Heart Rhythm Expert Forum
Chest pain and blood pressure
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Chest pain and blood pressure

I have an autonomic neuropathy and experience varying symptoms-

A few weeks ago I experienced a sensation of heaviness across my chest and erratic heartbeats throughout the course of a week- an hour after waking I would begin to have this heavy sensation and then 2-3 hours after that i would begin to have a crushing chest pain that would last until late afternoon then disappear- this continued for one week with the chest pain becoming stronger each day- after that week it went away.
During the last two days of this episode I took my blood pressure several times- I mainly got less than average blood pressure readings, but each one had a "heart" which my machine was indicating was an irregular heartbeat- I also had at least 2 strange readings, the strangest being 86/69- my normal Bp is 120/80. I have never had the "heart" show up on the monitor anytime before or after this episode- I also haven't had any Bp readings outside my normal range since. I always take my Bp sitting at my desk the same way each time.

What could I have likely been experiencing??  I dont see a cardiologist for another 2weeks and I'm still experiencing some (but less) erratic heartbeats.
4610897_tn?1393869202
Hello. Thank you for your question.

I have read your case description. Here are my thoughts:

If a patient complained of similar symptoms, I would be very concerned with what you are describing. I would counsel such a patient if the symptoms of crushing chest paint that was accelerating in a “crescrendo” pattern over course of days to go to the emergency department immediately. My primary concern would be unstable angina, which is a type of myocardial infarction (heart attack). The erratic heartbeats, which are often called palpitations, could be the cause or a complication of such a condition. They could represent any great number of abnormal electricities of the heart, called arrhythmia. I would be most concerned with ventricular tachycardia, a certain type of arrhythmia associated with low blood pressure (hypotension) or ischemic heart disease (coronary artery disease, unstable angina).

In regards to the fact they are “irregular” by your heart rate monitor, this could signify a few conditions in particular. Atrial fibrillation is a common arrhythmia that is irregular. But abnormal beats called premature ventricular contractions (PVC’s) or premature atrial contractions (PAC’s) could cause irregularities.  

After performing a detailed history and physical exam and obtaining an ECG in the office I would discuss the following tests in such a patient:

1. Holter monitor (ECG monitor that is worn for 24 hours up until a few weeks and brought back to the office for intepretations).
2. Echocardiogram (ultrasound of heart that looks for structural abnormalities)
3. Coronary angiogram or a stress test after further discussion with the patient about the nature of their symptoms and the risks/benefits of a coronary angiogram. This test would be to look for coronary artery disease, or blockages of the arteries that supply the heart.

I hope this provides some insight into how physicians would approach such a problem. Again, I recommend any patient like this see immediate evaluation for any further episodes of chest pain or if  patient  passes out (syncope) or feel like you are going to pass out (presyncope). They should also seek immediate evaluation if their blood pressure is low especially when it is associated with any kind of symptom described above. A low BP would <100/60 or 100) as you may be having an arrhythmic event.

Very Respectfully,
Dr. S
4 Comments
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Avatar_f_tn
Thank you for your response.

If I were to be evaluated by my doctors office during an episode (in case this happens again)- would a simple ekg and him listening to my heart possibly capture the event? I'd prefer to be seen by my physician first and then go to the emergency room if needed.
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1770925_tn?1365622122
This sounds like my problems I have AFIB and I will find very mild pressure across my chest. my doctors ran the two day nuclear stress test and I came out okay . Your comments on this very similar to my case thank you for the information
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1770925_tn?1365622122
When I have the chest discomfort, I eat a granola bar bar or some gum drops, and the problem goes away.  My doctors don't believe me, but I am convinced nutrition to muscles, all muscles, is a problem. I have AFIB and recently came out ok on a nueclear heart stress test.
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