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Forum Name: Ischemic Heart Disease

Question: Chest pain with left arm going numb


 xDeexDeex - Fri Sep 26, 2008 5:39 am

Hello,

I'm a 20 yearold female and for the past 2-3 months i've been having worrying symptoms.
I'n my family so far everyone from my mums side of the family has died from a heart attack. We also have a history of diabetes, lung & breast cancer.

It started off as what i thought was indegestion but then after taking many meds and weeks gone by i realised it just had to be something else.
I'll use the most extremt example of what happened..

Was sitting at home relaxing watching tv as normal when I felt my heart starting to "flutter". It was very strong and i was having to lean over for about 2 mins to deal with the feeling- aswell as taking quick breaths. Afterwards my chest (in the middle to left side) seriously starting hurting very bad and within 5 mins my left arm had gone numb and i got what i can only describe as shooting pain in my left shoulder so i shouted on my mother. By the time she got upstaires i almost fainted so she called an Ambulance. After them telling me it must have been "nothing" i went to the doctor to get a second opinion. I explain this happens alot so so i had a stress test which came back fine and this is also not anxiety related. I also went for an ECG scan, but during i tried to explain it wouldnt show anything as i wasnt having one of my attacks at the time, and as expected it didnt. Im now worried by doctor thinks im putting this on as he seems to disregard all the symptoms i list to him aswell as my family history. I would just like some advice on maybe what to do or what this could be as the pains are now more frequent and hurting more and i would like to know what this is asap!
 John Kenyon, CNA - Tue Sep 30, 2008 7:46 pm

User avatar Hello -

I can well understand your concern, especially with the positive family history for heart disease. While there may be something going on that involves your heart, I don't think it is ischemic disease. First, even in the classic few families where heart disease is rampant, age 20 is pretty young (those families often have members who develop significant disease by their 30s, which is still awfully young compared with the general population). This does not mean you can''t have heart disease, but it does make it less likely. There's more arguing against ischemic disease, however. For one thing, you've had a stress test, EKG, and possibly (it's not entirely clear from your post) a nuclear scan of the heart. At any rate, you've certainly done enough to elicit any symptoms that would be caused by ischemia. So what could this be? There are several possilities. First, you might have mitral valve prolapse (MVPS) or at least MVP syndrome, which is often documented without proof of actual prolapse. People who suffer from this relatively benign disorder often have palpitations such as you describe (as do most of us, but MVP-ers tend to have them even more); they also often have atypical chest pain ("stabbing" is usually not a descriptor used by people having a heart attack); they often have combinations of symptoms (which is what a syndrome is) that include lightheadedness or faintness, anxiety (you seem to have ruled this out, but the patient is often the last one to recognize or acknowlege anxiety -- strange, but very true); finally, they often have fatigue, shortness of breath or other symptoms, but yet tolerate excercise very well. So this is one possibility. You would need to have an echocardiogram to know with any certainty, and sometimes this, as mentioned above, does not show up the prolapse anyway, although if you get lucky it will.

Since I'm not willing to write this off to MVP, which is one of the most common benign heart abnormalities (actually considered a variation of normal by some doctors because it is so common), I'll give you a second possibility, less likely, but still possible: coronary artery spasm. In this sort of event, which can be totally random but usually occurs occasionally (and in some patients even on a daily basis), one artery supplying the heart muscle can go into spasm and nearly close itself off. It usually lasts from 5-20 minutes, rarely any longer, and during the acute episode the EKG often appears to show an infarct in progress, only to return to normal as the episode subsides. While this is far more rare than MVP, it is also more common than generally thought, but is often difficult to catch and prove. The symptoms are similar to heart attack, but the pain is usually quite a bit more severe than in a textbook heart attack, in which pain is substernal, insidious, and usually described as pressure or squeezing. This problem can be diagnosed by more invasive methods than an echocardiogram, usually by performing a cardiac catheterization, during which a substance is introduced into the heart via catheter or IV line, which will provoke spasm in an artery which is already prone to this. A positive result strongly suggests coronary artery spasm (generally known in medical circles as Prinzmetal's angina). This is then treated medically, with drugs, sometimes the same family that is used in stubborn MVP syndrome, although with the latter it is preferred that no medication be prescribed unless the symptoms are consistently and severly disruptive of the patient's life. In the case of Prinzmetal's angina it is more important to try and prevent the episodes, as they can, though rarely, cause actual damage.

So then: your first step would be to determine if you have MVP and/or MVP syndrome, with or without anxiety as a complicating factor. This is the most likely answer, and is most common in otherwise healthy young females. The spasm problem usually (not always) occurs starting in the 30s and more males have it than females. If you have MVP syndrome (with or without proven prolapse), you may be prescribed a type of drug called a beta blocker, which usualy helps prevent the kinds of episodes you described, or at least makes the symptoms more mild. If anxiety is found to be complicating the issue, an anti-anxiety drug may also be added. Usually, though, cardiologists prefer to avoid medicating the patient if possible.

I hope this is of some help to you and perhaps eases your mind some. Please follow up with us as needed, and let us know if you've had an echocardiogram already, as well as a nuclear scan. Good luck to you. Stay in touch here.
 Dr. E Asis - Wed Nov 26, 2008 9:03 pm

User avatar Most probably its an MVP, you have to rule it out first before you entertain any other diagnosis. I'm also considering that you have a thyroid problem if you're always having palpitations. Better request for thyroid function test to rule out hyperthyroidism.

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