Atypical chest pain

Posted By Charlotte  on December 09, 1998 at 15:13:58:







I am a 55 y/o female with a strong family history of diabetes but am unaffected at this time.  I also have hypothyroidism treated with .15 Synthroid with a TSH of 2.09.  I was evaluated for atypical chest pain and have had an echo showing R and L atrial enlargement and L ventricular hypertrophy.  Recently I have had an increase in episodes of atypical chest pain which usually starts in my R jaw and may or may not proceed to my mid-chest.  I become diaphoretic, my BP generally goes above 170/90 (my normal is about 135/80) and my EKG shows no ectopy.  Nitro helped during this last episode which lasted more than 20 minutes.  Usually I just stop what I'm doing and ride it out knowing it will eventually subside.  When I was first diagnosed with hypothyroidism (Hashimoto's thyroiditis) I was having these pains at least once a month preceded by a week or so of increasing fluid build-up where I felt SOB.  An echo at that time showed MVP but once I was medicated appropriately the episodes decreased to no more than once or twice a year.  My echo no longer shows prolapse and a thallium exercise treadmill was essentially normal.  I still precede these episodes with the build-up of fluid, feeling more and more SOB until the chest pain occurs.  I have diuresed heavily afterwards with no diuretics.  My Internal Medicine doctor is at a loss and told me to try some research on my own.  My labs are essentially normal except for an LDH of 1250 and an AST of 49 which is a change.  Chest X-ray is WNL except for a linear density in the left base which is unchanged.  I told my doctor I'm just low on naturietic (?sp).  He just laughed.  He offered me a return visit to the cardiologist and if that evaluation is normal then a work-up with an EGD, etc.  I have a mildly progressive decreased exercise tolerance in the last year or so but am otherwise essentially healthy, working daily at my nursing job and maintaining my home.  I would appreciate any other suggestions you might have for follow-up.