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Overweight, normal BP and EKG. Having chest pain and fast heart beat while climbing. What could be the reason?

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Hi.. I am 49 year old female and I am overweight..weight 250 lbs...normal BP..normal cholesterol..normal EKG..sometimes I can walk or climb stairs and feel awesome..was recently in Vegas and walked the strip back and forth no problem in the heat..but sometimes when I climb stairs after I reach the heart is beating faster but nothing out of the normal..but I feel a little winded and I get this light chest pain that worsens when I take a deep breath..however the second I stop walking or climbing the pain goes away immediately and lasts no longer than a minute or two? Can this be angina? If it could be angina would it not be present each time I walked or exerted myself?
Posted Tue, 28 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 23 minutes later
Dear Ma'm
Thanks for your query to us.

A chest discomfort (more like heaviness or as if someone has put a weight on your chest), mainly in mid chest (behind breast bone), coming up with exertion/ emotional stress, lasting for more than 2-3 minutes and going away with rest, is characteristic of angina. It may radiate to both arm , up to lower jaw (above) & to umbilicus (below). It may be associated with shortness of breath, sweating, nausea and unspecified uneasiness.

A discomfort which lasts for less than a minute which worsens with a deep breath, can be localized, is less likely to be angina.

Since you are overweight also, we have one very valid reason for your shortness of breath/ discomfort.

All the factors mentioned above are reassuring but not confirmatory. I would like you to take up an ECHO & stress test, after discussing with your cardiologist, to clarify the issue. This has multiple benefits. Not only he will tell you more about your symptoms by examining you, but will also let you know if there is any suspicion of lung disease clinically. An ECHO will rule out a structural heart disease. A stress test will not only rule out angina but will also let us know your exercise capacity. It will tell us the need to further investigate and will help in tailoring an exercise program for you.
Yes normally chest discomfort should come up every time when you use stairs or exert but variable threshold angina is well known.

Hope I made it easier for you.
Feel free to discuss further.
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
Follow-up: Overweight, normal BP and EKG. Having chest pain and fast heart beat while climbing. What could be the reason? 7 hours later
Thank you doctor..yes you have helped me..however what I would like you to confirm is that could the extra weight I am carrying make me have the mild chest pain and breathlessness when climbing stairs and that is the only reason I get these symptoms because I am deconditioned? Is this a common complaint for overweight people? I will certainly get checked out by a doctor. I went to a cardiologist last year and they did not seem concerned to be honest. But I will ask for another referral. Just wondering if deconditioning and being overweight could cause these same symptoms? Hope to hear back soon!
Answered by Dr. Sukhvinder Singh 2 hours later
Dear Ma'm

Breathlessness or shortness of breath is fairly common a complaint in obese/overweight people. In fact weight is the sole reason for breathlessness in a large number of obese people. However chest pain can not be explained only on the basis of overweight. In certain reasons for chest pain, weight may be a contributory factor (for example "lax cardia" or "Reflux disease") but chest pain just because you are obese cannot be explained.

Some people feel chest pain when they are rapidly breathing because of sensation arising from upper airways due to exposure to relatively dry air. However there is no confirmatory test to differentiate between this sensation and cardiac chest pain except stress testing. We conclude this only retrospectively after a normal stress test.

I hope it helps.
Feel free to write for further queries.

Sukhvinder XXXXXXX
Above answer was peer-reviewed by
Follow-up: Overweight, normal BP and EKG. Having chest pain and fast heart beat while climbing. What could be the reason? 1 hour later
Thank you. Okay so tonight I needed to prove something to myself and I climbed the flight of stairs in my home every half hour up and down twice. There are 15 stairs in this flight of stairs. I did them twice every half hour for 4 hours. I did not feel the pain at all, was still breathing well and the highest my heart rate went up was 115 and came back to normal rate of 78 within a minute of finishing the stair climbing. Now I will get checked out next week by my doctor but I am very puzzled as to why I get this chest pain when climbing a flight of stairs everywhere except home. Could be a bit of anxiety? I just think that with heart problems it would not pick and choose when the symptoms will appear. What are your thoughts?
Answered by Dr. Sukhvinder Singh 8 hours later
Dear Ma'm
My apologies for answering late.

Yes, normally the heart pain should not pick and choose (except for patients of 'variable threshold angina').

It is good that you did not get angina and there is a possibility that your test may also turn out to be favorable but once you have an exertion related pain chest, it should be evaluated as per best medical practices, which warrants a stress test at your age.

For ruling out anginal heart disease, We plan the stress test in such a way, that you have to have a minimum degree of load on your heart before it is concluded that you do not have significant disease. I mean that the exercise you do at home, although a good try, but may not have achieved levels sufficient to incite angina. For example, you must achieve a heart rate of ~145 beats per minute in the stress test to make the results meaningful; below this heart rate the result can be at best INCONCLUSIVE or Unfavorable but it can not reported as favorable. Similarly for a healthy heart you must do certain duration of exercise else it will be labelled as poor exercise capacity (which is again unfavorable). That's why I can not accept your attempt in lieu of a stress test.

Hopefully I explained the concept to you. Please do not hesitate to ask further.

Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Overweight, normal BP and EKG. Having chest pain and fast heart beat while climbing. What could be the reason? 1 hour later
Thank you so are very I took the stair to work again and I was very anxious because it always happens when climbing the flight of stairs to work..when I got to the top my heart rate was 130 bpm and I felt fine..I continued to walk through the parkade to the elevator that takes me to the 8th floor of my workplace and I felt just shortness of breath and my heart rate was down to normal even before I walked to the elevator from the stairwell case..I will definately get checked out but maybe I just was anxious..I feel the most anxiety in the morning for years..but I need to have angina ruled out for sure...just made me happy that the climb today to work was unremarkable and normal. Anything you have to add to this doctor?
Answered by Dr. Sukhvinder Singh 1 hour later
Dear Ma'm

Nice to hear such a positive thing from you. Morning time anxiety is a common thing for office-goers but I hope you will overcome this by your strong willpower. Anxiety / psychological issues sometime present as physical illnesses/ problems. But as a student of medicine I always remember the principal that "Psychological causes should be considered once you have ruled out physical causes".

Hope I answered your query to your satisfaction.

Sukhvinder Singh
Above answer was peer-reviewed by
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