Heavy heart.
June 9, 2013 9:36 AM   Subscribe

You are not my doctor, but you might know what kind of doctor I need to find or what kinds of questions to ask. Please help me piece together a plan so I can get some health issues sorted out.

Before I dive in to the details, please know that I understand chest pain is very serious and if I were in any kind of pain, I would go to the hospital immediately. I am not asking for medical advice or an internet diagnosis - I am just trying to figure out what my next steps should be regarding my current situation.

So, I have some weird chest feelings (I wouldn't describe it as pain) and I don't know what to do. There's a bit of history here, and a few current factors that might come in to play, so I'll try to lay it all out.

About 18 months ago, I went to see my gynecologist about going on the birth control pill but my blood pressure was unusually high so I was told I needed to get it under control before birth control would be an option. Although I was overweight (still am, though to a much lesser extent), my blood pressure was so high for my age (mid-20s) that it caused my doctor some alarm. I was sent for a bunch of blood tests to see if I had any hormonal issues or if there was an obvious cause for hypertension, but nothing was found. Because I was active, consistently losing weight, and consumed a low-sodium diet, the doctor was concerned about my high blood pressure, and sent me for more tests. Over the course of a few months, I had an EKG (electrocardiogram) done, an ultrasound of my kidneys, and then a chest ultrasound.

After these tests, 3 different rounds of urine and blood collection, and seeing 2 different specialists, I was told nothing is wrong with me and my blood pressure might just be high because of stress. My blood pressure did come down a bit as I lost more weight, but it's still a bit high for my age (usually 130-140 over 80-85). I didn't have any pain or symptoms, so I just kind of left that mystery alone, and promised my doctor I would check my blood pressure at least once a week to make sure it didn't skyrocket. I also agreed to leave birth control out of the question for a while until my blood pressure normalized (as it seemed like it might). Since all of this happened, I moved to a different part of the world. Now I live in the Middle East and since arriving in January I've had some sinus issues (recurring infection) but no major health issues.

However, over the last few months, I've had this weird sensation in my chest. 80% of the time, it's only on the left side, but sometimes it spreads across my entire chest. I do feel weird sensations in my left arm as well, but I used to suffer from anxiety attacks so I think it is likely related to anxiety (once I start feeling weird things in my chest, I get a little worried/panicky and out come the anxiety symptoms). It's not pain or tightness in my chest, but I would describe it as a heavy feeling. It happens pretty much everyday and usually just comes and goes. It's never so bad that I am uncomfortable, but it's noticeable. I mentioned this to a doctor I saw about my sinuses (when asked if I ever had trouble breathing) and he said it was probably my chest/lungs adapting to my new environment. But as time goes on, I feel less like it has to do with my lungs, and I am becoming concerned it may be to do with my heart.

I saw a gynecologist last month and she prescribed me the birth control pill (after checking my blood pressure and listening to my history, of course). I started taking it about 10 days ago, but stopped after 7 days because that weird sensation in my chest seemed stronger (and spending too much time on Google and webMD convinced me of many scary things).

So:

Yes, I realize I need to see a doctor. I am going to drop by a clinic tomorrow and see if I can get an appointment ASAP. However, what I need to know is:

- If I had an EKG and a chest ultrasound done, what other tests can they do to determine whether this is a real problem or just a weird kind of anxiety phantom pain?

- What kinds of questions do I need to ask to make sure I am getting thorough care? Everything I read online about chest pain or discomfort terrifies me, so I want to be sure I am doing everything I can do properly.

- Is it possible that my horrible sinuses are causing me some kind of chest pain? The only real health problem I know that I have is chronic sinusitis.


Possibly relevant details:
- 26 year old female
- Losing weight over the last year at a healthy, steady pace (still slightly overweight)
- Very active (gym 5-6 times a week, on my feet all day) but no side effects from exercise
- Family history of hypertension and obesity
- Recently moved from the Pacific Northwest to the Middle East

Sorry for the length! Thanks in advance for any guidance you can give.
posted by gursky to Health & Fitness (15 answers total) 1 user marked this as a favorite
 
However, over the last few months, I've had this weird sensation in my chest. 80% of the time, it's only on the left side, but sometimes it spreads across my entire chest. I do feel weird sensations in my left arm as well

That alone means you are (very) right to see a doctor and get an appointment ASAP. I was in a similar situation and ignored these and other signs for a long time (there are good reasons why much of the literature on this is scary). To cut a very long story short; I nearly died, and am still unsure how much long-term damage I've done.

Ask them to also check your heart rate (you might be already, but didn't mention this). In addition to whatever treatment or examinations happen, keep a pain and tension diary. Note down times, and a note of the intensity. You may pick up on patterns which otherwise are not apparent.

but it's still a bit high for my age (usually 130-140 over 80-85)

That's more than "a bit high" for a 26 year old. As BP inevitably increases as we age, you do need to get that significantly lower. Thankfully you're addressing this now, rather than in 30s or 40s.

