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What Causes Discomfort In The Chest And Fatigue While On Nitroglycerin?
Question: I'm 24 years old. I've been having on and off chest discomfort all day and have been feeling extremely weak. I've survived brain cancer and have been two years cancer free. I Postural Orthostatic Tachycardia Syndrome now as well as a DVT in my leg. I don't believe the clot has moved to my lungs, because I've had this pain before. It just never been so intense and causing me to feel pain in my shoulders or arms. They've checked my heart multiple times and say that I have no coronary artery disease or heart problems besides the fast sinus tachycardia and on occasion SVT. The sinus node ablation failed. My aunt was told the same thing when she was young and ended having a heart attack at 30. She had some type of spasm and has small veins. I don't know if they've checked me for that. I've gone to the ER several times this year and have not been taken seriously. I was given Nitroglycerin because it is the only thing that helps. I don't want to take it because my blood pressure is a little low already. I need some relief immediately. Should I go the ER again or just follow up with the cardiologist? And What could this be?
Brief Answer:
Pulmonary embolism to be ruled out as soon as possible
Detailed Answer:
Hi Dear,
Thanks for selecting HCM to ask your query!
Have noted all your details,
A history of chest discomfort in a patient with Deep vein thrombosis have to be taken very seriously ,i would suggest you to go to the ER as soon as possible and get a 2d echo done .
Blood thrombus from vein may migrate to your lungs and cause a condition called pulmonary embolism ,it may be possible that its not pulmonary embolism ,yet in a patient of DVT presenting with chest pain ,a 2D echo is a must!
we have to rule out the possibility of pulmonary embolism as if neglected it can pose a serious threat to life.
A clot can migrate from veins to lungs any time ,its not necessary that if your tests were previously normal then you can't have pulmonary embolism.
Low blood pressure with tachycardia with intense chest pain are highly suggestive of pulmonary embolism
advised
HRCT chest
2d echo
D dimer test as soon as possible.
your second query is in regards with vasospastic angina ,in which angina is caused due to spasm in small coronary vessels
Its called as prinzmetal angina ,but you say that your chest pain responds to nitrates ,which is not a feature of prinzmetal angina,though its common in young age but patient usually responds to calcium channel blockers like verapamil ,a response to nitrate is not seen .Its a diagnosis of exclusion there is no definitive test to find out whether the angina is due to spasm of vessels,once all other causes of chest pain and angina are ruled out patient is treated with calcium channel blockers therapy to see the response.
As you have not mentioned what tests have been done in past to rule out the possibility of coronary artery disease in your case, Ii would suggest you to go for a Stress thallium test ;once your are cleared for pulmonary embolism.
Stress thallium has a sensitivity rate of almost 97% ,if it is also normal then other causes of chest pain which mimic cardiac pain and responds to nitroglycerine can be considered like Oesophageal spasm.
Even a trial therapy with verapamil can be given to rule out prizemetals angina as there is no test to diagnose it,its a diagnosis of exclusion.
But right now my advice is go to the ER get your tests for pulmonary embolism done .
Thank you !
If you have any more query feel free to ask
Dr Rishu Saxena
Cardiologist
Pulmonary embolism to be ruled out as soon as possible
Detailed Answer:
Hi Dear,
Thanks for selecting HCM to ask your query!
Have noted all your details,
A history of chest discomfort in a patient with Deep vein thrombosis have to be taken very seriously ,i would suggest you to go to the ER as soon as possible and get a 2d echo done .
Blood thrombus from vein may migrate to your lungs and cause a condition called pulmonary embolism ,it may be possible that its not pulmonary embolism ,yet in a patient of DVT presenting with chest pain ,a 2D echo is a must!
we have to rule out the possibility of pulmonary embolism as if neglected it can pose a serious threat to life.
A clot can migrate from veins to lungs any time ,its not necessary that if your tests were previously normal then you can't have pulmonary embolism.
Low blood pressure with tachycardia with intense chest pain are highly suggestive of pulmonary embolism
advised
HRCT chest
2d echo
D dimer test as soon as possible.
your second query is in regards with vasospastic angina ,in which angina is caused due to spasm in small coronary vessels
Its called as prinzmetal angina ,but you say that your chest pain responds to nitrates ,which is not a feature of prinzmetal angina,though its common in young age but patient usually responds to calcium channel blockers like verapamil ,a response to nitrate is not seen .Its a diagnosis of exclusion there is no definitive test to find out whether the angina is due to spasm of vessels,once all other causes of chest pain and angina are ruled out patient is treated with calcium channel blockers therapy to see the response.
As you have not mentioned what tests have been done in past to rule out the possibility of coronary artery disease in your case, Ii would suggest you to go for a Stress thallium test ;once your are cleared for pulmonary embolism.
Stress thallium has a sensitivity rate of almost 97% ,if it is also normal then other causes of chest pain which mimic cardiac pain and responds to nitroglycerine can be considered like Oesophageal spasm.
Even a trial therapy with verapamil can be given to rule out prizemetals angina as there is no test to diagnose it,its a diagnosis of exclusion.
But right now my advice is go to the ER get your tests for pulmonary embolism done .
Thank you !
If you have any more query feel free to ask
Dr Rishu Saxena
Cardiologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Answered by
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