Should I worry about my chest pain?

February 5, 2006 12:58 PM

How worried should I be about my current chest pain?

I'm 18, female. Overweight (and working on not being), but not obese. I'm on the pill (cilest), and pretty much every time I've been to the GP for the checkup/new prescription every three months, the doctor has commented on my high blood pressure. Only once has it been high enough for me to have to come off the pill for a month.

I recently switched GPs due to going to university in a different city, and when I went to the new one for the first time for my new pill prescription, the high blood pressure was again commented on. The doctor asked if I had a history of various things in my family, and I said that yes, my father had two serious incidents of blood clots in his legs/chest about 10 years ago. Doctors had asked about that previously, but had deemed it to not be a problem.

This time however, the doctor asked me to return in a week to have my blood pressure checked again by a nurse. I did, and during that week experienced some chest pain at seemingly random times, not caused by anything in particular. I mentioned it to the nurse, who said it was nothing and that I should only worry if I have calve/head pain (which hasn't happened). My blood pressure was, again, high, but not to the extent that I have to do anything other than go back in a month.

However over the past week (the nurse visit was a week ago) the chest pain has continued. It's entirely possible that this is all psychosymatic, as when the doctor said that high blood pressure is unusual in my age group I did freak out a little and think "omg i'm going to have a heart attack/stroke".

I'm planning to go to the GP tomorrow, but is there anything I should do in the meantime? Basically, should I be freaking out and dashing to A&E?

posted by Lotto to health & fitness (19 comments total)

I think the only bad thing you can do is listen to AxMe (with a few exceptions) on medical advice for things like this when you're already going to see the doctor tomorrow. The doctor is very likely to be correct in what he tells you. Just be sure to tell him everything and that you ask questions until you understand.

All you'll get here is positive confirmation from armchair physicians based on any anecdotal evidence they can remember about that one triathlete friend of their dad's cousin that died leaving the doctor's office after being told everything was fine.
posted by kcm at 1:02 PM on February 5, 2006

Here, I'll save you the six degrees of separation. I had a stroke when I was 27. I was on the pill at the time. First-hand anecdotal! I think the pill is from hell, obviously.
posted by astruc at 1:12 PM on February 5, 2006

Wait until you hear from the doctor. May be something as benign as heartburn. I went to the ER because I thouht I was having a heart attack and it ended up it was just spicy food chocolate and coffee. Anxiety doesn't help either.

Relax and see the doctor. Good luck.
posted by terrapin at 1:16 PM on February 5, 2006

the salient pts:
1. you have a family history of blood clots
2. you may have chronic high blood pressure
3. you are taking contraceptive pills

#1 is significant because if _you_ have a clotting disorder, you should not be taking the pills. this is an absolute contraindication. however, not all blood clots have genetic roots; you may not have a clotting disorder.

#2 is significant because chronic high blood pressure (hypertension) is a relative contraindication. there are many causes for elevated blood pressure, including nervousness over getting yr pressure checked.

your nurse is wrong when she said that you should only worry if you have calf/head pain. while yes, blood clots do often form in the deeper veins of the calf and can cause strokes in the head, clots in the calf may not cause pain, and clots in the head rarely cause pain. also: clots can form _anywhere_, and can move to the lungs. google up "pulmonary embolism."


at any rate, chest pain can be caused by many things, benign and emergent. there are a bunch of questions that can be asked and things that can be checked to help determine whether or not the pain is a symptom of something major. yr physician probably has checked up on these things.

the bottom line is this: i don't know enough about you or what's going on to say if you're ok or not. i would trust yr physician at this point, over what anyone else says on AskMe, including me. and to that end, i say: don't sweat things. have a nice day, and go tomorrow.
posted by herrdoktor at 1:31 PM on February 5, 2006

herrdoktor: my dad had a PE, possibly 2.
posted by Lotto at 1:37 PM on February 5, 2006

High blood pressure rarely causes pain. You just drop dead one day. Thus the name, "silent killer".

At your age, it's almost impossible to have the heart problems that older people often have. You may have laid the foundations for trouble later on, depending on your habits, but the hens have not come home to roost yet. So you don't have angina from almost-clogged arteries.

I would guess your pain is due to a muscle strain, perhaps from lifting weights as you try to not be overweight. Strains in your ribcage area can last a long time, have pain that comes and goes, and generally be worrisome.

I would continue what you're doing: follow through with the doctor, do what is necessary to keep your blood pressure under control, continue exercising, take an aspirin a day if you're worried about blood clots, and don't worry too much.
posted by jellicle at 1:37 PM on February 5, 2006

Many hospitals have help lines staffed by nurses. Look in the phone book and call. Especially with your family history, better safe than sorry.
posted by konolia at 2:08 PM on February 5, 2006

Having that kind of pain is really scary, no matter if it's fairly benign or not. I had something similiar last year (substituting persistent anemia & heart mumur for high blood pressure). The mumur got the all-clear from a cardiologist, but still worried. Eventually got referred to a specialist & found out the pain was from a pulled/scrunched muscle in my neck. Got a orthopedic pillow and it fixed itself in about a wk. That said, health/medical issues are very, very individual. Listen to your doctor. If you don't feel like they're listening to you or explaining away your concerns, shop around (if your insurance allows it). A good doctor can really put your mind at ease.
posted by ejaned8 at 2:12 PM on February 5, 2006

herrdoktor: my dad had a PE, possibly 2.
there are tons n tons of causes of PE, and non-genetic causes account for a small percentage of cases. there are tons n tons of causes of chest pain, and heart attack and PEs account for a small percentage of cases. the reason why chest pain warrants a workup is that if, in the rare case, it is due to something bad, that something bad is really, reaaaally bad.

