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What Causes Severe Chest Pain And Extreme Fatigue In An Elderly Woman?
Question: I am a 74 yr old female who has had a work up by a cardiologist and he can find nothing wrong with me. I went to the ER 2 days ago with mid sternum chest pain and was also ruled okay. I continue to have chest pain along with extreme fatigue and almost to the point of thinking the drs. are missing something. I have had a long history of chronic problems bleeding ulcers, fibromyalgia, knee replacement and breast cancer in 1979 that was "cured" with mastectomies and no radiation. Albuterol was prescribed to me as the only med for this chest pain. It is sharp, worse while lying down, and causes me to lie about. I woke this morning with a very heavy compression on my chest... much like the term "elephant sitting on my chest". I am a retired R.N. and am puzzled with these symptoms and also with the lack of a diagnosis.
Tests: CBC, chest x-ray, EKG, CAT scan of chest for ? clots, echocardiogram ( I have mitral valve prolapse and asymptomatic) and a stress test with contrast. I was initially referred by my GP to the cardiologist because of an abnormal EKG " has had an anterior infarction". I was surprised as I had had a 2 week feeling of SOB at rest when I went to my dr. and had no pain. The EKG the cardiologist did was the same dx.
I need help. Thank you.
Tests: CBC, chest x-ray, EKG, CAT scan of chest for ? clots, echocardiogram ( I have mitral valve prolapse and asymptomatic) and a stress test with contrast. I was initially referred by my GP to the cardiologist because of an abnormal EKG " has had an anterior infarction". I was surprised as I had had a 2 week feeling of SOB at rest when I went to my dr. and had no pain. The EKG the cardiologist did was the same dx.
I need help. Thank you.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that your symptoms (chest pain while lying down) are not typical for myocardial ischemia.
Gastro-esophageal reflux or an aorta aneurysm could be the cause of this symptomatology. Chest or backbone metastastasis related to the mamectomy that you have performed could explain a similar clinical scenario too.
That is why they have performed a chest X ray study, CAT scan of the chest and a cardiac ultrasound.
From the other hand, fibromyalgia, gastric ulcers could also cause chest pain.
Regarding the resting ECG that you have performed, you should know that taking into consideration your complicated past medical history, it may be related to a myocardial infarct, which has been not too symptomatic.
Did they perform cardiac markers (enzymes)? This would be the test of choice to investigate if it is an acute myocardial ischemia occurring at the moment of chest pain, or a past myocardial infarction.
Further investigations (like coronary angiography) may be needed, if the diagnosis of past myocardial infarct is established.
Nevertheless, would like to review your uploaded resting ECG for another professional opinion.
Hope to have been helpful!
Kind regards,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully read your question and would explain that your symptoms (chest pain while lying down) are not typical for myocardial ischemia.
Gastro-esophageal reflux or an aorta aneurysm could be the cause of this symptomatology. Chest or backbone metastastasis related to the mamectomy that you have performed could explain a similar clinical scenario too.
That is why they have performed a chest X ray study, CAT scan of the chest and a cardiac ultrasound.
From the other hand, fibromyalgia, gastric ulcers could also cause chest pain.
Regarding the resting ECG that you have performed, you should know that taking into consideration your complicated past medical history, it may be related to a myocardial infarct, which has been not too symptomatic.
Did they perform cardiac markers (enzymes)? This would be the test of choice to investigate if it is an acute myocardial ischemia occurring at the moment of chest pain, or a past myocardial infarction.
Further investigations (like coronary angiography) may be needed, if the diagnosis of past myocardial infarct is established.
Nevertheless, would like to review your uploaded resting ECG for another professional opinion.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Ilir,
Thank you for your response. I have been occupied with getting more tests done. I had a confer today with Dr. XXXXXXX XXXXXXX Board Certified Cardiologist, and after looking over the tests, he ordered another look at the echocardiogram, focusing on the mitral valve which had been previously diagnosed as being "prolapsed". This p.m., he feels that this 2nd look was still "okay", but is still concerned about the SOB and extreme fatigue with chest pressure in the sternum. He has ordered a pulmonary function test for me in the next day or so. This is based on the fact that I had a mastectomy in 1979 with 8+ revisions of the reconstruction after my implants. His feeling is that the scar/keloid tissue in that area could be causing some constriction where it might be interfering with my breathing. So that's where we are now. I will share your findings with Dr. XXXXXXX I think you are right on target and I am sure Dr. XXXXXXX will concur. I will keep you posted. Thank you again.
