AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
I am a 32-year-old male, former 1-pack-a-day smoker for 5 years (quit a few months ago), with no history of heart disease or heart attacks in my family, but I am hypothyroid. In late April I started having episodes of chest pains, chest pressure, rapid heartbeat, and sharp/burning pain in my left arm. I went to the ER in April and had a slightly abnormal EKG, but negative blood work for heart attack. To be safe, they did a treadmill stress test. That was also slightly abnormal, although I didn’t have any notable chest pain during the test. The cardiac nurse noted that it took my heart a long time to return to a normal rate, which she said indicated I was out of shape and to exercise more. The ER said that despite the slightly abnormal EKG and treadmill stress test, CAD was very unlikely. But they still ordered a 64- slice nuclear PET/CT study anyway, just to be sure. They said the nuclear PET/CT scan was completely normal and ruled out that any of this was coronary:
Calculated left ventricular ejection fraction 79% at rest and 74% at rest. Transient ischemic dilation ratio at .92. Total calcium score 0. Normal rest and pharmacologic stress myocardial perfusion PET; total calcium score of 0 in the 10th percentile.
They then felt it was panic attacks. But the sporadic chest pain and arm pain worsened throughout May, and I started to develop PVCs. A few weeks ago, during one episode, the pain extended into my jaw and I went back to the hospital. They did several EKGs over a 12 hour period and watched my heart on the monitor for 24 hours. EKGs were all completely normal, but they saw the PVCs on the monitor. They ran blood tests and found I had iatrogenic hyperthyroidism, which started in mid-April when my doctor upped my Synthroid dosage. The hospital cardiologist said this is likely all related to the hyperthyroidism because my heart was working too hard on the thyroid medication overdose. She said the only other test they could do would be an angiogram, but she said “no way” they would do one on me given the prior PET/CT. She believed I was too young, that it was too risky given my heart being irritated by the iatrogenic hyperthyroid state, and said the PET/CT was all clear. She also said they have more confidence in this diagnosis because I had none of these symptoms before they increased my thyroid dosage in April. The cardiologist and endocrinologist said that these symptoms should go away in 2-4 weeks, once the excess thyroid medication is out of my body. It has been over 2 weeks and I still have bothersome left arm pain and sporadic dull to sharp pain in the middle to left side of my chest. I am still concerned and wonder if I should see a cardiologist, but my PCP says that the PET/CT was conclusive and not to worry about it—be patient. He said it was doubtful that I developed CAD at this age because I am so young, with no family history, despite my 5-year smoking stint. They are doing an echocardiogram tomorrow, just to rule out a possible mitral valve prolapse. Can you tell me if I am worrying too much or if I should pursue this further?
PS - my last lipid panel showed cholesterol at 149, Triglyceride 186, HDL 34, LDL/HDL ratio 2.3, Non HDL cholesterol 115, LDL 78.
Answer Dear Jack,
I think you're okay and don't need to pursue this further.
Press firmly on the area that hurts. If pressure modifies the pain, makes it better or worse, you have proven that it's chest wall pain since you can't press on heart or lungs. Chest wall pain can be a big nuisance but is no threat to life or health. Aspirin, Tylenol or ibuprofen may help.
You are too young to have coronary narrowings, and the PET/CT proved you have none. No calcium rules out significant coronary disease.
Pay attention to diet, stressing fish and fowl rather than products from mammals, and limit carbohydrates to lower triglycerides and maybe improve your HDL. Substitute vegetable oils like olive oil for carbohydrates and animal fats if needed to maintain weight, but keep your weight in the clearly normal range. All this will lessen risk of coronary disease when you're 50.
Please write back if this note doesn't answer all your questions.
