High Cholesterol-slight chest pain and breathing problems

[Knowimcrazy]

Hello Dr. and thank you for anwering question.

Here are my stats:
1. I just turned 35 a week ago and I am 6'4' 265lbs (obese)
2. My BP is around 118/70
3. My rest pulse is around 75
4. take about 11-15 breaths per minute
5. My Choles over the past 2 or 3 years has been 198-210 total with an HDL of 33 and an LDL of 140.
6. 2003-2004 had ECO, ECG, Stress Test (non-Thallium) and a chest MRI Scan (with a score=0, no calcium) EVERYTHING NORMAL
7. DAD-high Chol, BP no Heart Attack, 59, mom OK
8. At 20 my total chol was 117.

In Jan 2006, I weigh 280 my stats were same as above.  I worked out and ate great until May 2006  and weigh 242 and had a stressful thing happen in my life so ate bad and didn't work out for 3 months (June-Aug 2006).  

In July 2006, I started feeling a bit of chest pain and left arm pain and breath prob so I went to the Dr.  He wasn't worried because of BP normal.
MY CHOLETRL WENT UP TO 232 TOTAL, 161LDL and 34 HDL, in July.

2 weeks ago, I went to new card. and he said my ECG, BP and Pulse was normal. Wanted to do scan, though he want money.

5 days ago to the emerg rm chest pain and arm pain and breath prob again.  ECG norml, breath norml, chest x-ry (norml) left after few hrs and said to go to card. for stress test.

A. Could I clog arteries in only 3 yrs with a LDL of 141/HDL34 with perfct stats in 2003-2004 if ate bad?
B. Clog in 3 months of bad eating if LDL 161/HDL34?
C. Do I need Angiogram know how risky it is?
D. Am I at high risk for Attack at 35?
E. I work out 1 week so far, can I continue?
F. Is it too late for me?

[CCF-M.D.-MJM]

Hi David,

Chest pain is tricky.   Because of your age and risk factors, your risk of coronary disease at your age is very, very low.  We do occassionally see someone in their 30's need a stent or bypass, but again, this is very rare.

I am glad to see that you taking your risk factors seriously.

A. Could I clog arteries in only 3 yrs with a LDL of 141/HDL34 with perfct stats in 2003-2004 if ate bad?

This is very unlikely.  That being said, we take chest pains very seriosuly and that should be evaluated.

B. Clog in 3 months of bad eating if LDL 161/HDL34?

Again, very unlikely.  You should do your best to control these risk factors.  If it takes medications like a statin to bring your cholesterol under control, you may need to do it.

C. Do I need Angiogram know how risky it is?

Only if you have ekg changes, a positive stress test, or a very convincing story for cardiac chest pain.  If you are so concerned that this is cardiac and you can't stop thinking and worrying about it, it is also reasonable to do a cath for this reason.

D. Am I at high risk for Attack at 35?

Everybody is at risk for a heart attack, your risk is very low.  If you don't control your risk factors, your risk of heart disease increases with age.  Do your best to control your weight and cholesterol.

E. I work out 1 week so far, can I continue?

That is a question that I cannot comfortably answers with out meeting and examining you.

F. Is it too late for me?

Absolutely not. All you can do is try to control your risk factors and see your doctor if you have concerns.  I would have this episode of chest pain evaluated and take the appropriate tests.

Good luck with controlling your risk factors and I hope you feel better soon.

[Pulseman]

I am no doctor but it sounds to me like you just need to continu exercising and get into better shape. of course you should be checked out but I think regular cardi exercise is the best thing you could do for yourself. I bought a treadmill 2 years ago and use it at least 6 days per week. Since i started the cardio workouts I have been able to cut my daily Asthma med in half and have only need the rescue inhaler twice all summer compared to 4-5 times per week two years ago. My pulse and BP are both lower now as is my cholestrol. Please do not give up on exercise or on life. You are young with a lot of time left. It is never too late.

[Knowimcrazy]

Thank you, Doctor.  And I am and I will do what you say.

