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Having chest discomfort and shoulder pain. Family history of cardiac and pulminary issues. Any complication?

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45 yo female (smoker)- on and off chest discomfort and sholderblade pain with what seems like inigestion but too high up. Sometimes either rapid heartbeat or skipping. Newest symptom quick pain in chest that corresponds to exhale and accompanied by an uneasy feeling. Family history of cardiac and pulminary issues. Been under a lot of stress lately, just wondering if mental or medical symptoms - FYI - BP 120/65 (avg) 180-190 Cholesterol.
Posted Sun, 12 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.

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. At age 45, 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. You have additional symptoms of skipped beat and rapid heart rate which merits investigation.

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 +/- (More frequent readings are necessary to say either way)
Obesity and Sedentary Life Style+/- (your height, weight and exercise habits)
High Bad Cholesterol and Lipid Component +/- (Complete Lipid Profile needed)
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. Smoking and Family history you have identified.Therefore, I will strongly recommend consulting your doctor; doctor will do complete physical examination, may complete the list as well as do the EKG followed by TMT which may tell us the cause of pain. A Holter may be necessary to diagnose your symptoms of skipped beat and increased heart rate. A chest x-ray in a smoker is a must.

For the time being the way you have described the pain it does look cardiac, yet it could be precursor of worse things. Sooner you take advice from professional better quality of life you are going to have.

Well, something difficult to follow but easy to advise I kept for the last is you will have to Stop Smoking (you can take help of nicotine patches, nicotine spray or nicotine gum; behavioural therapy and professional help).

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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