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Severe chest pain and pressure
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!
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!
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.
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.
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
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
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
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
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 (:
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 (:
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.
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.
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
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