Severe chest pain and pressure

[leopol]

I am a 120lb 45 yr. old woman, perimenopausal, healthy, active. Was hospitalized at 1 a.m. one night with SEVERE chest pain and pressure that was felt front and back and into the left shoulder, neck and jaw. Heart rate was 128 at rest. Nitro didn't do anything,  morphine didn't help pain. Was given blood thinners and beta blockers which finally slowed rate and eased pain some. Chest was sore for days and still doesn't always feel right. ALL tests ( blood enzymes, ekg's, stress tests, cat scan and x-rays) are O.K.
What can this be? One doctor thought I might have strained a muscle in the chest that spasmed. I was lifting heavy things that week ( I often do) and 5 days prior to this I seemed to have pinched a nerve under the left shoulder blade which still hurts.
Is coronary artery spasm a possibility here?  Cholesterol has always been high but triglycerides 46. Doctors don't really have an answer. Since the pain was SO SEVERE  and scary ( I was giving end-of-life decisions to my husband on the way to the hospital) I'd like to make sure it doesn't happen again!

[CCF-M.D.-MJM]

Hello,

Sorry to hear about your pains.  These situations are often the most difficult.  It is relatively easy to rule out heart attacks, aortic dissections, and pulmonary embolisms -- these are the usual players in life threatening chest pain syndromes.  Unstable angina can be more difficult and coronary spasm is very difficult to prove.  Could it be spasm -- sure it could be, but without relatively invasive tests no one can tell you how likely it was.  Believe it or not, panic attacks are often more painful and scarey than actual heart attacks -- panic attacks are also a possibility.

If you have the pain again I would seek medical attention like you did the first time, but it may be equally as difficult to figure out what the cause is.

Thanks for posting.  Good luck.

[leopol]

Hi
I forgot to mention, I was also short of breath. B/P was o.k. Mine is usually on the low side.

[mend]

Have you gotten a cardiologist?  Women have different symptoms, and I would want to have a dr in that field.  I have a friend that went to ER with severe heartburn, and they did all the tests you had done and they told her she had reflux.  Two days later she had to go back and, she had had a heart attack.  When your body tells you something is wrong, then you should check it out.  I passed the thillum test with flying colors, and later they found out I had 5 blocked arteries.  I was told after the Thillum test that I was fine.  I had symptoms while exercising at times, so they decided to do a cath.  They were surprised to find the blocked arteries.  Let me know how you do.

[my3reasons]

Hello.  I am curious what symptoms you had while exercising and did they happen every time?  I am asking because that is the only time that I have symptoms of sob, chest pain and my hr is usually high 180's+.  I don't have the symptoms every time that I exercise, usually once every week or two.  I workout 5 days a week.  I have had ekg, thallium stress test, echo and holter monitor.  All were fine except hm did pick up tachy and I have been on several medications in hopes to help.  Atenolol, varipamil and now toprol.  None have really worked, hr goes high and I still get the same symptoms.  Bp is 138/88, had been 130/80.  I will go back to my GP soon and he said if the toprol hasn't worked he would have a cardio look at my case.  I just want to get back to working out and not have these problems.  I hope you are doing well now and thank you for listening.

[andie3330]

Have you ruled out costochondritis - inflammation and pain in the sturnum area? Just a thought. My sister went to the ER with this, thinking it was her heart.

[talylor]

hello andie. was curious if you read my last post regarding my holter test results. your opinions, advice and support have meant alot to me these past weeks. my doctor said he didnt think i needed an event monitor when i told him i didnt have a big one while being monitored. the feelings to me are different than the small ones but again....he said my monitor was fine and he didnt think it warranted any further testing at this moment. wasnt too happy with that when i hear people can have sporadic and very infrequent arrythmias. he said he wanted to try klonopin for a few weeks to see if there is any difference and take it from there

[leopol]

No doctor ever mentioned costrochondritis. Can it cause pain that severe along with an elevated rate for that long?(a few hours) I'll look into this. Thanks!

[andie3330]

I thought that maybe the elevated heart rate could be from the anxiety of thinking it was a heart attack. I can easily have a heart rate that high from anxiety. I know it can cause pretty severe pain - from my sister's description - she's not one to overreact or complain.

