Chest Pain and Fatigue: A Guide for Patients with Diabetes and Hypertension

Q: Chest Pain and Fatigue: A Guide for Patients with Diabetes and Hypertension

Dear Mr. <br>Anong：<br>1. <br>Your height is 163 cm, weight is 103 kg, and your body mass index (BMI) is 48.9 kg/m², which classifies you as severely obese. <br>Consequently, your risk of developing the following conditions is increased： hypertension, dyslipidemia, metabolic synd

There is a persistent dull pain in the chest near the heart, in the upper back close to the heart, and in the left shoulder?

Hello Dr.
Hsiao: I am 163 cm tall and weigh 130 kg.
For a long time, I have been experiencing persistent dull pain in my chest near the heart, in my back near the heart, and in my left shoulder.
I have diabetes and hypertension.
I have seen specialists in cardiology, orthopedics, rehabilitation, and traditional Chinese medicine.
I have been on medication for a while, but the effects have been limited, and no underlying cause has been identified.
Each time I visit a doctor, I am only prescribed pain relievers and anti-inflammatory medications.
Could you please help me understand what might be wrong with my body? Sometimes I experience palpitations, and now I get short of breath when climbing stairs or engaging in physical activity, although it hasn't reached a point where I can't work.
On my days off, I feel extremely tired and just want to sleep, lacking motivation to move.
How should I address my issues? (I previously had a long period of staying up late, eating late-night snacks, and consuming a lot of fried foods for about two years.
Could this have led to an accumulation of toxins?)

A Nong, 30~39 year old female. Ask Date: 2016/12/18

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Anong:
1.
Your height is 163 cm, weight is 103 kg, and your body mass index (BMI) is 48.9 kg/m², which classifies you as severely obese.
Consequently, your risk of developing the following conditions is increased: hypertension, dyslipidemia, metabolic syndrome, type 2 diabetes, coronary artery disease, obstructive sleep apnea, degenerative arthritis, gout, depression, and more.
2.
From a clinical perspective, when encountering a patient with chest pain, the four life-threatening conditions to rule out are myocardial infarction, aortic dissection, pulmonary embolism, and pneumothorax.
If these four conditions can be excluded, given your age and situation, it is essential to monitor and control hypertension, hyperglycemia, hyperlipidemia, and hyperuricemia to prevent complications.
Additionally, weight management is crucial; it is recommended to aim for a gradual weight loss of no more than 450 grams (1 pound) per week.
Rapid weight loss can lead to rebound weight gain, potentially resulting in a higher weight than before.
Weight loss should be coordinated with your diabetes and hypertension medication regimen, so it is imperative to discuss this thoroughly with your primary care physician rather than implementing changes haphazardly.
Eating should be done slowly and mindfully, aiming for 80% fullness at each meal, along with appropriate post-meal walks and regular daily exercise.
Avoid high-sugar, high-fat, and high-calorie diets, particularly trans fats and high fructose corn syrup.
Additionally, maintaining warmth, ensuring adequate sleep, and managing stress levels are also very important.
I believe that by implementing these measures, your symptoms of palpitations, shortness of breath, and fatigue will improve.
3.
Regarding the question of whether you are consuming too many toxins, it is difficult to determine; however, weight loss and increased water intake should be beneficial.
4.
I strongly recommend that you engage in a thorough discussion with your primary care physician to explore effective strategies for your health management.

Reply Date: 2016/12/18

More Info

Hello, thank you for your question. It sounds like you are experiencing a complex interplay of symptoms related to your diabetes, hypertension, and possibly other underlying health issues. Let's break down your concerns and explore some potential avenues for understanding and managing your symptoms.

Understanding Your Symptoms
1. Chest Pain and Fatigue: Given your history of diabetes and hypertension, chest pain can be concerning. It may be related to cardiovascular issues, especially since you mentioned experiencing heart palpitations and shortness of breath with exertion. Diabetes can lead to cardiovascular complications, and hypertension can exacerbate these risks. It's crucial to rule out any serious heart conditions, especially if you have not had recent comprehensive cardiac evaluations.

2. Pain in the Back and Shoulder: The pain you describe in your back and shoulder could be musculoskeletal in nature, especially if it worsens with certain movements or positions. However, it is essential to differentiate between musculoskeletal pain and pain that could be cardiac in origin. Given your symptoms, a thorough evaluation by a cardiologist may be warranted, including tests like an echocardiogram or stress test to assess your heart's function.

3. Fatigue and Sleepiness: Chronic fatigue can stem from various factors, including poor sleep quality, medication side effects, or the metabolic effects of diabetes and hypertension. If you have been experiencing long-term sleep disturbances or poor sleep hygiene, addressing these issues could significantly improve your overall energy levels.
4. Lifestyle Factors: You mentioned a history of late-night eating and a diet high in fried foods. These habits can contribute to weight gain, poor blood sugar control, and increased fatigue. A balanced diet rich in whole foods, vegetables, lean proteins, and healthy fats can help manage your blood sugar levels and improve your overall health.

Recommendations for Management
1. Consultation with Healthcare Providers: Since you have seen multiple specialists without a clear diagnosis, it may be beneficial to have a coordinated care approach. Consider asking your primary care physician for a referral to a multidisciplinary team that includes a cardiologist, endocrinologist, and possibly a nutritionist. This team can work together to address your symptoms holistically.

2. Cardiac Evaluation: Given your symptoms of chest pain and heart palpitations, a thorough cardiac evaluation is essential. This may include an electrocardiogram (ECG), echocardiogram, and possibly a stress test to assess your heart's health and function.

3. Lifestyle Modifications: Focus on improving your diet and physical activity levels. Aim for a balanced diet low in processed foods and high in fiber. Regular physical activity, even in moderate amounts, can help improve your cardiovascular health and manage your weight. Start with gentle exercises, such as walking, and gradually increase intensity as tolerated.

4. Monitoring Blood Sugar and Blood Pressure: Regular monitoring of your blood sugar levels and blood pressure is crucial. Keeping a log of your readings can help your healthcare team make informed decisions about your treatment plan.

5. Mental Health Support: Chronic health conditions can take a toll on mental health. If you are feeling overwhelmed or anxious about your health, consider seeking support from a mental health professional. They can provide coping strategies and support as you navigate your health challenges.

Conclusion
Your symptoms are multifaceted and require a comprehensive approach to management. By working closely with your healthcare team and making lifestyle changes, you can improve your overall health and well-being. Remember, it’s essential to advocate for yourself and seek the care you need to address your concerns effectively. Don't hesitate to reach out to your healthcare providers with any new or worsening symptoms. Your health is a priority, and with the right support, you can work towards feeling better.

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