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Chest pain, dyspnea, increased heart rate
Hello,

I am a 21 year old female, and for about 2 months I have been getting progressively more symptoms. It started out with unusually short of breath while doing my normal exercise routine (usually 2 zumba classes a week and one day of walking/jogging). Then I got to where I couldn't walk up a flight of stairs, or from my car to class without not being short of breath. I have also had progressively worsening chest pain that started after the first onset of dyspnea. It normally comes at night when I am laying down, and especially after I have had a more active day. It lasts for 30-45 min usually and gets better when I sit up, so I have had to keep myself propped up on pillows to be able to sleep. I usually wake up at least once a night with SOB and chest discomfort, that requires me to reprop myself. I visited the student health center at my university, where I had a (normal) EKG and wore a 48 hr Holter which showed tachycardia up to 170. I was referred to a cardiologist, and my appt is on thursday.

Last Thursday I took an Aleve for menstrual cramps before bed (which I have used for years for cramps), and about 15 min afterwards had severe chest pain that was sharp and searing. It lasted for most of the night. The next night I again  took an aleve and again had the severe chest pain. I went to the ED this time as the pain was unlike the ones I normally have. For the time I was in the ED and admitted, I had a sustained elevated heart rate (105-115). They didn't give me anything for it, and after about 10 hours it went down into the 90s. My blood pressure was 160s when I arrived, and after many hours made its way down to the 130s (my BP is generally 120s/70s).

As far as tests go, my potassium was a little low (3.3) and my TSH was high (9.7). They did a TTE that showed vigorous systolic function (unsure what that means) and an estimated EF of 65-70%. Everything was normal except for the  LV posterior wall, ED (11.3 mm) and the relative wall thickness (.51).

They discharged me after the echo and just told me to keep my visit with the cardiologist and get my TSH checked again in a month.

Any thoughts? Mainly, I just don't know enough about echo results to know if my abnormal values really mean anything at all. I am 5'6", overweight at 175, but my cholesterol/lipids/ all of that are normal. As far as stress goes, I really don't have a problem with it.  I changed jobs in November which got rid of my major source of stress and I love where I work now, and I no longer work night shifts (I did that along with going to school full time for 1.5 years). I am a senior in college, but this semester i'm only taking 12 (easy) hours, and don't even have classes T/R, I couldn't ask for an easier semester.
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To answer your questions regarding the echo (TTE, transthoracical echo):

Vigorous systolic function: I haven't heard this name for it before, the common expression is "good heart contractility" or "highly contractile left ventricle", and it's not a bad thing. EF of 65-70% means that the heart pumps 65-70% of its blood out in the body each pump. Normal is 50-70% so you are in the upper normal area. A low EF (below 50) can be a sign of heart failure. Maybe you were stressed during the echo? Mine was above 70% (I hate echos.. ;)

LV posterior wall, ED 11,3 mm: Upper limit of normal, too. It means the thickness of your left ventricle wall when the heart is filled with blood. Normal is as far as I know 8,0 - 12,0 mm, but it's often slightly less in females. Mine is 10,5 mm. Often the wall thickness is overestimated, remember that an echo is a two-dimensional picture, and depending on how the doctor holds the transducer, the results may be too high, just like when you slice a banana. If you do not hold the knife at a 90 degree angle towards the banana, the slice looks larger than it actually is.

Relative wall thickness 0,51: (normal <0,43), How thick the walls are related to inner volume. In your case: 11,3 mm x 2 = 22,6 mm. This is 51% of the inner volume, which in your case is 22,6 / 0,51 = 44,3 mm.

What is the cause of this? Sometimes a high blood pressure but you say your blood pressure is 120/70 which is great. Sometimes it's a normal variant, but you should ask your doctor. In theory it may have some relation with your chest pain and shortness of breath, but not necessarily. You could ask your cardiologist about this too?

High TSH may be a sign of subclinical hypothyroidism. Also, follow up your low potassium, is there a cause for this?

We are not doctors and can't provide a diagnosis, but ask your cardiologist. This will probably give you answers.

Good luck!
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