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Chest pain, skipping heart beats, tingling in calf muscle, discomfort under rib, dizziness, breathlessness. Could it be pulmonary embolism?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
over the past few weeks Ive started to develop some chest pains. At first, I noticed my heart skipping a beat when I was on the treadmill. Instead of the usual "lubdub" sound it would feel more like "lub..dub". I had to immediately get off the machine and walk around to catch my breath and feel better. The next day I had some chest pain when I got up from bed, that seemed to be worse when I took a XXXXXXX breath. Since then the pain has been ok and not as reoccurring until 2 days ago when the same feeling of pain when taking a XXXXXXX breath occurred.

I have started to feel more skipping beat feelings as well as developed pain in my left arm as well as tingling sensations in my left calf muscle and throughout my arm. Yesterday, I began to notice pain and extreme discomfort somewhere just under my heart in my rib area, as well as the same area except on my back. It feels as if there is something stuck there (kind of like behind my ribs in my body) and my back feels stiff, and hurts when I move or adjust, like if I strained it but only in one direct spot. Ive tried to stretch out but this seems to only make it worse and it even hurts when Im sitting and laying down. I have noticed that I have become very nervous, weird rushing tingling sensations in my left leg, some dizziness and have shortness of breath. After doing some research online, I came across something called "Pulminory embolism" does this sound like it could be that? What signs can I look for to confirm/deny this?
What do you think It may be and what should my next step be?

Currently, my back is what is bothering me the most. It is not really tender to the touch but when I press the spot on my ribs where I feel the stuck feeling, it does hurt a bit. I have had a few sensations of wanting to pass out but have not fainted yet. I am still getting small pains down my arm and my leg still feels odd at times. Please help.
Posted Mon, 21 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 5 hours later
Thank you for the query.

The feeling of skipped beats is usually due to an arrhythmia of the heart when there are premature complexes. These could be atrial, ventricular or junctional premature complexes.

This can be diagnosed by an ECG taken when the arrhythmia is actually happening. If the extra-beats happen very infrequently (but at least a few times per day), a 24-hour Holter monitor can be done to record the ECG continuously for 24 hours and then analyzing it to identify the frequency, type and nature of the premature complexes. The treatment would depend on the exact diagnosis.

The pain that you are feeling looks like a musculo-skeletal pain. The tenderness felt on applying some pressure at the painful site, the increase in discomfort during XXXXXXX breathing, certain postures, etc all point to the musculo-skeletal origin of the pain.

The exact cause can be determined by your physician after he examines you in detail. Local measures like analgesic sprays/gel applications and oral tablets of NSAIDs should provide adequate relief.

The tingling sensation passing down till your leg could also be brought about by problems relating to the vertebral column including the inter-vertebral discs. This might cause some pressure on nerve roots and result in such radiating pain/tingling. This needs to be further evaluated by your physician, neurologist or orthopedician.

Pulmonary embolism refers to a condition where there is blood clot formation in the veins of the legs or pelvis or elsewhere and parts of the blood clot get dislodged, travel along with the venous return to the heart and get lodged in branches of the pulmonary arteries (vessels to the lungs from the right side of the heart). The severity may vary from very trivial to very major and critical depending on the size of the blood clot, among other things.

It is usually rare to get this at your age, in the absence of risk factors for blood clotting in the veins like smoking, diabetes, immobilization, XXXXXXX vein thrombosis, thrombophilias, stasis of blood flow in the veins, varicose veins, etc.

I hope this answers your query. Feel free to contact me for any further clarifications.
With regards,
Dr Raja Sekhar Varma,
Consultant Cardiologist
Above answer was peer-reviewed by
Follow-up: Chest pain, skipping heart beats, tingling in calf muscle, discomfort under rib, dizziness, breathlessness. Could it be pulmonary embolism? 2 hours later
Thanks for your prompt reply Doctor.

Is there anything I can do/take on my own to begin feeling better? Is a musculo-skeletal situation serious? How is it caused?

I seem to get these symptoms in waves. At times I feel great and other times I feel absolutely terrible, like Im either about to have a heart attack or pass out. What can I expect to happen over the next few days?

What signs should I look for that will tell me when to seek medical attention?

Answered by Dr. Raja Sekhar Varma 20 hours later
Thank you for the reply.

You can get relief from the musculo-skeletal pain by using analgesic sprays at the site or rubbing in any analgesic gel/ointment. There are many over-the-counter preparations which you can use straightaway.

The exact source of the pain can be diagnosed only after a physician has examined you clinically and, if required, after doing some basic investigations like X-rays. The cause could be from the intercostal muscles, costo-chondral joints, intercostal nerves, pectoral muscles or any other similar/related causes. There could also be problems related to the vertebral column or the intervertebral discs. While most of these causes are not serious, you still need to diagnose them and get the cause treated for lasting relief.

Since you are having recurrent pain and also palpitations, you do need to get to a qualified physician and get yourself examined clinically and do the baseline investigations. It is important to have a correct diagnosis and then treat appropriately rather than try a shotgun approach with home remedies. Therefore, I would advise you to seek medical help at the earliest. Once the diagnosis is clear, you can easily be counselled on what exact symptoms to watch out for, what are the danger signs and when emergency treatment is a must.

For example, if the palpitations are diagnosed to be due to ventricular ectopics, then you will need emergency attention if there is a run of fast, rapid, heartbeats, if you feel giddiness or lose consciousness during these episodes. On the other hand, if the palpitations are only due to sinus tachycardia due to stress or anxiety, then treatment should be directed at reducing stress and anxiety, no cardiac drugs are needed and it is unlikely that there will be any emergency.

I hope this answers your query. Feel free to get back to me for any further specific clarifications. If there are no further follow-up questions, please accept my answer.
With regards,
Dr RS Varma
Consultant cardiologist
Above answer was peer-reviewed by
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