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Experiencing strong chest pain, severe interior trembling and weakness. Smoked, had pneumonia. All test normal. What else it could be?

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58 yr old female smoked 3-4 cig per day up to a month ago. She had puemonia XXXXXXX 1 2013 antibiotics did their job but she never felt 100% feb experienced strong chest pain, severe interior trembling and weakness. She had ekg chest x-ray blood test stool tests heart lungs blood pressure and all test showing within normal range. She is not a nervous person, she is very calm, she is happy at work and at home. I don't believe that she is under any stress. She is going to work as an insurance broker, the cheat pain has calmed, but she is still experiencing interior trembling and weakness. doctor has said that 24 hr heart monitor would be the next step. Any ideas?
Posted Mon, 20 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later

Thanks for writing to XXXXXXX

A 24 hour heart monitoring (commonly known as holter monitoring) is performed to know any heart rhythm disturbances (to see if there was abnormal heart rhythm at time when patient had certain symptoms), ECG changes of angina (ST depression) and to correlate patient's symptoms with their ECG.

In this case the doctor probably is thinking that patient has abnormal rhythm whenever she has episode of XXXXXXX trembling and weakness. By looking at ST changes he may also get an idea if these symptoms are due to possible angina.

Has she undergone a stress test (TMT/Stress ECHO/ Thallium) also in your work up? if it was also normal, then anginal heart disease would not be a possibility.

A generalized weakness and at times, some benign rhythm abnormalities (atrial ectopics) may occur post-pneumonia, but three months is quite long time for that too. Is she currently on any drug?

Please feel free to discuss further with details and follow-up questions.

sukhvinder XXXXXXX
Above answer was peer-reviewed by
Follow-up: Experiencing strong chest pain, severe interior trembling and weakness. Smoked, had pneumonia. All test normal. What else it could be? 12 hours later
She is not on any drugs. She has not had a stess test. The weakness and trembling is always present, although does increase with certain activities and worsens with prolonged activity. She has always been a very healthy person. She is only slightly over weight(maybe 20lb).
Answered by Dr. Sukhvinder Singh 6 hours later

Thanks for the details.

1. If a Stress test was not done, then obstructive Anginal heart disease cannot be ruled out, but again, an always present trembling and weakness does not favor anginal heart disease at all.

2. If a plain ECHO (cardiac ultrasound) was done in the work-up? I assume it was normal when you wrote heart/lung/ blood pressure all normal. I am confirming this because, a normal ECHO would make possibility of any heart disease causing these symptoms in her very low and a systemic illness or post pneumonia weakness would be higher on cards.

Hope this helps. Feel free to write further

sukhvinder XXXXXXX

Above answer was peer-reviewed by
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