[Knowimcrazy]

Thank you, Dr. M. I will try everything I can.

be well

[suzzie1]

Hi Al,  I went to Dublin thismorning to see a new cardio. I had an echo and a stress test done. The echo results were as follows :                  
          Mitral pulmonary pressure 35mm 41
          Good LV function
          Late Systolic MVP...small
          Moderate overall MR
          3 Clefts in Anterior MV 'Coflet'  (not sure what that word is meant to be I cant read the technicians writing)                                                          They said the stress test was ok, though I had to quit due to irr heart beats and some chest pain at 7 minutes. I also recently wore a holter monitor for 24 hours which showed 57 ectopic beats, 1296 ventricular ectopic beats (a rate of 57 per hour), and 10 MF ventricular ectopic beats. My cardio wants to do an abliation and at the same time an angiogram. Im worried about the ablation!!  What are your views on this procedure, and the echo and holter results ?? :/

[jmike1_]

Hi David!  I am one of those "rare" guys in their 30's (although I'm at the endstage - 39) that does have CAD.  I've had 5 heart caths which resulted in 4 stents in my LAD and one of those stents clogged and had to be reopened.  All of this happened over a 4-month time span starting in MAR 06.  So don't let someone convince you that "rare" means impossible, because it doesn't.  However, I am not trying to raise an alarm with you.  I was in good shape (army guy) and well within my weight standards (actually, I've lost over 25 pounds during this), but had symptoms that convinced me that something was wrong.  The doctors took some additional convincing however, because they thought that I was too young to be having these problems.  Even after receiving 4 stents and an additional angioplasty to open one of them, they still try and tell me my chest pain must be from something other than cardiac problems.  So, as a younger guy, you'll have an uphill fight in convincing anyone you have a cardio problem.  BUT, I'm a believer in a person being able to "sense" something is wrong with them if there is in fact a problem.  So if you have a strong concern that something is wrong, I'd recommend you look for a cardiologist who is willing to listen and do some key tests.  I've passed all my EKGs and normal stress tests, and from what I've read/experienced, these aren't always reliable anyway.  However, I'm a big believer in the Nuclear Stress Test - it is the test that got me on the road to treatment.  I'm also scheduled for a 64 CT Scan (think that's right) next week, so I'm hoping that is a good test as well as I have continuing pressure.  Anyway, wanted to share a story as someone near your age who understands that it can be frustrating for we younger-types to get anyone to listen.  But if you get good tests and come out clean, then I say try and relax, get into better shape, and live a good life.  Best of luck to you, and God bless!

[Eddie 14]

J Mike,

One question - was your overriding symptom chest pressure?

I rarely, if ever get chest pressure.  Once every few months, generally while under heavy work stress.

Exercise - no problems.

I do however get a lot of PVC's, jaw pain, left shoulder pain.  All more shooting in nature.  Sometimes at rest, more often under stress, less during exercise.

My hope is all this is stress.  I've passed a stress echo (most recent after the PVC's got bad) and a 64 slice CT in April, and a Nuclear Stress last December (ER).

Something is "wrong" but not sure what.  I've done everything short of a stress, and I just don't get pain during exercise. I exercise pretty hard when I do.  This other **** however is worrysome.

[Erik36]

I am a 38 year old male who had chest pain while on my treadmill so I stopped it and the pain went away in 5 minutes. I tried doing the treadmill again and it took 9 minutes for the pain to return with a vengeance. I stopped immediately and drove myself to the ER where they did bloodwork, an ECG, a stress test, a Nuclear scan which all came back normal. Normaly someone would be relieved at these findings but the Cardiologist was convinced that what I had experienced sounded too much like Angina so he recommended a Cardiac Catheterization that same day. He took me to the Cath lab and did the Cath himself and found all my arteries to be completely clear. Boy was that a relief for me and him! I feel great knowing it wasn't my heart. Now if I get the chest pain I ignore it and it goes away. Have the Catheter if it will ease your mind. But if you get a clean bill of health from a Cath, don't become complacent. Keep dieting and exercising. I continue to exercise and eat right and take Zocor for my cholesterol so when I am 76 my arteries will still be clear and I'll be healthy.
Good luck!

Erik

[Knowimcrazy]

I am thinking of getting at Catherization just to make sure everything is OK.

