Chest Tightness and Weakness: Heart Health Insights for Young Adults - Cardiology

Chest tightness, generalized weakness, heart problems?

---

Hello Director Wu, I am 23 years old and have been experiencing chest tightness for about two months.
I have undergone cardiac ultrasound, stress testing with redistribution cardiac catheter flow, Doppler color flow imaging, CT angiography, and extreme bicycle exercise at two different hospitals.
One of the hospitals diagnosed me with Wolff-Parkinson-White (WPW) syndrome, but since I am currently not experiencing any episodes, they could not provide a definitive diagnosis and did not follow up.
However, the chest tightness continues to recur, and recently I have also felt slight pressure and pain in my left chest and the inner side of my left arm.
I tend to get anxious easily and would like to inquire if the following reports indicate any cardiac-related issues, as I have to wait some time for my next appointment and would like to know the results in advance.
Is there any immediate danger? During the exercise ECG test, the nurse informed me of some abnormal findings and asked me to wait for the doctor to explain...
Given my current situation, am I in danger?
Purpose: 1(V) Dx; 2( ) PTCA; 3( ) PTMV; 4( ) Drugs; 5( ) CABG; 6( ) Rehabilitation; 7( ) Arrhythmia; 8( ) Screening; 9( ) Others
Pre-exercise ECG: Blood Pressure: 117/79
Medications: ( ) Yes, (V) No
Patient Fasting: ( ) Yes, (V) No
Stage: Speed/Grade (MPH/Grade): (1.7/10) (2.5/12) (3.4/14) (4.2/16) (5./18)
Minutes: 2’ 5’ 8’ R2’ R5’
Blood Pressure: 149/80 186/78 175/76 155/60 140/61
Minutes:
Blood Pressure: / / / / /
Exercise Terminated Because of:
A.( ) Maximal Effort
F.(V) Dyspnea
K.( ) Chest tightness
B.(V) 90% Maximal Heart Rate Obtained
G.( ) Arrhythmia
L.( ) Can’t catch-up speed
C.( ) ST Segment Shift
H.( ) Leg Pain
M.( ) Exercise intolerance
D.( ) Chest Pain
I.( ) Hypotension
N.( ) Vasovagal Response
E.( ) Fatigue
J.( ) Dizziness
O.
Total Time: 9’11’’
MHR X MSBP: 179X 186= 33294
Maximal Achieved Rate: 179
Maximal Predicted Rate: 197
90% Predicted Rate: 177
Prepared by: F104246 Zhang Wei-Han
INTERPRETATION OF EXERCISE ECG
1.( ) Normal ECG at maximal effort
2.( ) Normal ECG at submaximal (90%) predicted heart rate
3.( ) Normal ECG at “inadequate” heart rate of
4.( ) Abnormal ST junction and segment elevated
5.(V) Abnormal ST segment depression:
A.
Downsloping mm
B.
Flat 1 mm V5
C.
Upsloping mm (from j point to at least 0.08 seconds)
6.( ) Other (Specify)
Comment:
1.( ) Positive
2.(V) Negative
3.( ) Inconclusive (specify)
4.( ) Complication (specify)
5.
Other
Report: The Tl-201 myocardial perfusion SPECT study was performed with dipyridamole pharmacologic stress.
Intravenous dipyridamole was administered at a rate of 0.142 mg/kg/min for 4 minutes.
The administered dose was 8.2 ml (5mg/ml).
The patient experienced headache/dizziness during the stress test, which was relieved by aminophylline.
The Tl-201 myocardial perfusion SPECT study performed 5 minutes after intravenous injection of Tl-201 and 4 hours later revealed homogeneous distribution of radioactivity in the myocardium of the left ventricle in each study.
The EKG-gated functional study showed: Stress LVEF=72%, Rest LVEF=68%.
Stress defect: 12% of total myocardium.
Reversibility: 78% of total (LAD: 50%, LCX: 70%, RCA: 0%).
Impression: - No evidence of myocardial infarction or ischemia.
Report: Echo machine:
Patient source:
【Atrium and Aortic Root】
AO (mm) = 29
LA (mm) = 31
【Left Ventricle】
IVS (mm) = 9
PW (mm) = 9
EDD (mm) = 50
ESD (mm) = 29
EDV (ml) =
ESV (ml) =
LV mass (g) =
LVEF: by M-mode measurement: 71%
LV Wall motion: Normal wall motion
【Right Ventricle】
TAPSE = mm
【Diastolic function】
Mitral inflow E/A: ? (E/A ratio:)
Septal E/e: ;
Lateral E/e: ;
【Valve】
MS: nil;
MR: nil;
AS: nil;
AR: nil;
TS: nil;
TR: nil;
PS: nil;
PR: nil;
【Other findings】
IVC diameter: mm with sniff collapse > 50%
Intracardiac vegetation:
Pericardial effusion: None
Intracardiac thrombus: No
Congenital lesions: None
Conclusion:
1.
No cardiac chamber dilatation
2.
Normal LV systolic function with normal wall motion
3.
Normal RV systolic function
4.
Equivocal MV prolapse
Clinical information: a 23 Y/O man, progressive and intermittent chest pain for 2 days.
CTA of aorta without and with IV contrast medium enhancement shows:
Comparison: No available comparison study.

Findings in concern:
1.
No evidence of aortic dissection, intramural hematoma, or perforated aortic ulcer.

Other Findings:
1.
No remarkable finding in liver, gallbladder, spleen, pancreas, bilateral adrenal glands, and kidneys.

2.
No pancreatico-biliary tree dilatation.
Portal veins and hepatic veins are patent.

3.
Patent main trunks of SMA and SMV without evidence of obstructive bowel or colon lesion.

4.
Clear mesentery and omentum.
No ascites.
No pneumoperitoneum.

5.
No enlarged lymph nodes in abdomen and pelvis.

6.
No active lesion in bilateral lungs.
No pleural effusion.

7.
No definite bony destruction in the scanned field.

IMP: No evidence of acute aortic syndrome.

1.
Basic rhythm is sinus rhythm.
HR around 45~139 bpm, mean HR=87 bpm.

2.
Minimal HR was 45 bpm at 05:48 due to sinus bradycardia.

3.
Maximal HR was 139 bpm at 10:49 due to sinus tachycardia.

4.
Rare APCs with a total of 5 beats.

5.
No VPCs.

6.
The patient’s diary events were related to sinus rhythm.

---

Chongyou, 20~29 year old female. Ask Date: 2022/12/10