I think I would also consider the possiblity of coronary artery spasm - which often occurs during sleep and can cause extreme pain - if a spasm caused a temporary and/or incomplete blockage your tests could still be normal despite severe pain.

Of course, this is just my layperson's opinion. Best wishes to you. Andie

[andie3330]

Hi,
Your monitor results look very good as far as I can tell. That thread was closed or I would have commented earlier.  Ventricular ectopics are PVCs - which you had 25 single PVCs and one pair (which I assume means a couplet of two PVCs back to back without a regular beat in between). I think this is normal, benign, finding and that most people in the general population would, at times, have this number of PVCs.

Superventricular ectopics originate in the atria (ex. PACs) and you had 66 of these. I think you had 12 single PACs and 1 pair - perfectly benign and normal. You also had 50 superventricular (atrial) ectopics that occured in runs - with one run lasting for 22 beats. I think that this is equivalent to a couple very, very, short episodes of superventricular tachycardia (SVT) which is also benign and not worth worrying about. People can have episodes of SVT that go on for hours at a time and it is still benign as long as it is not causing other symptoms like shortness of breath or fainting.

As far as your symptom log matching up to the report, I'm not sure how much the person who interpretes the computer's report from your monitor is going to go back and look at your written log to try to match events up with symptoms. Especially with a benign, healthy report like you have - it probably just isn't worth their time. The bottom line for the person looking at the report would be: "Is there anything here that is concerning or that requires follow-up". In your case, the answer is "no", so they probably just leave it at that.

I think your report is very reassuring - most people would be content to drop the issue and let it go and think "great, my heart is fine and the variations in my rhythm are well within normal, healthy limits" But, I understand that you feel the need to have a definitive explanation for your "big ones" (which I'm guessing are due to the same events that have already been recorded on your monitor, but for whatever reason you experience them more intensely at times). A 30 day, looping event monitor is probably the only way you're going to know for sure what the "big ones" are. I don't think your doctor feels the NEED to know because, based on the monitor results and your whole health picture, she or he is confident that your heart is fine.  Maybe YOU think you need to have a definitive answer - I am very much like that - I THINK I want to know everything 100% - but just by saying that, I see the absurdity in my way of thinking. We really don't know anything 100%, and health issues much less so. So, bottom line is "I don't know" - I just try to do what gives me peace of mind. Best wishes, Andie

[momto3girls]

Hi,

Just wanted to chime in about the costachondritis.  I've had it for about 10 years and made several trips to the ER thinking it was my heart.  It is such a nuisance and pain, literally!  Mine feels like a horrible cramp right in the middle of my chest where your ribs meet the sternum and is worse if I move or twist my body, especially if I squeeze my shoulder blades back.  Stress and lack of good sleep makes mine 10 times worse too.  Definitely explore that avenue as I was sure it had to be my heart and was stunned when the doctor told me about costochondritis.  Mainly it's an inflammation of the cartilage that connects your ribs and can flare up anytime.  Look it up, it's very interesting.  Best wishes (:

[talylor]

The thing that confuses me most is that he said he didnt think my "symptoms" were heart related AT ALL. He said the monitor was fine during the 24 hrs and since I was having symptoms during this time and no red flag came up...he didnt see any connection. I asked about the ectopic beats that DID show up and he said they were normal findings...EVERYONE GETS THEM. The BIG ONES i seem to not be able to let go of, because those are the ones I get smack in the upper middle chest, into the throat, those are the ones where that one time I felt my heart go whacky for a few seconds. Those are the ones that send me in panic mode. I did get ONE semi strong one...one in the areas that panic me, while on the monitor, but again, not REALLY strong, just knew what it was when I was getting it, cause the feeling is different. I asked him did that correlate with the EKG (aka was it the SVT or whatever) he said again...NOT THE HEART. The small ones I feel in the left breast, stomach even, sometimes throat (especially when bending) and get them all thru out the day that although they upset me, I just let them pass.

My doctor seemed suprised I even mentioned the event monitor or that I even knew what it was. I told him I know that people can have something wrong that only gets picked up after weeks of being on one. He said based on all findings thus far, he didnt agree. He told me to wait it out, he thinks this is all going to go away, to take the Klonopin and see him in 6 weeks. 6 WEEKS????? Wow. I hope I can hold out that long. If I get a big one in the meantime, I dont know if I should go running back to him or convince myself...ITS NOT THE HEART...LET IT GO! I KNOW and event monitor will give me peace of mind, but doesnt seem like I will get that any time soon.