Also you mentioned:

Recently moved from the Pacific Northwest to the Middle East

Are you staying properly hydrated, as can imagine that the amount of water your body needs has increased? You need to regularly drink water - good water - before you notice yourself become thirsty.
posted by Wordshore at 10:08 AM on June 9, 2013


Regarding what tests can be done: repetition of all the tests you had. A few months can make a difference. The EKG you had, was that a cardiac stress test, if not they might do that.
Additionally they might want to put you on a 24hrs-test for blood pressure.
I am assuming the chest ultrasound was to detect any structural issues with your heart, which they didn't find.

Another angle to explore: did the GYN examine your breasts/ do you do self-exams? A growing mass in the tissue can feel like it is chest pain, even the arm thing is not unheard of. It can be a small, totally benign lump - an ultrasound can help diagnose after a lump was identified - and still cause that weird chest sensation.
Other things to consider: gas/bloating can give a feeling of chest pain / tightness. Did they remark on air in your abdomen when they performed the kidney ultrasound? (If you had this ultrasound because you had pain in your kidney region, that kind of pain can also be caused by gas).

Just saying that your high blood pressure might actually be not related to the sensation in your chest. If you don't have one already, you might consider buying a home monitor so you can check your blood pressure daily.
However, chest pain is no joke, I second a symptom diary and seeing a doctor.
posted by travelwithcats at 10:24 AM on June 9, 2013 [1 favorite]


Have you had a sleep test? Unexplained, persistent high blood pressure in a young person can be caused by sleep apnea. Treating the apnea lowers the BP. And no, you do not have to snore to have sleep apnea. If you have not had a sleep test, insist on one.
posted by Rosie M. Banks at 10:56 AM on June 9, 2013


One of the tests they may do is a Holter monitor or event monitor. That's where they wire you up and send you home with a cardiac monitor, so they can catch any arrhythmias or other events that happen while you're away from the office. It's just like taking your car to the mechanic -- the problem will disappear right when you've got someone looking at it, and you can't really sit around the doctor's office waiting for it to happen. So a home monitor that they can then compare to your subjective report of symptoms may be ordered by the doctor.

I don't want to scare you, as there are any number of things that may explain your symptoms, but I had similar sensations when it turned out I was having a potentially fatal arrhythmia and eventually I passed out. At first I probably would have described them as squeezy/sore/muscle ache-y, but it never reached the standard crushing pain you hear about. So you are quite right that this is nothing to mess around with.

In fact, I would consider carefully whether you might describe this as pain (or at least "discomfort") to your doctor, to make sure it gets taken completely seriously. If you've got a high pain tolerance, or if as a woman you have non-standard presentation of cardiac issues (most of the standard "symptoms of heart attack" are from studies done on men, and it turns out that women frequently present differently), or if you're describing things in a way that your doctor doesn't quite understand, you could be dismissed without having your issues adequately addressed. Don't lie or exaggerate, but don't minimize either.

On the other hand, it could very well be anxiety issues, especially since you have a known history. After my arrhythmia I've had anxiety that included palpitations and chest discomfort; fortunately, I also have a prescription for Xanax and can generally figure out whether it's anxiety (almost always) or something more serious (never, since I got treated for the arrhythmia). A monitor will help them determine that -- if you're feeling discomfort and there's nothing weird going on with your heart, or maybe your blood pressure's rising but nothing else, they may figure it's anxiety. Which would be great, because you could get treated for that and know that your heart had checked out as okay. (So basically, I've had personal experience with weird chest sensations that could kill me and weird chest sensations that couldn't hurt me if they tried. Even now I can't tell the difference in the feeling unless I check my pulse/BP.)

If you can see a cardiologist, that's probably a good place to start. Though they're more likely than a GP to fall into the trap of thinking everything looks like a nail, they're also the ones who will have greater expertise in the various sorts of things that can cause chest discomfort and have the tools to determine the source. They're also accustomed to referring people to sleep doctors and so forth to deal with underlying issues.
posted by katemonster at 1:03 PM on June 9, 2013


There's a 1% chance you would benefit from an echocardiogram and a 99% chance you would benefit from addressing your anxiety.

It would be helpful to know when this started to figure out which is the case.
posted by hobo gitano de queretaro at 1:24 PM on June 9, 2013


All the comments above are fine, and I wouldn't suggest this if I were the only commenter, but I would say don't panic. Yes, get yourself checked out, but I have twice been rushed to hospital with chest pains for every sort of test, and come out all clear. There is a history of heart disease in my family, so there is a bit of a vicious circle: I feel pain in the chest and I get anxious about it; the chest tightens further...

