Various - chest pain

[Jo52]

Hi wonder if you can help.  I am a personal trainer and have a 63 year old female client. I have kept her at a moderate intensity for some time and she has lost a lot of body fat so all was looking great.  She does have high blood pressure when I take it, and left bundle branch block.  I wrote to her doctor
when she first came to me and he confirmed her blood pressure ok and she was able to work at a vigorous intensity! according to her age.  She also had a masectomy 3 years ago and has damaged her lymph in her legs permanently from a childhood accident.  I have had to hold her back constantly as she will work if left alone until gasping for breath and chest pains.  
Recently she went for a preop check for breast reduction of the remaining breast and they will not perform an exercise ECG on her for fear of her having a heart attack (this is from her) and she is being investigated furthewer as they do not want to put her under as afraid she will not come out from this.  I am very worried, I have decreased all her workouts, I see her 2 x a week,  We went for a 5km walk on grass yesterday, I monitored her throughout talking etc all seemed fine then at the end she complained of tightness right accross her chest and pain, although no tingling in fingers and no pain down arm.  She said I am too fussy, but I am worried. The other very strange thing is that I do put a heart rate monitor on her when she exercises and normally I have to hold her back to keep her at a safe level, but yesterday and the time before her rates were massively lower average heart rate i the low 70's.  I thought perhaps it is my moniot, but I have checked this with others, myself and hubby and it is working correctly.  Does any of this sound familiar to anyone any advice would be appreciated,  I can just say to her that I cannot work any longer with her, but this is not doing her any favours and when she first started with me she was very depressed and exercise and healthy eating has lifted her from this.
Thank you

[Jo52]

Thanks I know you are right, this is how I have been thinking, I see her again on Monday and this is the way I am going to go with her.  She is very stubborn and I have said to her on several occasions that I am worried, but her answer is no need she would have had a problem already if it was going to happen.  Like you say it will be on my shoulders.  We have become good friends now it has been some time we have been working together.  I hope she takes it the right way,  her doctor was quite mad I think in the first place to say she could exercise at a vigourous intensity, thank goodness I went my own way and did not do this!
Thanks for your advice.

[Barbarella]

I'd tell her to go to her doctor and tell him/her about the chest pain/tightness in chest she is getting during or after her exercise.  I would tell her that until you get a slip from the doctor telling you that she can continue to exercise despite her chest pain you cannot exercise with her anymore until you get the reassurance from her doctor.

I would not worry about whether this will not do her any favors.  Should she have a heart attack or stroke on you during or after exercise it would be on YOUR concience and maybe even later backfire on you i.e. "you knew that I had chest pain but you let me keep on exercising anyway" or her loved ones could say that to you, and even a lawsuit could be in the works.