Is there a risk of dying from getting one?  They go up your vein right?  Do they put you on general anasthesia?

What are the risks?

[jmike1_]

Eddie,
   My overriding symptoms are chest pressure in the center of my chest, and a pinching sensation in my shoulder and back.  I also at times had a dull ache in my left chest that carried through to my back.  I have at times had sharp pains, but I am pretty well convinced (by experience and cardio's opinions) that much of that is really not cardiac related.  The chest pressure I get seems to be my true tell-tell sign, and unfortunately it is coming back pretty strong over the past few weeks.  Can't seem to shake this thing, in spite of a very good diet and exercise regime.  As far as PVCs, etc. I can't comment much on that, as I haven't had that issue.  Lots of posts have come up regarding that though, so recommend you look over the archives (I see something on PVCs every other day).  Something that did pop up as of late in me is a fluttering sensation in the center of my chest - I'll have to discuss that with my cardiologist at my next appointment.  Hey, at least all this keeps life "interesting"!  Take care, and best of luck in getting more information and help for your issues.

[jmike1_]

Forgot to mention, Eddie, that my chest pressure would be considered "unstable".  It doesn't just come on when I'm exerting myself, I have it during rest as well.  This leads cardiologists to say they don't think it's cardiac, but I've had every other test in the book, and all (but heart caths) have come up clear.  So until someone convinces me, I'll continue to believe that my chest pressure is not a good sign.  Take care!

[Eddie 14]

Yeah,

That is what makes this difficult.

Exercise definitely does NOT bring on chest pressure.  I have simlar symptoms as you with the shoulder pinching etc.  

Work stress, or stress over this seems to be the only trigger I can isolate.  That said I know SOME of the stuff in my shoulder is muscular, as streching helps.  The PVC's and chest pains at times worry me.

My dilemma is this, I'm 34, passed all the tests, and all of this came on late last year while under a lot of stress work and otherwise.  So, I can buy the stress explanation.  BUT even with vacations, and stress meds it didn't make things better.

I would think that if stress brought it on, exercise would do the same.

It's one of those things, i'm sure if I pressed hard enough I could get cathed, but I don't want it if I don't need it.  

The 64 slice CT is supposed to be just about the same accuracy wise.

I've had 2 cardiologists dismiss it as non-cardiac, but I felt both just looked at my age and exercise tolerance, and the tests and figured no-way.

That said, after 10 months of this now, I have to think it would have gotten worse, or I would have had an event.

[Eddie 14]

Just re-read your original post in this thread.

You mentioned the nuclear stress got you headed in the right direction..

was it pain, or did they actually see something on there?

thanks a bunch.

[Eddie 14]

Just re-read your original post in this thread.

You mentioned the nuclear stress got you headed in the right direction..

was it pain, or did they actually see something on there?

thanks a bunch.

[suzzie1]

I forgot to mention that yesterday my cardio said ''he does not believe in arterial spasm'' I was thinking, and said ....WHAT !!!!  He then said that there is ''NO SUCH THING ''....what the heck is that about?????????????

[jmike1_]

The nuke stress test showed ischemia, which convinced the docs that maybe was something wrong.  After they kept me on hold for quite a while, they finally did a heart cath as a result and I ended up with 3 stents in my LAD.  Complained of continuing discomfort, and they said that was impossible.  They did another nuke stress test which again showed ischemia, and then they followed with another heart cath and I got my 4th stent (the docs were eating a little crow then).  So I credit the nuke stress test as the first valid test I've had - I very much discount the EKG and stress test as a valid indicator FOR ME (I'm sure it is good for others).  I'm sure an EKG can tell me if I've had a heart attack, but it is tough to get the docs to understand that I'm really hoping to get treatment to AVOID a heart attack - not wait til after I've had one.  Again, I would recommend as a minimum having the nuke stress test and/or the 64-slice test before jumping to the heart cath because while common I don't think it should be the first-line option because of its invasiveness.  But as I stated originally, I imagine you know your body better than anyone and must make a good, sound decision on that yourself.  Good luck and hope you feel better soon!

[tracy311]

A related discussion, If nuclear stress test is ok does that mean I should not worry? was started.