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Treatment For Lightheadedness, Tingling Sensation In Arm, Pain And Tightness Around Chest?
Question: Female, age 59, center line chest pain, feeling of pressure on chest, "band of tightness around chest", pain in left and right arms, tingling in both arms, pain radiates to left back, lightheaded feeling of passing out but does not. Heart does not feel like it is racing.
Had all cardio tests including nuclear stress, ekg, enzymes, lipids, echocardio, all negative. Blood pressure is usually 124/70, sometimes during the attacks, which have become increasingly active over a period of years the bp will spike to 185-190/ 90 and sometimes drop as low as 80/40. Non smoker, non drinker, slightly stressful job but not major. Any suggestions beyond panic attacks?
Had all cardio tests including nuclear stress, ekg, enzymes, lipids, echocardio, all negative. Blood pressure is usually 124/70, sometimes during the attacks, which have become increasingly active over a period of years the bp will spike to 185-190/ 90 and sometimes drop as low as 80/40. Non smoker, non drinker, slightly stressful job but not major. Any suggestions beyond panic attacks?
Hi XXXXXXX,
Welcome to Healthcare Magic!
Your symptoms are suggestive of cardiac trouble but the work up for acute problem of heart origin is negative. Your BP fluctuations are too much.
It is commonly seen in dyautonomia, a problem seen in diabetics, Parkinson, Alzheimer and elderly people.
Do you have any of these conditions, or a family history of them.
Other possibilities are transient cardiac arrhythmias, bronchospasm- a respiratory problem,
Panic attacks, if you are stressed and have anxiety neurosis type personality.
A rare tumor called pheochromocytoma also produces features like this and needs a CT Scan of abdomen to detect it.
Please have a detailed physical examination by a local physician and also get BP checked in lying down and standing position.
Please let me know in a follow up query.
Welcome to Healthcare Magic!
Your symptoms are suggestive of cardiac trouble but the work up for acute problem of heart origin is negative. Your BP fluctuations are too much.
It is commonly seen in dyautonomia, a problem seen in diabetics, Parkinson, Alzheimer and elderly people.
Do you have any of these conditions, or a family history of them.
Other possibilities are transient cardiac arrhythmias, bronchospasm- a respiratory problem,
Panic attacks, if you are stressed and have anxiety neurosis type personality.
A rare tumor called pheochromocytoma also produces features like this and needs a CT Scan of abdomen to detect it.
Please have a detailed physical examination by a local physician and also get BP checked in lying down and standing position.
Please let me know in a follow up query.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your initial response to my inquiry Dr Choudhary.
I have written the initial inquiry and this follow up for my wife (59 yo wf)
The BP fluctuations have only been in the last few episodes, the latest as tracked
by the ER. The BP cited to you of 80/40 was incorrect it should have been
85/58 with a pulse rate of 40. The presenting BP was 185/90 by the EMResponder. Usual reclining BP is in the range of 105-115 over 70-80.
There is no family or personal history of diabetic disorder, Parkinson or Alzheimer.
Personality type is not one of stressed or anxiety or neurotic personality.
The detailed exam by both the cardiologist and review by the attending XXXXXXX medicine lead all came up negative. CT scan was neg..
I have written the initial inquiry and this follow up for my wife (59 yo wf)
The BP fluctuations have only been in the last few episodes, the latest as tracked
by the ER. The BP cited to you of 80/40 was incorrect it should have been
85/58 with a pulse rate of 40. The presenting BP was 185/90 by the EMResponder. Usual reclining BP is in the range of 105-115 over 70-80.
There is no family or personal history of diabetic disorder, Parkinson or Alzheimer.
Personality type is not one of stressed or anxiety or neurotic personality.
The detailed exam by both the cardiologist and review by the attending XXXXXXX medicine lead all came up negative. CT scan was neg..
Hi XXXXXXX,
Welcome back.
The BP of 85/58 mm Hg with a heart rate of 4o/min shows their is hemodynamic compromise. At this BP the heart rate should be above 100/min.
There is a doubt of dysautonomia or there may be a conduction disorder/arrhythmia at level of heart which may be a cause of decreased blood supply transiently.
Which seems to be the cause of tightness in the chest.
Another manifestation is there can be a surge of BP, again causing shortness of breath/ chest tightness.
You have already had enough work up and check up, still the trouble is persisting.
I would like to advised a Holter monitoring for arrhythmia and meanwhile get BP checked at the time of chest tightness. Is her hemoglobin level is okay.
Sometimes anemia cause tightness episodes in the chest.
I wish her a great XXXXXXX
Welcome back.
The BP of 85/58 mm Hg with a heart rate of 4o/min shows their is hemodynamic compromise. At this BP the heart rate should be above 100/min.
There is a doubt of dysautonomia or there may be a conduction disorder/arrhythmia at level of heart which may be a cause of decreased blood supply transiently.
Which seems to be the cause of tightness in the chest.
Another manifestation is there can be a surge of BP, again causing shortness of breath/ chest tightness.
You have already had enough work up and check up, still the trouble is persisting.
I would like to advised a Holter monitoring for arrhythmia and meanwhile get BP checked at the time of chest tightness. Is her hemoglobin level is okay.
Sometimes anemia cause tightness episodes in the chest.
I wish her a great XXXXXXX
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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