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Heart Disease (Expert Forum)
Concerned about chest pain, SOB, etc following dental absess and cellulitis
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Concerned about chest pain, SOB, etc following dental absess and cellulitis
by cricket, Sep 25, 1999 12:00AM
I had a dental absess stemming from a cyst that led to cellulitis in the face. During the beginning of the infection I started experiencing recurrent chest pain, and shortness of breath after exercise or even walking up steps or sometimes even while sleeping. I also noticed an increase in palpitations. I was on Keflex for 3 weeks prior to oral surgery (we were on vacation out of state and I was too ill to drive home for a while) followed by Clindamycin 10 days post oral surgery, a couple weeks later the chest pain came back and so did a very deep jaw pain...they assumed the tooth was starting to get infected again so 10 more days of Clindamycin and while on that developed respiratory infection and bronchial asthma so added 5 days zithromax, also asthma drugs and prednisone. The chest discomfort has become rather persistent especially following any kind of physical activity. I have had a history of mitral valve prolapse and also arrhythmia in the past which were only PVCs and they haven't bothered me
for years....I know it sounds crazy but I can almost pinpoint this chest pain starting with the pain in my mouth. I have tried to be patient with this because I know PVCs are benign and I had an echo about a year ago (to determine whether or not it was necessary for me to continue premedicating for dental purposes). The echo was basically normal, the only deviations were mild left atrial enlargement, borderline high/normal ventricular pressure (31), and mild regurgitation in pulmonary, mitral and tricuspid valves. I was told none of this was of any concern. A holter monitor redocumented that the ectopic beats were PVCs (they had become so normal to me I didn't even know I was still having them when I had the test done). It did say there was instances of ST segment depression of 1 mm lasting on average slightly over 4 minutes per occurance....but nobody ever explained what this was and the told me not to worry about anything, so I haven't. My resting pulse used to be high in the 90s but with exercise I
had gotten it in the 70s...now it is in the low 100s again. For the last month or so, I have tried to continue to exercise but have found it very difficult and frequently either can't or have to stop, because of the pain/discomfort, and the fast heartrate/shortness of breath. I am tired of waiting for it to just go away, and a couple of times have almost went to the ER because I started feeling so poorly with it, but don't want to look stupid since I've had tests done before that showed everything was ok. Today is another day that makes me feel like I should go to ER, yet know it's probably just me worrying about nothing. My allergy/asthma doc has been asking me to see a cardiologist for a while, but have been unable to get an appointment anywhere before mid to late November. I do have a history of thyroid disease, undifferentiated connective tissue disease, Sjogren's syndrome....there is no organ involvement, plus of course the asthma history, and the recent dental infection. So I figure any of these
or the multiple meds I have been on might be responsible for the ill feeling. I am only 41, a woman, I have a terrific cholesteral profile, and my blood pressure usually tends to run perfect...the only other real risk factor I have is that I am relatively obese (although I don't look as heavy as I am) at 5 feet 3 inches and 180 pounds. My friend says I should go to ER especially when she took my pulse and felt the skips. Yet I know in my head that all previous tests were normal so I shouldn't worry about this....it does befuddle me that it started during the infection and now that the infection is gone the chest still hurts. I do tend to have low grade fevers all the time, about 100 degrees, but that is normal for me ever since having started the connective tissue disease. Please advise whether or not I should relax and follow what my brain is telling me (and wait for the Nov appt and just get things rechecked at that point just to make sure) or whether these symptoms are significant enough to go to
the dreaded emergency department....something I really want to avoid. Also, if you could enlighten me on what the only abnormalities mean, the left atrial mild enlargement, ST segment deprression, and pressure of 31....and whether these things should be rechecked on a regular basis or if they are unchanged in November will that likely be the end of it. Sorry this is long....this whole situation is making me experience an anxiety that I have NOT felt in years. Cricket
