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Chest pains and questions about testing
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Chest pains and questions about testing

Hi, I'm 31 (nearly 32) around 5'7" and weigh about 266lbs after losing about 98lbs and for the past 6 weeks I have been having chest pain on exertion. There have been 12 episodes now, 10 on exertion and twice at rest (once while having a bad dream and it woke me up and once during a bit of a stressful time sitting).

On one occasion in the first week or so of this starting, I went to the ED because the pain was more severe than it had been before. The pain starts in the centre of my chest and radiates up into my jaw and left shoulder, it's like a heavy, tight squeezing kind of pain, like indigestion but totally different which I know makes no sense but it's just not the same...and if I rest, it goes away. It's like someone has grabbed me in a bear hug and isn't letting go. I also get very sweaty, a bit breathless and it sometimes feels like my heart is going to thump right out of my chest. The ECG and blood tests at the ED showed nothing untoward, no heart damage/attack, no sign of a clot and chest X-ray was clear so I was referred to the Rapid Access Chest Pain Clinic.

I was there today for a stress test, I completed all 9 minutes of the treadmill test, without the pain coming on - but towards the end there was some pain in my jaw and from my central chest but it was more like the precursor to the pain, the starting feeling but then the test ended and I rested and it didn't turn into anything. The heart tracing showed no problem and I was told that it didn't show that my heart was having any lack of oxygen at all, however they were going to pass my case onto the cardiologist for review. They called me this evening and told me that the cardiologist has said it's not angina given the negative stress test but that he wants to see me in clinic for review of my symptoms.

It wasn't actually mentioned at all before that phone call that they were looking at angina, first I heard of it was 'The cardiologist says it's not angina' which was a bit of a shock given my age but obviously good news! I did however make the mistake of looking up angina just to get some idea of why they were looking at that and I see why, reading the symptoms is like ticking boxes, it's exactly what happens to the letter. I then made the mistake of looking up the stress test because I wasn't really sure exactly what that had tested and saw some information that says it can be wrong sometimes, or rather it can miss a blockage that is smaller but the smaller blockage can still cause a problem.

Could this be possible? I'm not overly sure what they're thinking, I'm in the UK and doctors here tend to run on the 'You don't need to know that' side of medical knowledge so you're often just left wondering while they poke you. I'm pretty worried overall because the pain is really quite scary and I don't really know when it's going to happen because sometimes the same level of exercise does and doesn't cause the pain, also the stress test today was more than I usually do and again, didn't cause the pain, not fully anyway. Given my weight it's obvious I'm very overweight, (but am working on that!), so the fact that I got through the test all the way and could even chat as normal for the first 6mins, shows that I'm not completely unfit at least. It was tough but I could do it, if you see what I mean and until these episodes started 5-6 flights of stairs was my limit before getting too out of puff to continue, but now I'm struggling after 3 and 4 starts the tight, heavy feeling in my chest if I don't take a breather.

They asked the usual questions about stress as I am a mature student back at university and couldn't take the appt offered to me yesterday because I had an exam - trust me, this isn't a stress thing or a 'get out of an exam' thing. I love what I'm doing, it's the first thing that I've been passionate about for a really long time and I also love the research and stats module that exam was for so I wanted to take it lol. Plus, I'd have been given an automatic pass if I'd have taken the hospital appointment and skipped the exam given the circumstances…I could have taken the easy route lol!

I don't really have any idea what the next step will be or when and I don't know how to handle these episodes if and when they happen. The only thing that makes them stop after a while is rest and obviously I don't take any medication as they seem confident that it's not something bad.

I know these kinds of posts after looking online are usually from crazy hypochondriacs but I'm really not like that. I have found out recently I have a family history of heart disease so that's made me a bit more nervous, BUT I found that out AFTER the ED trip.

I'm REALLY sorry this is so long, I'm just a bit confused and worried and exhausted by it all. I'm not sure how much longer I can just 'deal with it' on my own :(
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I have had an email saying there's one new response, but I don't see one. Am I doing something wrong? :\
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A little update, in case anyone at all out there can give me some advice…

Had another 'episode' today, was pushing the full cart around the grocery store and started to feel the pain coming on again, tried to take it slow but there's not really many places to rest in there so got my stuff through the checkout and headed home. The woman at the checkout asked if I was okay because she said I was really pale and I explained I just wasn't feeling very well.

Have also noticed that my resting blood pressure appears to be a lot lower than normal. I'm usually about 125/70 at rest and I'm now running between 95/52-101/75 (top to bottom ranges from yesterday and today). After some form of exercise this climbed to 135/71, whereas yesterday my BP was around 150/90 at rest, climbing to 179/100+ at the height of the test. Can't remember the absolute maximum that it climbed to, but I know the highest I saw the systolic was 179 and the diastolic was over 100, but by how much I'm not sure.

Now I'm aware that my lowest BP has been within normal ranges, although the 52 is a bit below, but I'm just surprised. Doctors have always been surprised that my BP was fairly 'normal' given my weight etc, but I figure that's a good thing.

