Angina?

For the last month, my cardio. has attempted to identify the nature of my heart arrhymthmia (some sort of tachycardia).  He put me back on an event recorder after I passed out a couple of weeks ago.  A little after that fainting incident, I began to develop a dull, burning discomfort in my chest, predominantly on the left side underneath my left breast.  Over the last two weeks, this discomfort has come and gone lasting sometimes as little as 2-3 minutes to up to a couple hour. Typically, the "pain" that last longer more than a few minutes spreads to my left shoulder, upper arm, and sometimes my lower neck.  I took an event recording when this was happening and apparently my pulse was in the 30s.   I informed my cardio. about this pain, and he told me that the pain was most likely not of cardiac origin, especially in some my age (21 years old).
  Does this sound of cardiac origin or am I worrying about nothing?  

[Cleveland Clinic, MD]

Dear Christina,

Doctors tend to look for certain conditions in certain groups of people.  In a young woman it is unlikely that heart disease is present but nothing is impossible.  There are many other causes of chest pain that would be more likely to be causing your symptoms.  

Amongst the cardiac causes of chest pain not due to ischemia are: pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see there are a number of potential causes that your doctor will have to work through with you.  However, more than likely the cause will not be something serious in someone your age.

[Debi]

Be careful of those who say a young woman can't have heart problems.  I am 48, not as young as you but.  I had shortness of breath w/excersion, then tired, pressure and heavy feeling in my chest.  Which all started after the flu, so for 4mos they treated me for bonchitis, then wanted to start stomach test when this didn't clear up.  Finally I insist on a Cardio Dr, after searching the net for answers.  All test came back OK, I couldn't have heart problems.  We finally did a cardiac catherazation and they found I my left main artery to the heart was blocked and the one next to it.  So I ended up having emergency double by pass surgery.  I'd recommend a catherization, maybe if its your heart they can catch it and treat it without major surgery.  Plus all the women in my heart Rehab group, all were dismissed as something else until they ended up w/surgery.  Don't be put off because your a woman or young.  Good luck