Expert: David Richardson - 7/16/2006

Question
43-yr old widowed mother of 3, non-smoker, no drugs/alcohol, high cholesterol (263), overweight, some exercise,  no medications, no allergies.  Family history: father died at 59 (stroke); mother alive.  I have had heaviness to point of pain off and on for 2 weeks on left side above heart, starts in middle of chest and extends to left arm.  Pressing on the muscles does not cause or increase discomfort.  Discomfort DOES increase though with deep breaths.  Happens regardless of activity level. Other symptoms: fatigue, left arm or left side of neck will ache at times.  I will be at work and suddenly aware I’ve been taking short breaths to avoid deep breathing and also holding or rubbing the shoulder area and above chest like it could make the pain go away.  QUESTION:  Is this heart or coronary related? I’m especially worried due to high cholesterol.  Thank you

Answer
Dear Elaine,

Are you the lily maid of Astolat?

You're very intelligent.  You've ruled out chest wall pain already.  Not many people know to press on muscles to see if they're causing the discomfort.  Pain from coronary narrowing usually occurs with exercise and is relieved by rest.  Pain worse with breathing doesn't sound coronary at all, but like inflammation of peridardium, the sack in which the heart lies, or of pleura, the outside lining of the lungs. Any cough or fever?  I think you should see a doctor, preferably a cardiologist, ASAP next week  Tell him your story and let him listen to heart and lungs.  Maybe chest x-ray will help.  And an echocrdiogram may help.  Ask the echo doc to look for patent foramen ovale as well as pericarditis, since your father had a stroke and patent foramen ovale (hole in the wall between the two upper chambers of the heart) is a preventable cause of stroke.  The hole can easily be closed.  If all those exams don't help, you probably should have a treadmill stress test monitored by radioisotopes or echocardiogram.

Please write back if you have other questions or think I can help in any way, and PLEASE, OH PLEASE, let me know what you find out.  Many people don't bother.

David Richardson