normal' but I am concerned about heart enlargement. Especially since my previous EKG's were normal and now I have 2 abnormal ones in the last 2 weeks.
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