you're prolly ok. yr physician prolly has done the appropriate things to rule out anything acute. i'd sit back, relax, and listen to some funny tunes. carry more faith in a doctor who's seen you over some random doods on the internet.
posted by herrdoktor at 3:00 PM on February 5, 2006

also your insurance may have a nurse hotline. they are great to talk to in the meantime.

do you have to take the pill?? how bout an IUD? they are really becoming more and more of an option for people who cannot take the pill for what ever reason.
Also see if the doctor has some good suggestions for your weight loss. My doc thinks South Beach diet is a good option because it promotes healthy eating and it was designed by a cardiologist. I have had lots of friend have good luck with it or weigt watchers. or maybe he can recommend a nutritionist.
I just think a lot of your problems would be greatly diminish with weight loss. From the tone of your email, I can tell you don't want to live your life in fear.

good luck...please just try and take it easy until then.
posted by TheLibrarian at 3:57 PM on February 5, 2006

You have chest pain, a family history of DVTs and PEs, and you're on oral contraceptives. I'd go to the ED if I were you.

jellicle, your advice about something so potentially deadly is so freaking wrong and scary and off base that you should honestly consider never answering an AskMe health question again.
posted by gramcracker at 5:08 PM on February 5, 2006

Frankly, I'm surprised you were allowed the pill, having known your own family history regarding blood clotting and high blood pressure.
posted by sian at 6:09 PM on February 5, 2006

Never a bad idea to go to a doctor when chest pain is involved.

Now for a true story : My friends father was experiencing a dull ache in the center of his chest. This went on for a few days, and he was often seen wandering around, rubbing his chest and looking worried.

He went to the doctor, who checked him out, then sat down and told him the news ...

... He had bruised his sternum, and rubbing it constantly was keeping it bruised and tender. His heart was in fine shape.
posted by tomble at 9:36 PM on February 5, 2006

I once went to the ER thinking I was having a heart attack, turns out I pulled a muscle in my chest. (Yes, yes, laugh away.) The key, the doctor said, was that my pain was reproducable (when he pushed on my chest, it hurt) and surprisingly, he said that a badly pulled chest muscle can feel very much like a heart attack.
posted by katyggls at 11:55 PM on February 5, 2006

Ask your doctor about a possible workup for hypercoagulability syndromes of a genetic nature. Depending on the circumstances of your father's clots and the rest of your family history, an evaluation may certainly be in order. The most common syndromes that are assessed include Factor V Leiden, Prothrombin G20210A mutation, Protein C & S deficiencies, Antithrombin III deficiency, hereditary hyperhomocysteinemia, antiphospholipid syndrome, and elevated Factor VIII. Note that in the right setting, even with a negative workup, it may still be advisable for you to consider discontinuing oral contraceptives, or for that matter, to discontinue them now until you find some resolution to your concerns (which are certainly valid). Also note that if you pursue this evaluation, you should consider seeing a specialist as in my experience, primary care practitioners often have difficulty appropriately interpreting the results of hypercoagulability tests and their implications.

Know that a heart attack based on what you've said thus far would still be incredibly unusual, not to mention inconsistent with how you've described your pain. That said, acute or chronic pulmonary embolism is a more realistic concern, and this more often than not occurs in the setting of no obvious calf pain (feel free to educate the nurse on this matter).

As always, the short answer is to go see your doctor. Your concerns are valid and should be addressed by someone who has both the proper medical training and the benefit of a complete history and physical examination.
posted by drpynchon at 2:10 AM on February 6, 2006

gramcracker: thanks for your stupid comment. There's never a shortage of people who will shout "RUN TO THE EMERGENCY ROOM NOW!" for any health-related question, even if the asker is describing something that is 99.99999% likely to be a strained muscle. I'm glad you were the one this time.
posted by jellicle at 5:58 AM on February 6, 2006

Update:

I went to the GP today. She listened to my chest, and declared that nothing sounded off at all, so it must be a strained muscle or whatever.

Incidentally, she also switched me from the combined pill to the progesterone-only pill, with a view to sorting out my blood pressure. I have to say, I'm feeling rather pissed off at contraceptives in general at the moment.
posted by Lotto at 12:16 PM on February 6, 2006

I'm assuming your GP did whatever was necessary to ensure that you're not having a PE or heart attack.

The good news about switching to a progesterone-only pill is that you're not increasing your chances of developing a PE/DVT/clot, as you would if you took a pill containing estrogen.

Bad news: you need to be sure to take the pill at the same time, every day. I don't remember off-hand, but I think it's got to be within a couple of hours each day.

Sorry you're pissed. Hope this thread helped somewhat.
posted by herrdoktor at 1:20 PM on February 6, 2006

jellicle: I'm a medical student. I don't shout "RUN TO THE EMERGENCY ROOM NOW!" unless I think it's warranted.
posted by gramcracker at 3:59 PM on February 6, 2006