Sudden abrupt chest pressure

[jason_k]

Hello Doctor, I am a 32 year old male that have experienced chest pain while on a treadmill a few times over, pain that felt like blood was pumped out of my heart and could not fill up fast enough. heavy pain in the center of the sternum. this pain would come suddenly and only last a few seconds while shocking my body, I would break out in a sweat. I follow a healthy diet, except on the weekends I will eat Pizza. I have no family history of heart disease except my grandfather was diagnosed with a bad valve in his 70's. I weight train modorate to heay weights and do walking cardio of about 3.5 to 4 mph about 5 days a week. I have a resting heart rate of about 40 to 45 beats per minute. My bp is 135 over 75. All bloodwork came back normal. My cholesterol total is 135, hdl 49, vldl 6, ldl calculated 80. I had 2 EKG's, both normal. Stess Echo normal with slight heart enlargement(cardiologist said it was most likely athletic heart). Cardiologist feels my heart is fine and the pain is not heart related, although it felt like the heart stopped for a sec. or could not handle the demand. I also wil get fluttering palputation from time to time, seems they come on for no reason. I am concerned with this and the low resting heart rate. If it is athletic heart, how long would one have to be lazy for the heart rate to return to a normal range of 60 beats per minute. I have stopped training for 2 weeks now to rest incase I pulled a chest muscle(I do not have muscle pain). Just very concerned about the low heart rate and the sudden angina like pain get. What are your thoughts and advice?

[CCF-M.D.-MJM]

Hi Jason,

With all those test showing no cardiac abnormalities, I don't think you should be too concerned.  A low resting heart rate in a young person is a good thing -- I wouldn't recommend stopping exercise to increase your heart rate.  The probability of you having significant coronary artery disease with that risk factor profile and your age is very, very low.

If it is athletic heart, how long would one have to be lazy for the heart rate to return to a normal range of 60 beats per minute.

I would not do this unless your doctor has asked you to rule out other conditions.  6 weeks should be enough for an enlarged athletic heart to return to a normal size.  Again, I would only do this if your physician recommends it.

I have stopped training for 2 weeks now to rest incase I pulled a chest muscle(I do not have muscle pain). Just very concerned about the low heart rate and the sudden angina like pain get.

Given the sensation you describe, it is more likely that you had a PVC (premature ventricular contraction) that felt like a pause.  If this happens frequently, you should be able to capture the event on a holter monitor or event recorder.  Don't be afraid to ask for a second opinion if you are very concerned, but from what you describe it does not sound dangerous.

I hope this answers your questions.  Good luck and thanks for posting.

[jason_k]

Thanks for responding to my concerns. Is PVC (premature ventricular contraction) something I should worry about? The frequency of this happening was once to 3 x's a month. Because of this I am afraid to push myself cardio-wise on the treadmill when working out. My fear is that I am going to suddenly drop dead while working out when this happens. Or is this something I can just ignore considering my low risk factors for heart disease? Thank You.

[Schmoomcgoo]

I think the Holter monitor is a good idea to give you some assurance and/or explanation of the sensation you are feeling.  Also, my husband (whose resting heart rate is very similar to yours) was told by his cardiologist that his heart would appear to be larger than normal because it is at rest more than a heart that beats faster.  That said, if you have an "athletic heart," why is your systolic BP 135 at age 32?  By the latest guidelines, that is pre-hypertensive. ( http://www.americanheart.org/presenter.jhtml?identifier=3011728 )  Also, 3.5 to 4 mph is a brisk walk.  Does that get your heart rate up?  I ask because I am restricted to a heartrate of 110 or lower and I walk at the same speed and I'm a female with more than a decade on you.  Maybe I'm way off base, but these things don't seem to add up to me

[jason_k]

Thanks for the comments. at 4.0, I get my rate to about 110. Like I have said, lately I have been afraid to push myself past that. I also felt my bp should be lower for the low reting heart rate and my age. Any suggestions on bringing that down, I will really focus on cleaning up my diet even more and continue the cardio. I will bring up these concerns with my doctor. Everytime I talk with them, I feel like they are not as worried about it as I am, most likely because of my so far so good results, age and no family history. I believe we know our bodies and when something is not right, you can just tell. In my case, I strongly feel something is wrong, I just don't know what. And if it is PVC, it happens to much and the pain is to severe. I have had heart palputations before, but this pain is so crushing and severe when it happens that it stops me completely in my tracks.

[anacyde]

PVCs are extremely common, especially among many of us here.  Take a look through the archives and your mind will be put at ease :)  In a normal heart, which it sounds like yours is, PVCs are not a concern.  Some people have the unfortunate experience of being very aware of each one, like me.  It's not pleasant, but it won't kill you.  My cardiologist basically told me to ignore them and stay active.

[jason_k]

thank you, I feel mor at ease.