FYI on Monday March 1, 2026, and after I wrote to you, I went to see my primary physician and was feeling very ill ( Pain # 9 on pain scale ). She recommended I stop the Nexium and begin Carafate 10 mgm ac and hs for my chest symptoms of fullness and pressure. I did so and have noted a decrease in the pain in my chest. Also, all blood tests and blood workup for enzymes were done in the ER and were WNL. I am a novice at sending reports via this route, but I will ask Dr. Jones's nurse to help me with this. I always welcome all opinions and recommendations, as this is extremely important for me to get right dx and take care of it.
Thank you for your response. I have been occupied with getting more tests done. I had a confer today with Dr. XXXXXXX XXXXXXX Board Certified Cardiologist, and after looking over the tests, he ordered another look at the echocardiogram, focusing on the mitral valve which had been previously diagnosed as being "prolapsed". This p.m., he feels that this 2nd look was still "okay", but is still concerned about the SOB and extreme fatigue with chest pressure in the sternum. He has ordered a pulmonary function test for me in the next day or so. This is based on the fact that I had a mastectomy in 1979 with 8+ revisions of the reconstruction after my implants. His feeling is that the scar/keloid tissue in that area could be causing some constriction where it might be interfering with my breathing. So that's where we are now. I will share your findings with Dr. XXXXXXX I think you are right on target and I am sure Dr. XXXXXXX will concur. I will keep you posted. Thank you again.
FYI on Monday March 1, 2026, and after I wrote to you, I went to see my primary physician and was feeling very ill ( Pain # 9 on pain scale ). She recommended I stop the Nexium and begin Carafate 10 mgm ac and hs for my chest symptoms of fullness and pressure. I did so and have noted a decrease in the pain in my chest. Also, all blood tests and blood workup for enzymes were done in the ER and were WNL. I am a novice at sending reports via this route, but I will ask Dr. Jones's nurse to help me with this. I always welcome all opinions and recommendations, as this is extremely important for me to get right dx and take care of it.
Brief Answer:
My opinion:
Detailed Answer:
Hello again, dear XXXXX!
I agree with your attending cardiologist that a pulmonary function test should be part of the diagnostic work up regarding shortness of breath.
Also regarding your chest pain, I recommend discussing with your doctor on the possibility of a fibrogastroscopy to rule in/out possible gastritis, active ulcers, or GERD (gastro-esophageal reflux).
Degenerative backbone disorders are necessary to be investigated as well.
I remain of the opinion that all the previous suggestions at the beginning of our thread should be clarified.
Let me explain that a careful review of your numerous medications should be considered, because some interactions may lead to respiratory depression, profound weakness, etc. involving at least partially as responsible causes in your actual complaints (SOB, profound tiredness, etc).
- Cymbalta and Oxycodone interaction may lead to elevation of Oxycodone plasma concentration with subsequent respiratory depression.
- Fentanyl and Oxycodone interaction may lead to increased effects of both of them by pharmacodynamic synergism, causing possible serious or life-threatening interaction: may cause respiratory depression, hypotension, profound sedation, etc.
- Benadryl and Oxycodone interaction may cause increased plasma levels of Oxycodone with subsequent increased sedation, etc.
So, it is necessary to discuss with your prescribing physician about a possible optimizing of your actual therapy (possibly reducing any of your actual drugs).
Hope to have been helpful to you!
Let me know about your tests results.
Regards,
Dr. Iliri
My opinion:
Detailed Answer:
Hello again, dear XXXXX!
I agree with your attending cardiologist that a pulmonary function test should be part of the diagnostic work up regarding shortness of breath.
Also regarding your chest pain, I recommend discussing with your doctor on the possibility of a fibrogastroscopy to rule in/out possible gastritis, active ulcers, or GERD (gastro-esophageal reflux).
Degenerative backbone disorders are necessary to be investigated as well.
I remain of the opinion that all the previous suggestions at the beginning of our thread should be clarified.
Let me explain that a careful review of your numerous medications should be considered, because some interactions may lead to respiratory depression, profound weakness, etc. involving at least partially as responsible causes in your actual complaints (SOB, profound tiredness, etc).
- Cymbalta and Oxycodone interaction may lead to elevation of Oxycodone plasma concentration with subsequent respiratory depression.
- Fentanyl and Oxycodone interaction may lead to increased effects of both of them by pharmacodynamic synergism, causing possible serious or life-threatening interaction: may cause respiratory depression, hypotension, profound sedation, etc.
- Benadryl and Oxycodone interaction may cause increased plasma levels of Oxycodone with subsequent increased sedation, etc.
So, it is necessary to discuss with your prescribing physician about a possible optimizing of your actual therapy (possibly reducing any of your actual drugs).
Hope to have been helpful to you!
Let me know about your tests results.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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