worsening clenching in chest, pressure, and pain upon exertion

[linnet741]

I used to be a competitive athlete. I was diagnosed at about eight years old with mild asthma.  As a child I sometimes had occasional difficulty with aerobics, despite my athleticism. This difficulty manifested itself in  difficulty breathing, pressure in my chest, feeling a little ill, and a leaden/tingling feeling in my legs upon aerobic exertion. At the time, I attributed this to my mild asthma, for which I had an Albuterol inhaler.

Upon entering college in Fall 2007, I semi-regularly worked out in my school's gym. Though I did not stay in "competitive form", I did not gain weight and still considered myself quite fit and strong. I noticed some increased difficulty on the treadmill (pressure and slight pain in my chest, but again, attributed it to asthma).

The Spring of 2008 I enrolled in an aerobic running class.  Within 15 minutes of mere jogging, I was having terrible difficulty, though I had in advance taken my Albuteral. Whatever was wrong, I don't think it was asthma. I had horrible, clenching sensations in my chest -- I felt as if my heart were seizing up. My head pounded, and my heart was racing so fast it hurt.  It wasn't long before I had fallen to the end of the line. I was also sweating excessively.  I finally dropped to the ground (unnoticed to the rest of the class, who plowed on ahead). I do not recall passing out, though I very nearly did. Everything in my peripheral vision was black, and the black was steadily encroaching on my central vision. I felt awfully ill, and I really believed my heart would hammer its way out of my chest.  

I don't remember how long I lay on the sidewalk before  the school janitor found me and hoisted me away to the school's health center, where they told me I looked terribly white. They said something about my blood pressure too, but unfortunately I do not remember what it was.

It took me many hours till I felt like I could stand up again, and even then I still felt drained and fragile. The Health Center kept me under surveillance for these hours, and after I failed to do anything else interesting, sent me away with an advisory to come back if the symptoms repeated.

The next class the very same thing happened. This time I was forbidden to return to the class, as I was clearly unfit, but the Health Center still had no idea what was going on with me. It was convenient for me both academically and financially just to ignore my condition and simply avoid activities that were becoming ever more strenuous for me. I would try my Albuteral inhaler, but it never made any difference.

Later that year I mentioned these difficulties to my physician in my annual checkup, along with my concern over my lifelong  tendency toward sudden drops in blood pressure -- i.e, when I rise too suddenly, everything goes black and I pass out.

I also explained that every once in a great while, though,  a blood pressure "spell" may come on out of the blue, even when I am just standing around. In these spells, my eyesight gradually blacks out -- like ink is seeping into my vision, finally obliterating it at the very center of my vision. This is followed by a gradual loss of hearing. Then I usually pass out (or, if i'm lucky, cling to consciousness from some distant place). I come-to by gradually regaining my hearing. Then I start to see a pinpoint of light, and the ink starts to drain away.

My doctor simply theorized that these spells were probably nothing more than vasovagal syncope. He did not seem very concerned about my aerobic difficulties and did not counsel I look into them further.  

A final, and isolated incident which I will include, in case it is somehow relevant.  About 5 or 6 years ago, I was waiting quietly on a bench in an empty room. A friend entered, and spoke to me. I heard her say words; I saw her clearly, and I was able to think clearly. However, I could not understand what she was saying. I knew it was English, but for me the meaning had gone. The words were hard and senseless and incomprehensible. I mentioned the incident to another friend much later, who wondered if a stroke would explain that isolated inability to comprehend speech.

It is now the fall of 2009.  I have not much change in weight, and I walk regularly, so though I cannot dance or run anymore I would still consider myself to be healthy. I cannot stress enough that my diet is splendid and my weight normal and that my body seems strong -- it is just incapable of THE SLIGHTEST aerobic exertion. My condition has degenerated to the point where I cannot ignore it anymore. I can no longer climb stairs even slowly without pausing to catch my breath -- I even have to consider carefully my routes about campus so as to avoid steeper hills, staircases, etc. With the slightest aerobic exertion, my heart seizes up and my breathing becomes labored. I feel pressure on my chest and a stabbing pain, and I sweat a lot. My head will pound. And it always takes a long, long time for my body to recover, my pulse to grow steady, my breathing to normalize.