Could this resting BP drop be attributed to anything though? I seem to be skimming the borders of hypotension and I would have expected the exact opposite tbh!
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Having known angina for years, from the age of 46, I can tell you that your Cardiologist shouldn't assume a stress test will reveal all. I can tell you that there are many factors involved which I learned from experience and taught my cardiologist about. One is air temperature. The colder the air you breathe, the quicker symptoms will come on and the stronger they will be. Another example is how soon after eating you exert yourself. My stress test was quite good for someone with a blocked left artery, and my nuclear scan looked normal. If it wasn't for me having a stent due to a heart attack, they would have sent me home as fit. During the stent fitting, my problem left artery was observed, and so they knew full well what my condition was like. What you describe certainly sounds like angina and for it to cease when you rest, suggests it is the heart. If your Cardiologist won't do an angiogram, I would ask for a CT-Angio to be done which is non-invasive. Make sure he is aware that you did feel some discomfort at the end of the stress test. I had my first heart attack at 46, and my left artery had obviously been blocked for years looking at the state of it. If this is heart disease starting, believe me, you want to get on top of it ASAP. Also, you need to get your lifestyle risk factors in order because you have a family history of it, No smoking, healthy diet, regular exercise, blood cholesterol level check and avoid as much emotional stress as possible.
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You have presented a complicated problem, and one that even medical doctors don't seem/appear to have a good handle on.

Your stress test performance is great and surprising given you weight (assume you are using the same pounds as the USA standard - don't folks in the UK like to use stones?).  

Are you on any beta blocker, or other heart medications?  They will cause lower blood pressure and are in fact prescribed to lower BP - I take them for high heart rate and my BP has adjusted over the years and is mostly normal in spite of the BB meds.

Low BP can cause dizziness - was that what you felt?  Have you discussed the low blood pressure episodes with your doctor?  

Keep up the good work on getting control of your weight, even a little over weight can cause near and long term problems.  I suffer from mild obstructive sleep apnea (hey, I'm an old guy, I have earned it) and fond dropping form 250 pounds to 225 greatly reduced the apnea problem.  Now I am 6' 5" tall so 250 pounds fit better on me that on a shorter person, but I was still over weight and it was causing problems.
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Yes we use stones in the UK but I 'translated' because I noticed this is/seems to be a US based site, plus I know a lot of Americans so I'm used to translating weight and temperature lol. Yes a lb is still a lb in around the world lol, I'm currently about 19stone, fluctuates from 19 on the nose down to 4 lbs under but I think the gain in 4 lbs just now is a normal thing for a woman. Moving on lol.

No I'm not on any medication at all.

I do get light headed/dizzy when the episodes/attacks (I really don't know what to call them) happen and another happened today so I actually took BP/HR DURING it as up until now it's been after or at normal rest. My HR at the time was up to 138, despite having been sat down for several minutes (normal resting HR is 65-75 on average) and my BP was 87/53. I was really quite confused by that because I would have expected that my BP would have RISEN, not fallen.

It hasn't been discussed with a doctor yet because I'm yet to see the cardiologist, it's a bit of a slow process with our health system so my first medical intervention was the ER (ED to us), then a referral to the clinic where I had my stress test with two specialised cardiology nurses, who are now sending me to see the cardiologist. I just have to wait now for my appointment.
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That's interesting reading actually - the temperature has been dropping pretty suddenly and early here and I'm often out at the coldest times (very early morning, last thing at night) and MOST, but not all of these things happening have been while out in it. Tonight, it had been about 30mins since I'd eaten, nothing heavy just a light meal, but then needed to do some things around the house and moved a heavyish piece of furniture - well, at least it IS heavy, but it didn't feel heavy because it slid easily on the rug, before that I'd leant over a bed to pick something up that had fallen down the back but it wasn't like a stretch too far, it was within very comfortable distance with no need to stretch at all. Other than that I'd fitted two lightbulbs into some bedside lamps lol, I don't think I'd class that as strenuous though hah!
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976897_tn?1379171202
A lot of times it gets very confusing with Angina. I remember that I helped one of my Sons carry a new huge tv upstairs to his room which his friend had given him. It wasn't the new flat screen variety, it was the old cathode ray tube and weighed a ton. I was at the bottom end, taking all the weight and wasn't affected whatsoever. Yet some mornings getting out of bed, walking downstairs to get the mail, my throat would suddenly tighten and hit me like a ton of bricks, making me instantly stand still. Sometimes walking to my local shops (half a mile away) I could do the journey with ease. Other times I would really struggle. My body became more accurate than a spirit level on pavements, I could tell if it was an incline even if it was less than 1 degree. After my first stent, but still having a blocked left artery, I could achieve amazing results on some days, while others I would have to sit down after a few minutes as white as a sheet. They term it stable angina but personally I don't think it's always predictable at all.
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