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Overweight. Having mild heaviness and tightness in chest and swollen calf. What are the risks?

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Practicing since : 1981
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I am on overweight (250lbs) 5 ft 9 inches woman ---46 yrs old. I have 2 children and I have recently had mild chest heaviness/a little tightness and some achy shoulders (both sides, more right) and achy elbow (left). I also felt sort of lightheaded and went to the ER to rule out a heart attack. Nuclear stress test had great results as did xray and no cardiac enzymes in blood.

One week ago I had driven 8 hrs in the car with only one stop mid-way. Today I noticed that my right calf is very slightly swollen (sort of near where the sticker for heart monitor was placed) at the inside just below where the calf meets the lower leg and is very slightly warmer to the touch. My right leg is slightly achy (but I have some mild arthritis so maybe it is nothing)

I am feeling a bit like a hypochondriac but I am worried that the slight warmness and slight swelling (i think my right calf may often be a bit bigger than my left anyway) might be a sign of a blood clot or DVT and maybe that is why I had the symptoms that brought me to the ER.

Please let me know your thoughts on the wisdom of waiting until tomorrow to get it checked out---thinking ER will not have ultrasound tech avail on a late Sat night. I do not have any risk factors other than obesity and the recent long drive.

Thank you
Posted Fri, 10 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 45 minutes later
HI there,
Thanks for writing in.
I am qualified and certified cardiologist. I read your mail with diligence.
I do not think you are Hypochondriac. You seem to be a logical person who believes what we cardiologists try to get across for years. That in matters of heart you are guilty till you are proven innocent and burden of proof lies on you. (I think in US law there is same axiom where as English law is opposite that you are innocent unless proved guilty). In the first instances, when you went to ER, you still could be having angina with all tests you listed were normal. DVT is too serious a disease to be waited for ER to open its ultrasound if earlier exclusion is possible. It is good that by logical thinking you suspected it for it is threshold of suspicion which matters.

For cardiovascular disease there are certain risk factors.

Conventional Risk Factors with which above Risk factors accumulate:
Diabetes +/-
Obesity and Sedentary Life Style*
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*
* for sure you have this risk factor and +/- means we do not as yet. I urge you to eat the doctor, by ordering few more investigations he will complete your CAD risk profile.
Then start program of getting rid of modifiable risk factors as much as possible. Yes, for long car drives, keep your self hydrated, one break after 2 and half hour is essential stretch your legs.
Discuss with your doctor and dietetics department to make a menu for your daily consumption to begin with. Good Luck.

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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