I have heard that bulimia can damage the heart muscle, and have occasionally wondered if such damage has caused these difficulties. However, it is nonetheless true that my difficulties extend back into my childhood, before the eating disorder, and that said eating disorder was very brief (less than a month when I was sixteen years old).

I am sorry for such a long post, but for anyone who troubles to read it, I am very appreciative that you did so and I would be very grateful for any insight at all.

Thank you,

Linnet

[patientdoc]

hi!

i agree that you should really get checked out.  and asking your family if they have or had similar problems is very important.  some things are genetic and hereditary and can develop or worsen at certain stages of your life.

you should find a cardiologist (heart doctor) and maybe an endocrinologist (breathing doctor). you many be experiencing heat palpitations, which can be hereditary. with palpitations your heart can be racing at times and the clenching feeling might come on more during stress, like exercise or around the time of your period because of the hormonal changes.   when you see  the doctors  have them do an asthma test where you blow into something connected to a computer. also have them do a ekg  and eeg test, they are very simple and fast. they just  put little stickies on  you and measure your heart. also have them do a sonogram of your heart to check for structure, heart murmurs and palpitations. if all that comes out normal, ask to do a 2-4 week event monitor.   you have wires connected to your chest going into a cell phone and it monitors your heart 24/7 or as long as  the wires are connected to you. the phone sends the data to your doctor. and if you experience any symptoms there's a button on the phone you press and you can choose from a list of symptoms, and you can chose more than one, and send it in and your doctor will see that.  and the last test that you should have done  is a tilt table test, it measures your blood pressure and heart rate while you're sitting, standing,and lying down. it takes about 45 minutes.  and if you're having low blood pressure problems and feeling dizzy and lose sight, try eating something salty. like french fries, potato chips, blue corn chips, soup, rice and add  salt, soy sauce, etc. if this helps tell your doctor and they might put you on  sodium pills.

the best advice i can give you is to get help before it's too late.   and if you see one doctor and you feel like they aren't getting it or you don't get a good feeling or if  they're not listing to you just walk out and find another doctor.  you know your body and it's not in your head if you feel this. just keep up the good spirit and keep looking for a doctor that has ideas and is working with you.  

i hope this helps and good luck.  if you keep working on it you'll be just fine.  and keep exercising, but lightly. tale a small walk, try to go up 3 stairs at once and maybe in a few days 4 steps.  take it slow and keep trying.

[NTB]

hi, do you take the Albuterol a lot? that might be making the problem worse, especially if you have some sort of rare exercise-induced "variant angina". Since Albuterol is a stimulant, it might be constricting arteries even as it relaxes the lungs.

the symptom of heart pain seems bad to me. Repeated occurrences where the heart is so starved of oxygen that you have pain might lead to permanent damage - and eventually even heart failure far, far down the road.

you probably didn't have a stroke per se, but did have a lack of oxygen to the brain from other reasons, which mimics the effects of a classical stroke

variant angina is also called coronary spasm. You might even be having spasms in other arteries. You really should get it checked out. You are way past the point of merely fainting. If a doc prescribes nitroglycerin and that immediately relieves symptoms, then you will have a much better quality of life. Then there might be other steps/treatments that are more long lasting.

Another thing to do is to ask about family members who had any similar symptoms or known vascular conditions - some heart conditions are inherited and since you're too young for most of the common heart diseases (like atherosclerosis), one would look to inherited conditions as a possible cause.

As a pure guess, it might also be that you never had asthma, if you were diagnosed on the basis of the initial symptoms alone. Good luck to you, I bet you'll end up just fine :)