The first time was probably indigestion. The second time I was on holiday in the tropics, sleeping with the aircon on. I woke up in the middle of the night to go to the bathroom and I think the abrupt change from cramped position in a warm bed to walking across a cold room was enough to cause a muscle spasm across the chest. In the morning I woke up feeling fine, went for a swim, and still felt fine, then had the bright idea of checking out the internet for chest pains: as I read all all the warnings the anxiety immediately kicked in; the travel insurance people told me to go to a hospital at once, which I did. The tests all proved negative, thankfully.

Another time I was stressed out about life in general, and that manifested itself as chest pain. I was again about to check myself into hospital, but then told myself to at least relax my chest, which I did, and the physical symptoms disappeared.
posted by TristanPK at 1:34 PM on June 9, 2013


I second a lot of the stuff that katemonster said.

I'd had similar issues with what I could only describe as an odd and persistent pressure around the center of my chest, with some mild pain. Any time I focused on the feeling, it seemed like my heart rate was increasing, too.

I was eventually diagnosed with a congenital heart defect and the arrythmia that comes along with it. The path to finding it was 1) EKGs and echocardiogram, 2) they hooked one of those little boxes up to me, and loads of monitor electrodes. I wore the box for about 24 hours.
posted by nohaybanda at 1:34 PM on June 9, 2013


Seconding holter monitor. An EKG is just a snapshot, a holter can give them a movie of what your heart rhythm is over a period of time. You should note when the chest discomfort occurs and they can see if it coincides with something strange going on with the electrical activity of your heart (usually referred to as an arrhythmia or dysrhythmia).
posted by brevator at 2:10 PM on June 9, 2013


When you are not sure what system of your body a problem is related to (I.e. heart, lungs, gastrointestinal, musculoskeletal), a primary care doctor is the best person to start with. You might like to see a doctor trained in internal medicine - similar to family practice but they generally do not do any pediatrics or obstetrics.
posted by treehorn+bunny at 11:01 PM on June 9, 2013


Thanks for the answers, everyone.

I just came home from the doctor. I explained everything like I did above. The doctor wasn't concerned about my blood pressure (which was high, but that could be because the appointment made me nervous - it was 140 over 80). She sent me for an EKG but the results were perfectly normal, even though I did have the "heaviness"/pain at the time. She said that because I am young, don't experience any issues when I'm active, and because I haven't had shortness of breath, it doesn't seem like anything to be concerned about. It could be muscular or could be stress/anxiety. If I still have the same problem in a month, I can go back and ask to see a cardiologist.

I do feel better having seen a doctor, so have decided to just keep track of when I get the pain and how often, how intense, etc. in case I do go back for a second opinion.

Thanks again.
posted by gursky at 4:50 AM on June 10, 2013


It could be muscular. Sounds weird, but your mention of anxiety makes it sound a lot like what happened to me. From years of anxiety and inactivity and spending too long with my arms in front of me (reading and at the computer), the muscles in front, especially on my right, got tight and short and eventually the muscles over my shoulder blades couldn't compensate and started to be pulled out of alignment. It is not something most doctors figure out. I had three major muscle spasms in my right shoulder before I lucked into seeing an osteopath at urgent care who figured it out quickly and sent me to physical therapy. I only had some tightness in front and no pain in back until the spasms started. The physical therapist also said that my shoulders were badly out of balance.

In my totally non-expert opinion, you might want to start using an arm cycle to get those muscles moving just to loosen them up. From my PT I have a regimen of stretches and exercises that I try to do three time a week to keep it from coming back.
posted by monopas at 2:39 PM on June 10, 2013


thank you, monopas. I appreciate your answer!
posted by gursky at 10:36 AM on June 11, 2013


just wanted to add a follow up:

I went back to the doctor because the chest pain was happening more frequently throughout the day. I was sent to the cardiologist who ran another EKG (normal), exercise stress test (passed without problem), chest x-ray (normal), and an echocardiogram (normal). She also ran blood tests to check if my heart was releasing any enzymes indicating distress (nope) and ordered a fasting blood test to check if I have any deficiencies or other issues that might be causing the pain (nope).

so, I have no idea why I have the pain, but I still do. I'm adding the follow up because the cardiologist told me that it's possible to have chest pain for no reason, or for no clear reason, and it's okay to leave it untreated and see what happens. I'm treating it like a muscular thing for now (even though painkillers do nothing to help the pressure/pain/whatever) and try to remember that the doctor said it's no cause for concern. sigh.
posted by gursky at 7:15 AM on July 27, 2013


That is very true - the only important disclaimer is never to assume that chest pain is no cause for concern until the various life-threatening causes of chest pain have been ruled out, as in your case. I've seen far too many patients who talked themselves out of seeking care because "it's probably just stress" or "it's probably just indigestion" - and it wasn't. Glad to hear it wasn't anything serious, and I hope it gets better for you.
posted by treehorn+bunny at 6:50 PM on July 31, 2013


thank you, treehorn+bunny. I appreciate your response!
posted by gursky at 5:04 AM on August 7, 2013


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