for years....I know it sounds crazy but I can almost pinpoint this chest pain starting with the pain in my mouth. I have tried to be patient with this because I know PVCs are benign and I had an echo about a year ago (to determine whether or not it was necessary for me to continue premedicating for dental purposes). The echo was basically normal, the only deviations were mild left atrial enlargement, borderline high/normal ventricular pressure (31), and mild regurgitation in pulmonary, mitral and tricuspid valves. I was told none of this was of any concern. A holter monitor redocumented that the ectopic beats were PVCs (they had become so normal to me I didn't even know I was still having them when I had the test done). It did say there was instances of ST segment depression of 1 mm lasting on average slightly over 4 minutes per occurance....but nobody ever explained what this was and the told me not to worry about anything, so I haven't. My resting pulse used to be high in the 90s but with exercise I
had gotten it in the 70s...now it is in the low 100s again. For the last month or so, I have tried to continue to exercise but have found it very difficult and frequently either can't or have to stop, because of the pain/discomfort, and the fast heartrate/shortness of breath. I am tired of waiting for it to just go away, and a couple of times have almost went to the ER because I started feeling so poorly with it, but don't want to look stupid since I've had tests done before that showed everything was ok. Today is another day that makes me feel like I should go to ER, yet know it's probably just me worrying about nothing. My allergy/asthma doc has been asking me to see a cardiologist for a while, but have been unable to get an appointment anywhere before mid to late November. I do have a history of thyroid disease, undifferentiated connective tissue disease, Sjogren's syndrome....there is no organ involvement, plus of course the asthma history, and the recent dental infection. So I figure any of these
or the multiple meds I have been on might be responsible for the ill feeling. I am only 41, a woman, I have a terrific cholesteral profile, and my blood pressure usually tends to run perfect...the only other real risk factor I have is that I am relatively obese (although I don't look as heavy as I am) at 5 feet 3 inches and 180 pounds. My friend says I should go to ER especially when she took my pulse and felt the skips. Yet I know in my head that all previous tests were normal so I shouldn't worry about this....it does befuddle me that it started during the infection and now that the infection is gone the chest still hurts. I do tend to have low grade fevers all the time, about 100 degrees, but that is normal for me ever since having started the connective tissue disease. Please advise whether or not I should relax and follow what my brain is telling me (and wait for the Nov appt and just get things rechecked at that point just to make sure) or whether these symptoms are significant enough to go to
the dreaded emergency department....something I really want to avoid. Also, if you could enlighten me on what the only abnormalities mean, the left atrial mild enlargement, ST segment deprression, and pressure of 31....and whether these things should be rechecked on a regular basis or if they are unchanged in November will that likely be the end of it. Sorry this is long....this whole situation is making me experience an anxiety that I have NOT felt in years. Cricket
Doctor's Answer
by CCF CARDIO MD - CRC, Sep 25, 1999 12:00AM
Q: whether these symptoms are significant enough to go to the dreaded emergency department
A:It dosen't sound like an ER visit is warranted but I would see your doctor.
Q:Also, if you could enlighten me on what the only
abnormalities mean, the left atrial mild enlargement, ST segment deprression, and pressure of 31....and whether
these things should be rechecked on a regular basis or if they are unchanged in November will that likely be the
end of it.
A: left atrial enlargement - upper chamber of the heart is slightly big - nothing to worry about.
ST segment depression - tracing on ECG down. - unclear to me if significant not - your doctor can put it in perspective of the big picture.
Pressure of 31 - normal.
Probably don't need to be rechecked.
A:It dosen't sound like an ER visit is warranted but I would see your doctor.
Q:Also, if you could enlighten me on what the only
abnormalities mean, the left atrial mild enlargement, ST segment deprression, and pressure of 31....and whether
these things should be rechecked on a regular basis or if they are unchanged in November will that likely be the
end of it.
A: left atrial enlargement - upper chamber of the heart is slightly big - nothing to worry about.
ST segment depression - tracing on ECG down. - unclear to me if significant not - your doctor can put it in perspective of the big picture.
Pressure of 31 - normal.
Probably don't need to be rechecked.
