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Heart & Cardiology - Heart palpitations, chest heaviness, fatigue
Expert: David Richardson - 11/7/2009
Question
I am a 29 year old, active (run approx 10-13 miles per week) healthy female, and approximately one week ago started to experience heaviness in my chest. Thinking I was getting bronchitis, I went to my PCP and he said my chest was clear and I showed no other symptoms. He did an EKG and saw some "flipped t waves" as he called them, and felt palpitations. I was then fitted with a holter monitor for 24 hours. However, the next morning the chest heaviness had increased dramatically, and was accompanied by a feeling of being unable to get enough air, and alot more palpititations with occasional shooting pains over my heart area.
I went to the ER and was held overnight for observation, then admitted, for a total time in the hospital of 3 days. All bloodwork was normal, as was the EKG, echocardiogram, chest x-ray, MRI and leg ultrasound to check for clots. (Stress test was done yesterday so I do not yet have results, however the Dr only mentioned some PVCs on the EKG, and I thought I was going to pass out from the mild exercise)
Over the last few days my symptoms have gotten no better. I get dizzy when I stand up, and feel exhausted from a short walk to the bathroom. I have chest heaviness across my entire chest, frequent palpitations, and occasional sharper pains over the left side of my chest. Relevant history may include a 6 month Lupron treatment for endometriosis commencing in March 09, history of thyroid disease in mother, and no history of heart disease in anyone under 60.
Any ideas? My doctors seem to be stumped, and my symptoms have not eased at all.
Answer
Dear Jacqueline,
Measure your blood pressure sitting and then standing quietly for 1,3 and 5 minutes. If it gets below 90, that's the probable cause of your dizziness and fatigue.
The most common cause of pain in a young person is cramping of the muscles in the chest wall. If you can modify the pain, make it better or worse, by pressing on the area that hurts, then you have proven that the pain is coming from your chest wall. Chest wall pain is a nuisance but no threat to life or health. At age below 45, chest pain is very unlikely to come from clogging of the coronary arteries that supply blood to the heart.
If the palpitations are skipped heartbeats, these are normal heart activity, also no threat to life or health for someone with normal EKGs and echo.
Please write back if this note doesn't answer all your questions, and PLEASE let me know what you find out.
David Richardson
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