mild chest pain/skipped beats

  I am a 36 year old, over-weight female.  I have been a high caffine consumer
  for many years.  I have recently lessened my caffine intake and will soon be
  off completely.  I believe my heart may be skipping beats now and again.
  Sometimes I can only count them to ten, pause, maybe then to twenty, or more
  before the next pause.  This happens often, but not constantly.
  This has not been confirmed by a medical proffessional.
  Also for some time, I've avoid sleeping on my left side because I can feel
  my heart beat.  It doesn't hurt, but its an unpleasant sensation and again,
  not all together regular at times.
  Lately I have been getting small pains on my left side.  A sudden localized
  jab, sometimes longer like a pull. Not very painful but noticable.  Could
  be a pulled or strained muscle, but if so only on my left side and reoccuring
  for sometime.  My blood pressure has always been good. Enough to surprise
  that comment from the nurses when I've gone in for flu or whatever, like in
  Febuary. Not to say it is good now, I don't know.
  I haven't had dizzy spells (except when I feel a skip (monitering my pulse)
  and I get really scared)
  or the other normal heart related symtoms (symptoms).  Ever since I was a child I've
  gotten cramps on my left side where I have to sit or stand still and straight
  until they pass, hardly breathing.  But dr's mentioned my poor posture to
  my parents when I was tested for MS (?) in elementary school.
  Could dieting, eating properly, not too little, bring on these problems?
  I have a long way to go before I'm in a healthy weight zone. I had my
  gallbladder removed about two years ago, an attack brought on by weight
  loss.
  I have just started taking 100 mg of CoQ10 also.  Not on a dr's advice.
  When I get the pauses or just frightened at night, I take an asprine.
  Also, I realize I need to seek medical advice one on one here, is it better
  to start with a physcian or straight to a cardioligist?  We are not insured
  and this is all extremely frightening, and impossible when it must come out
  of our pocket.
  It is the only reason I haven't gone anywhere yet.
  Also, assuming there is a blockage problem, I read a phsician's site on the
  web who uses ultra sound instead of surgery.  I haven't seen such a thing
  mentioned anywhere else.  He states the plaque can removed safely this way,
  in one or a few visits. He also doesn't use physical stress tests due to
  the danger involved but gives stressful mental tests, puzzles. States these
  can actually be more helpful because most heart attacks come from mental,
  not physcial stress.  I would appreciate any adivice.  I will try to see a
  local dr next month.
  Thank you.

[CCF CARDIO MD APS]

Dear T Evans,
The best advice that I can give to you is that you should go see a general internist, i.e. a doctor who practices general internal medicine.  Even a family physician would suffice; regardless this doctor you chose should take a detailed history and do a complete physical exam, then proceed with addressing the issues of "skipped beats" and weight loss.  As you may know already anything such as stress, caffeine, chocolate, tea, and sleep deprivation can give you "skipped beats" which technically we call premature beats or PVCs and PACs.
You should try to deep track of your daily caffeine intake and see if with less caffeine and other stimulants the number of skipped beats lessens.  You also should read all that you can on dieting that involves changing bad eating habits and creating meals that are well balanced.  Beware of quick fix type diets, usually these are ones where you pay for pills to take.  The diet regimines that teach and counsel on good eating habits, even the ones that make you buy their food initially, are very good.  The only diet regimine that really works is one that includes a daily exercise regimine.  I mean everyday you do some form of exercise that gets your heart rate up and makes you sweat a little.  So, you say that you are overweight, and I tell you that initially you should do water exercises or take brisk walks outside or on a treadmill, and later when you
have lost some weight (and you are closer to your ideal weight) then you can switch to a more aerobic form of exercise if you wish.  Although your symptoms of chest discomfort sound very atypical (not likely due to heart blockages), you still need to see a physician prior to starting an exercise and diet regimine.  You are young enough that if the doctor gives you a clean bill of health except for your weight then off you are to the care of yourself and the most frequently you would need to see a physician from then until you are 50 would be solely dependent on how you feel and usually not more than once every 2-3 years.  As you can see this would not be expensive save for the initial office visit, granted you are otherwise healthy.  
You have already taken the first steps toward improving your health, I will just tell you a few very important heart health tips now.  The main offenders are smoking (must stop if you are currently smoking), high cholesterol (no more than 30% of your total daily calories should be from fats, and most drug stores or malls offer free cholesterol screening), high blood pressure (free screenings also available), diabetes (high blood sugars),sedentary lifestyle (no regular exercise), and family history of heart disease at young age (under age 50.)  Most of these offenses that we know contribute to the development of heart disease are modifiable by you and DO NOT require you seeing a physician regularly.  Congratulations on wanting to get on the healthy track, it shows that you have self respect, that you care about yourself, so please do not let the not having insurance idea scare you off the track.
As for the various treatments for heart blockages, yes ultrasound is one of the newest techniques on the market so to speak but as with anything "just developed" it has specific applications, and at this point in time you should not even assume that you have blockages.  I will not address any further the issue of coronary heart disease except to speculate on the stress subject as I can not even speculate that you have heart disease.  As for the stress subject, there are many ideas and studies of it's effect on the heart (mental stress), surely it is not the sole cause of coronary blockages and heart disease, but it probably does contribute to the development or progression of heart disease.  A good note for you here would be to say that exercise decreases mental stress significantly for most people.  
To finalize this, you need to see a physician for a general medical checkup, then under that physicians guidance start an exercise and weight loss program.  Look in to alternative ways to combat stress (yoga, etc.) if you need to, but do not waste your energy mulling over treatments for a condition (heart disease) that you as yet do not have.  And finally I forgot to tell you that PVCs and PACs are very common and almost always benign with a great prognosis.  I hope that I have answered the majority of your questions and good luck on the road to your improved health.  
Information provided in the Heart Forum is intended for general informational purposes only. Actual diagnosis and treatment can only be made by a physician.  If you would like to seek care at the Cleveland Clinic Foundation just call 1-800-CCF-CARE for information and an appointment.