[andie3330]

There is no question that PVCs and SVT can cause symptoms similar to what you describe, even though they are benign. Maybe your doc was just trying to emphasize that your heart is fine by saying "not your heart". Also, he might suspect there is something else going on that is not heart related. But I don't doubt that at least some of your symptoms are related to the PVCs. Andie

[talylor]

Well he does want me to follow thru with a gastroenterologist. My neurologist said the same thing. I was just so hesitant to do that until they could rule out the heart for sure.

I want to thank you so much for all your time with your responses. I have been having to hold this all in from my family and friends cause when all the tests keep coming back okay and I STILL insisted SOMETHING IS WRONG...they were yelling at me and telling me I wasnt thinking logically. That I was letting this change me and affect my life.

I wanted to ask you though, 1) when I feel the small ones, I never feel a skip in my pulse. Only the BIG ONES, any ideas? Would I ALWAYS feel a skipped/pause in pulse with these beats? and 2)do you think these things will go away? my doctor seems to think they will, I think either because he thinks something else (like gastro) is causing it or that this is anxiety related and once I calm down they will go away.

[woodruff]

Talylor, if what you're feeling is indeed PVCs, the BIG thumps you feel, associated with a pause, are the result of the ventricle (one of the big chambers) receiving a slightly larger amount of blood than usual.  To send the blood on its way with the next beat, that chamber has to pump a little harder, and that's probably the sensation you feel.  If your doc says your heart is fine, the big thump is harmless.  Unnerving, but harmless.  It just reflects the fact that the heart is stretchable, and can adapt to the amount of blood it receives.

Perhaps this website, with its animations, will help you understand what's going on:

http://science.howstuffworks.com/heart4.htm

Will the PVCs or weird feelings go away when you're less tense or whatever?  Maybe, maybe not, but I can tell you that when you're less anxious, you will be less aware of them, and you will feel more comfortable.

[talylor]

I guess I am just lost as to why my doctor said my feelings are not related to the heart. I JUST had one and I could literally feel the big THUMP in my chest (left side). Had two or three in a row. Yet he tells me my holter was normal and nothing to be concerned about. I expected him to say you are having PACs or PVCs and here is what you can try to take. But nothing. He just gave me the Klonopin.

[talylor]

Also...the ones that scare me...dont feel like thumps...these feel like the butterfly/hollow/going down a hill filling...EXTREMEMLY INTENSE. The thumps I feel big and small all thru the day. The going down the hill type ones...I got a little one while on the monitor. Not neither as bad as they can be.Yet me holter results showed:
TOTAL BEATS 111810
0.02% WERE VENTRICULAR
0.O5% WERE SUPERVENTRICULAR
0.0% WERE PACED BEATS
MEAN HEART RATE 79
MAX HEART RATE AT 8:45PM WAS 145
MIN HEART RATE AT 7:43AM WAS 47
VENTRICULAR ECTOPIC TOTAL 25, SINGLE 21, PAIR 2
SUPERVETNTRICULAR ECTOPIC TOTAL 66, SINGLE 12, PAIR 2
BEATS IN RUN 50, LONGEST RUN 22, @6:08AM - RATE 91

COMMENTS:
NSR, RARE PAC

Doesnt specify if my symptoms matched the holter. Doctor said he didnt think these results explained everything I am feeling. I said then I want an event monitor. He declined. At least til I try Klonopin for a few weeks. I KNOW ITS NOT GASTRO like he wants to follow thru with in the meantime. So I find that to be a dead end.

[andie3330]

Little ones could be PACs, big ones PVCs.  I could be wrong, but I don't think you would feel much of a pause with a PAC and I think there usually is a pause with a PVC. That's what you feel in your pulse, anyway. Actually, the pause only is felt because the PVC occurs before the ventricle fills completely with blood so it isn't felt in your wrist. Then the next regular contraction forces out more blood than normal -hence the heavy, stong beat.

