Back and chest pain

I am a 51 yo woman w/dxd periph vasc disease, a hx of strokes, difficult-to-control high isolated SBP, and a mitral valve prolapse with severe regurgitation. I had a complete hysterectomy 22 years ago and was on a mild estrogen supplement (premarin .3 mg) until a year ago. The hot flashes were horrendous and were increasingly accompanied by feelings of blackoutishness, headache, SOB, and chest pain that started including the arms. Plus, my BP went up (systolic habitually between 180 and 250, diastolic around 40)and the BP meds started giving me serious problems of other kinds. About 3 weeks ago, I went back on the premarin. SBP now back down to about 160, none of the other symptoms that came with the hot flashes-just milder hot flashes. Monday, I started having severe lower back pain that started at the hip and crept up toward the ribs making it hard to move. The pain seemed to pulse. The abdomen was tender too. Sleep and lying down relieved it. I thought I overdid the garden work. Tues. aft. it started up again but was gone by Wed. Wed. aft. it started in earnest when I drank some pop. Again, rest and lying flat was the only alleviating factor. Today, my "heart" hurts. Pulse is steady and hard. Questions: 1.Could the SOB/chest pain that came with the hot flashes be associated with heart damage? 2.Could resuming premarin be causing my current problems? 3.Should I be contacting my cardiologist? 4.Are back pain, pain on inspiration, or chest pain in the area of the heart assoc. with heart damage in a person with MVPR? 5.What should I be doing, if anything?
Thanks

[CCF-M.D.-RCJ]

Nobodyhome,

Thanks for the questions.

(1) Given your history of vascular disease, any chest pain or shortness of breath symptoms need careful and thorough evaluation to determine if they could be from your heart or other vascular structures.

(2) Probably not, but hormone replacement therapy in pill form would not be recommended.  If you find your post-menopausal symptoms do be severely disruptive to your life, then consider an estrogen patch as an alternative -- there is evidence that these may be safer.

(3)Yes.

(4)Chest pain of just about any nature needs evaluation in someone with your history.

(5) You should be contacting your doctor for a personal evaluation.  Although I love this website, I think it sometimes becomes a way for people to try to "shortcut" their medical care.  Don't short change yourself, we only live once.

Good luck.

[nobodyhome]

just as an addendum.  I just found out my coumadin level INR is 7.64.  Would that do this to me? (It's supposed to be between 2&3)

[Ianna]

Hi N,
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<I think the dr. here cannot help you answer these questions.
I suggest to go and visit YOUR dr. first, and let him find out where the pain in de abdomen comes from...(and the rest), he then can advice you what to do and where to go.>
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Hope you feel better.. -*Ianna*-

[nobodyhome]

In case anyone else is interested, the only test my doc could suggest was a CTScan to rule out aortic dissection/aneurysm.  I ended up with a non-contrast MRI and the results were negative.  Which is good.  However, I am left without a reason for the pain.