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Family history of heart disease. Having nausea, discomfort in breast and pain below sternum. How to get cured?

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47 yr old female. 5'5" 180 lbs History of heart disease in family (mother, brother) For about the last four weeks I have been having the following symptoms on and off every day: nausea, discomfort in my chest, center and left chest, left shoulder, left arm. Sharp short pains directly below my sternum. Waking at 3-4 am with shortness of breath, nausea, hot feeling across my chest, trunk and down my arms, hands tingly. Aches in my back - lower, middle, upper. Aches in my neck and shoulders. left jaw discomfort (not pain, just a very mild ache that comes and goes). Six months ago I had complete cardiac work up - EKG, stress test, echo, holter monitor -- all fine. I have very high anxiety on a daily basis - cannot stop worrying about my heart. Is disrupting my daily life. I take one aspirin a day. 75 mg effexor daily and recently xanax before bed to help me get to sleep. I am very very frustrated and sick of feeling sick all the time.
Posted Wed, 8 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 4 hours later
Thanks for asking your question.
I am a qualified and certified cardiologist and I read your question with dilig
For pain originating from heart you have to have two of three criteria satisfied. Which were not there perhaps when you got your examination done. Therefore, you could not be diagnosed the three criteria are:
1.Typical pain related to heart is “retro sterna” (Central) squeezing associated with sweating and increased heart rate and it radiates to neck and left arm. Important is the fact in what setting the pain occurs.
2. Cardiac enzyme changes namely CPK MB. Troponin and serum myoglobin
3. EKG suggestive of acute ischemic insult

At age 47, you have some identified risk factors for coronary artery disease; others you can fill in by personal knowledge and investigations. The idea is if you have a back ground of more known risk factors your chances of pain (even atypical pain) originating as a result of heart are much more.

At any age, following is the list of risk factors for future development of Coronary Artery Disease. Let me enumerate and you can place yourself the risk you are carrying ('*' means you have the risk factor, '+/-' means I do not know and about others you know better):-

Diabetes +/-
Hypertension +/-
Obesity and Sedentary Life Style+/- (you are overweight, not necessarily obese)
High Bad Cholesterol and Lipid Component +/-
Total Cholesterol above 190 mg%, LDL above 130 mg%, VLDL above 40 mg%,
Triglycerides above 150 mg%, Apolipoprotein B above reference value
Low Good Cholesterol and Lipid Component: +/-
Apolipoprotein a below reference range for the lab and
HDL below 40 mg% for man & and 50 mg% for woman
Family History 0f Coronary Heart Disease*
Increasing age*
Being a Man (as opposed to women) till the age 45*

From the list, above you have some risk factors. Family history, increasing age you have identified, stress I have inferred. Therefore, I will strongly recommend consulting your doctor; he may complete the list as well do the EKG/ TMT again which may tell us the cause of pain. recommendation is even to go for coronary angiography if the suspicion is high. Discuss with your doctor.
It is never too late to change. With your weight everything you do will have to be under supervision. It need not be cardiologist but your primary doctor can guide your way back to health - I am happy to read that. You may need drugs and he/she (or ask the dietitian) to advise you about diet low in calories and cholesterol, advise you on quantum of exercise. You ought to keep your weight under control for you do not want other attack. If you like non vegetarian you cannot take red meat but there is no bar (in taking certainly quantity had to be less) on egg white, roasted chicken and roasted fish.

You can complete the missing factors and write back and we can plan a strategy just worrying about it shall not help. Moreover, you could be having a totally different disease like Gastoro Esophageal Reflux Disease, and aspirin may be making symptoms worse. All your history is not typical of coronary artery disease.

Hope you found something useful in this answer. If you have any follow-up query I shall be happy to answer.


With Best Wishes
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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