PVCs and PACs are very unpredictable in their occurance and frequency. I had a ton of them for about six months - now I only notice a few each day. Sometimes I go for weeks without noticing any. The best thing you can do is eliminate all caffine, chocolate, get plenty of rest, and reduce stress. There are probably other lifestyle changes that will help, but these are what works for me. Andie

[woodruff]

OK, I think I see. Based on your Holter results, your doc must have agreed that you occasionally have ectopic beats, right?  By the way, a "normal" Holter reading can certainly include bunches of strange beats.  Some kinds are bad, and others are not, and the difference is pretty easy for a doc to see.  I think what he's saying is that your ectopy is not the bad type.

What seems a little odd to me--and what bothers you--is that he doesn't seem to believe that you are actually feeling the odd heartbeats.  Maybe he's just trying to reassure you that there's nothing wrong with your heart, but this is a strange way to go about it.  Has he said what he thinks is causing your sensations?  Gas bubbles?  You could try to pin him down on that.  Ask him flat out:  "Am I having ectopic beats?  Is it possible that I am feeling them?"  "If not, WHAT do you think I am perceiving?"

As to the weird "hollow" feeling you describe, I get that, too.  In my case, it's associated with the longish pause just before I feel the big thump of a pvc, and I suspect that it's related to the firing of the vagus nerve, which has connections both with the heart and with a person's emotional state.  A fearful person is going to be more sensitive to this kind of feeling, and you are clearly sensitive to what is happening in your body.

When you are less anxious (and I'm not at all sure that Klonopin is the best thing for long-term anxiety management), you will find that these sensations will be less intense, and may even fade, even if the extra beats are still there.  The chances are that they will occur again in your life, because although doctors can try prescribing a few medications like beta blockers, the medications themselves have side effects, sometimes worse than the condition itself.  Lots of people hope that OTC substances like vitamins, minerals, and herbs will help PVCs, but there no evidence to that effect.  Most of us with twitchy hearts just have to learn to live with them--or else waste our lives worrying.

[talylor]

Again, I thank you so much for your responses. Maybe you guys should start charging me for your services? LOL.

My Holter said RARE PAC. No mention of PVC's. I question the ventricular and supraventricular ectopic beats what were on my holter, and he said that is where the beat originates from, was within normal range, everyone gets them. I figured they had to be PVC's coming from the ventricular..yet the diagnosis was PAC. So I am now thinking the PVC just wasnt picked up. I did ask him if my symptoms were coming from these beats and he said "doubt it" which frustrated me to no end. I remember sitting in his office baffled wanting to scream WELL MATCH IT UP TO MY EVENT LOG FOR GOD SAKES. And I did ask him that and he said, if something gave up a red flag, the cardiologists would have marked it or something like that. I mean, you can get so intimidated in a doctor's office. You think you sound like a complete hypocondriac so you (at least I) walk out of there just frustrated. I have a nurse who works in my office building, showed her the results, she said they seemed good and I should feel good, I told her everything going on and she said ask for the event monitor, I told her he said no. She said she thought if there was anything really wrong, it would have showed SOMETHING with or without bad symptoms, but she did agree some things are so infrequent, it takes a longer monitor to capture it. She also said, "the diagnosis was PAC...so be glad...you dont want PVC, they are bad". GREAT. I JUST DIDNT NEED TO HEAR THAT.

So here I am, not drinking coffee, soda, alcohol...not going on amusment park rides, or swimming, so afraid quick movements and twisting and turning will bring them on. Here I am thinking I have these symptomatic PAC and PVC (cause as my doc puts it WE ALL GET IT just most people dont feel them) and for all I know maybe i DONT have these things. Maybe this is something else. I know in my heart...the event monitor is the only way I will be completely assured. I went to the gastro like he told me and HE said these beats can cause my symptoms and said the tests he can do to see if its gastro are invasive and does not want to do just yet cause he is not sure they are warranted. I COMPLETELY AGREE.

[talylor]

My above post was to you as well. I truly thank you.

[andie3330]

Your PVCs were picked up on your monitor - thats what the ventricular ectopics are.  Your nurse friend didn't know what she was talking about - if your heart is otherwise healthy, PVCs are fine. She may have meant that in people with major CAD or other structural heart problems a increase in the number of PVCs can be worrisome and require further investigation to determine if the heart disease is getting worse. But the PVCs themselves are not the problem.  Maybe your report only said PACs as a diagnosis because you had some runs of PACs. But I'm pretty certain that elsewhere in the report it said you were having PVCs (ventricular ectopics) and PACs (atrial ectopics).
Have you read the thread above this one where someone lists the ten steps that people with PVCs go through - if not, please do - its great - and so true. I'm going out of town for a few days - be back Sunday. Try to do something fun today - Andie

[talylor]

had not atrial ectopics on my results. just ventricular and supraventricular which is why i was totally confused as to why they stated RARE PAC as the finding. With all my research and this forum, I had enough knowledge to know that made no sense to me. My nurse coworker saw it said RARE PAC and went by that.

