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What Causes Chest Pain With Fatigue,palpitation And Dizziness?

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Posted on Thu, 3 Apr 2014
Question: Have suffered multiple heart related symptoms w. sudden onset a few months. Cramps/ spasm pains in left chest comes and goes. Not exercise-related, not skeletal-muscular in nature. Also sudden onset of palpitations, short periods of tachycardia, in general feeling of vibrating/ unstable sensation i heartbeat. Fatigue, lightheaded,no energy, dizzy. A few episodes of confusion. Not accompanied by panic or anxiety apart from concern. Normal EKG and echo showed moderat mitral and triscupid leakage. Some days nearly symptom free, then back. Sudden onset of burning pins and needles sensation in right hand and fingers lasted 3 hours, not accompanied with hyperventilation or anxiety, not after pressure on nerve (i.e. after sleeping on arm). Am worried about heart health. Considering MS as cause, mother and sister diagnosed with ms. Female. Age 44. Slim build. No other known diseases (apart from gastrointestinal troubles) Blood pressure fine. Bloodwork fine. Some family history of heart disease (maternal grandfather died from stroke in his 50's and uncles on meds for high bloodpressure and cholesterol). Any tips or advice on how to investigate? What could cause this spectrum of symptoms? NOT interested in anxiety related diagnosis, if it should be anxiety related, there is no danger.
doctor
Answered by Dr. Benard Shehu (4 hours later)
Brief Answer: Suggested to run further diagnostic tests... Detailed Answer: Hi, I have gone through your query and understood your concerns. To my opinion, based on your medical data, the problems you are facing might be related to : - heart rhythm issues - stomach issues I would suggest to run further tests to determine your right diagnosis: - Holter monitoring - stress test - abdominal ultrasound - upper endoscopy Depending on the test results, specific treatment will be prescribed. Hope it was of help! Dr.Benard
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Benard Shehu (13 hours later)
Hello and thank you for a clear and concise answer. I have already done a 24 hour halter, on an uneventful day, no XXXXXXX arythmias discovered, several palpitations shown. Also a stress test without any abnormal results. 7 months ago an abdominal ultrasound with no abnormal findings. Could my symptoms indicate variant angina? My mother suffered periodic heart cramps over many years, with weeks or months between episodes. She didn't drink or smoke, or use any medications until the far stages of multiple sclerosis. She was never examined for heart disease. My suspicions arose when I researched heart pains that occur at the same time several days, not really expecting to find any answers. I had been completely symptom free upon waking, after 4-5 hours at work, exactly same time several days in a row, severe spasm/ cramp feeling in heart. Lasting only seconds-minutes, disappeared after 5-10 minutes. No stress related incidents. Have been having these cramps at various times of the day too. They are not the type of pain connected with breathing in or out, which may easily feel heartrelated, and I have also felt many times without particular worry. All this is of course mere speculation based on assorted/ vague symptoms, but might they be indicative of Prinzmetals? And to exclude this, how should I go about when consulting my doctor, wishing to investigate this further. It seems that the diagnosism of variant angina can be quite elusive to conclude. Thanks!
doctor
Answered by Dr. Benard Shehu (6 hours later)
Brief Answer: Prinzmental pain is not periodical... Detailed Answer: Hi, To my opinion, yours is not indicative for prinzmentals. Please bare in mind that cardiac pain is not related to food and does not happen at the same time for several days. The pain during prinzmental is more alike to angina (due to coronary spasms). Angina itself is not periodical as your pain is. I suggest to do an ECG when you have the pain and to discuss with your cardiologist to schedule ct scan angiography and upper endoscopy. Dr.Benard
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Benard Shehu (3 hours later)
Thank you for your reply. Though I feel tempted to clarify that these pains are not in any obvious way associated with food intake or meals. However I realise that there may still be links, considering the fact that I also have periodic gastrointestinal pains and bloating/ gas problems. Perhaps this avenue of inquiry may yield a few answers. However re. Prinzmetals circadian and periodic nature, I beg to differ based upon a multitude of sources i.e. Quote: "The temporal pattern of the rest angina warrants close consideration in evaluating these patients, both in relation to its waxing and waning nature and its distinct circadian rhythm. Variant angina may remain quiescent for prolonged periods and then recur with multiple frequent episodes. During these "hot phases", stimuli that would not usually provoke an episode of variant angina, may induce an episode. " (http://www.escardio.org/communities/councils/ccp/e-journal/volume11/Pages/variant-angina-John-Beltrame.aspx#.Uxt_Mfl5MU8) Quote 2: "Prinzmetal angina Definition This medical disorder is characterized by periodic cardiac chest pain and tightness. Medical experts describe this condition as “unstable angina” since it occurs only at rest and does not have a predictable pattern." (http://www.patienthelp.org/diseases-conditions/prinzmetal-angina.html) Thanks :)
doctor
Answered by Dr. Benard Shehu (2 days later)
Brief Answer: Advised to do EKG on in pain... Detailed Answer: Hi, You are reporting "I had been completely symptom free upon waking, after 4-5 hours at work, exactly same time several days in a row, severe spasm/ cramp feeling in heart. " The variant angina symptoms include a periodical pain early in the morning which wakes you up, is associated with increases ST (you have normal EKG) and is alleviated by using nitroglycerin when used under the tongue. So the periodicity of your pain is not typical for variant angina. At this point, I still insist to do the EKG when you have the symptoms (pain) to see if there is ST elevation or not; thus, diagnosing variant angina. Dr.Benard
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Benard Shehu (2 days later)
One additional question. Could a Calsiumscore CT. scan show something the ultrasound didn't?
doctor
Answered by Dr. Benard Shehu (7 hours later)
Brief Answer: They are more specific tests... Detailed Answer: Hi, Thank you for following up. It is true that calcium score and Ct-scan angiography are more specific tests to identify calcium and stenosis on the coronary arteries as compared to cardiac ultrasound (which does not identify them). Dr.Benard Let me know if you have more queries. I'd be happy to assist you further!
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Benard Shehu

Cardiologist

Practicing since :2004

Answered : 2257 Questions

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What Causes Chest Pain With Fatigue,palpitation And Dizziness?

Brief Answer: Suggested to run further diagnostic tests... Detailed Answer: Hi, I have gone through your query and understood your concerns. To my opinion, based on your medical data, the problems you are facing might be related to : - heart rhythm issues - stomach issues I would suggest to run further tests to determine your right diagnosis: - Holter monitoring - stress test - abdominal ultrasound - upper endoscopy Depending on the test results, specific treatment will be prescribed. Hope it was of help! Dr.Benard