What post are you referring to about the 10 steps? Cant find it. And also, would these hearbeats explain the constart upper chest sorensess and unable to catch a deep breath? My doc tells me no which is anothe reason why I think he keeps telling me its something else doing this.

[woodruff]

Hey, talylor, I think I can "hear" in your writing that you're getting just a little less worried.  Still, you refer to not being able to catch your breath, and that is a classic sign of anxiety, when you've been given a clean bill of health (and you have been).  Likewise, your chest soreness may very well be due to tension.  When we're all cranked up, we tend to hold our chests and shoulders quite tightly, without even being aware of it.  Ask me how I know!

Also, you say this:

"So here I am, not drinking coffee, soda, alcohol...not going on amusment park rides, or swimming, so afraid quick movements and twisting and turning will bring them on."

When your heart is tossing off extra, goofy beats, it makes sense not to do things that might be expected to make it worse, so, yeah, cutting back on caffeine and alcohol are reasonable.  However, avoiding amusement park rides, swimming, and quick movements are not good choices.  The chances are that your odd beats will DIMINISH with activity, not increase.  The heart loves and needs exercise, maybe expecially when it's a nervous heart.

I worry that you may be flirting with a condition called agorophobia, which causes people to avoid situations which they associate with their symptoms.  Eventually, they can wind up virtually housebound.  A real disadvantage of living this way is that not only does it not help at all, but in treating your body as if you have a grave illness, you give yourself even more time to dwell on your symptoms.

It's because of this that I mentioned that I didn't think Klonopin was the best thing for you.  I suspect you would do better with long-term medication for chronic anxiety or panic.  If you haven't yet seen a nice psychiatrist who deals with these conditions, I suggest you do so.  If you're anything like me, you may want to try one of the SSRIs, as well.  Talk therapy for anxiety has helped several people here, but don't be frightened to try these drugs, because when you find the right one, it can be a godsend in giving you back a normal life.

[talylor]

Throughout all of this I have not missed a single day of work or stopped by regular routines. Still see my family, still go to sporting events, still have sex, still go for long drives in my car (one of fave things on a nice day)...but I admit...I do get nervous and worried sometimes hoping that while I am doing these things I have a GOOD DAY and for all I know these thoughts might very well bring them on.

I dont know how long I need to be on the Klonopin. I am on the losest dose. .5mg twice a day. Doctor says he things once my body and mind calm down, this will all go away. I always have a "what if" thought in my head about them missing something...and have had my moments of what if the techs who ran my tests werent experienced enough and didnt do it right, yes, i sank that low. I cant tell its low when I mentioned that to people and the look on their faces was all i needed.

I havent had a BIG one...since April 28 and 30. All since have been small ones...I dont know if that means I am getting better or that one is yet to come. The big ones never came every day.

[upbeat63]

Hope you've been able to find skippyheart's list, it's a good one, lots and lots of laughs, and lots of truth. It is what we all go through. That doesn't mean it's easy. PVCs and PACs can ruin your life, if you let them, not because they are "bad" but because you put all your focus on them.

I think I read your holter report said 66 events in 24 hours, but it didn't capture any of the "big" ones you feel that make you uncomfortable.

Just to give you a comparison, which I hope might make you feel better, my last holter recorded 1220PVCs/hr, so about 20,000/day, estimated at 20% of my heart rate. I get lots of "big" ones. But they are no more serious than the ones that happen all day long that I'm not aware of. The nurse at the doctor's office can't feel them when she takes my pulse. And I struggle to "feel" all of them myself, but I'm past the point of checking all the time. You'll get there too. Every once in a while I'll catch myself watching, or listening again, it's human nature, but finding activities to distract yourself of that nasty habit will be your godsend.

Goodluck with it all, keep reading, lots of people here who can help just by reading their stories and knowing they are still here.