Chest tightness, chest pain, back pain, and limb weakness?
Hello, starting from the end of February, I have been experiencing persistent chest tightness, dizziness, weakness in my limbs, left chest and back pain, shortness of breath, and fatigue.
After seeking medical attention, blood tests showed normal thyroid function.
Two days later, due to the persistence of symptoms, I sought medical care again, but by the time of the visit, I had no symptoms.
An ultrasound, electrocardiogram (ECG), and X-ray were performed, with the following results:
- PA systolic pressure: 30 mmHg
- Pericardial effusion: mm
- LV Function:
- PLVSF
- Hypokinesia (Normal EPSS < 10 mm)
- Estimated ejection fraction of left ventricle: 75% (Teichholz method)
- RV Function:
- PRVSF
- Hypokinesia (Normal TAPSE > 20 mm)
- IVC: 14 mm (Normal < 20 mm)
- Oscillating Vegetation:
- Thrombus:
- Mass/Tumor:
Interpretation:
- Mild Mitral Valve Prolapse (MVP), anterior leaflet
- Mitral regurgitation: Minimal
- Tricuspid regurgitation: Mild
- Pulmonary regurgitation: Minimal
- Diastolic function of LV: E/A > 1
- No LV regional wall motion abnormality.
24-hour ECG:
1.
Sinus rhythm with a rate of 48-114/min and mean 72/min.
2.
Intermittent ectopic atrial rhythms were noted.
3.
One Atrial Premature Contraction (APC).
4.
No Ventricular Premature Contractions (VPCs).
5.
No pauses longer than 2.0 seconds.
6.
No ST segment deviation greater than 2mm.
7.
No entries of symptoms were made in the patient diary.
A month later, during a follow-up visit, blood tests showed cholesterol levels:
- Total Cholesterol (T-CHO): 239
- Triglycerides (TG): 70
- Low-Density Lipoprotein Cholesterol (LDL-C): 148
I was prescribed antiarrhythmic medication and statins, which I am still taking.
I continue to experience intermittent chest tightness, dizziness, weakness in my limbs, left chest pain, and left back pain.
Recently, I have also started experiencing sporadic muscle cramps that last less than a minute, as well as intermittent numbness in my limbs (from the knees down to the toes and in the fingers), resembling poor circulation.
The blood vessels have also become more prominent.
Could you please advise if this indicates a heart, blood, or other issues, and what further examinations should be conducted? Thank you.
Tzu, 40~49 year old female. Ask Date: 2024/05/10
Dr. Wu Xueming reply Cardiology
The echocardiogram and 24-hour Holter monitor did not show any significant abnormalities.
If the chest discomfort persists, it is recommended to consult a physician in the outpatient clinic to see if an exercise stress test can be arranged.
Reply Date: 2024/05/10
More Info
Your symptoms of persistent chest tightness, dizziness, weakness in the limbs, left chest pain, back pain, shortness of breath, and fatigue are concerning and warrant further evaluation. Although you have undergone various tests, including blood tests, echocardiograms, and electrocardiograms (ECGs), the presence of ongoing symptoms suggests that a more comprehensive approach may be necessary.
Understanding Your Symptoms
1. Chest Pain and Discomfort: Chest pain can arise from various causes, including cardiac, musculoskeletal, gastrointestinal, and psychological factors. Given your symptoms, it is essential to rule out any cardiac issues, especially since you have a history of mitral valve prolapse (MVP) and mild mitral regurgitation. These conditions can sometimes lead to symptoms like chest pain and palpitations.
2. Dizziness and Weakness: These symptoms can be indicative of several issues, including low blood pressure, dehydration, anemia, or even anxiety. Your reported systolic pressure of 30 mmHg is concerning and should be investigated further, as it may indicate a significant drop in blood pressure, which can lead to dizziness and weakness.
3. Shortness of Breath: This can be related to cardiac issues, especially if there is any fluid accumulation around the heart (pericardial effusion) or if the heart is not pumping effectively. Your echocardiogram shows a normal left ventricular function, which is reassuring, but ongoing symptoms should not be ignored.
4. Muscle Pain and Numbness: The intermittent muscle cramps and numbness in your limbs could be related to circulation issues, electrolyte imbalances, or nerve compression. Given that you mentioned these symptoms are accompanied by visible blood vessels, it may be worthwhile to evaluate your vascular health.
Recommendations for Further Evaluation
1. Cardiology Follow-Up: Since you have ongoing symptoms, a follow-up with a cardiologist is essential. They may recommend additional tests such as a stress test, cardiac MRI, or even a coronary angiogram to assess the blood flow to your heart.
2. Neurological Assessment: Given the numbness and muscle cramps, a consultation with a neurologist may be beneficial. They can evaluate for any potential nerve issues or other neurological conditions that might be contributing to your symptoms.
3. Blood Tests: A comprehensive metabolic panel, complete blood count, and thyroid function tests can help identify any underlying issues such as anemia, electrolyte imbalances, or thyroid dysfunction that could be contributing to your symptoms.
4. Holter Monitor: If you have not already done so, wearing a Holter monitor for an extended period can help capture any arrhythmias that may not have been detected during your previous ECGs.
5. Lifestyle Modifications: While awaiting further evaluation, consider lifestyle changes that can help manage your symptoms. This includes maintaining a balanced diet, staying hydrated, managing stress through relaxation techniques, and engaging in light physical activity as tolerated.
Conclusion
Your symptoms are multifaceted and could stem from a combination of cardiac, neurological, and possibly psychological factors. It is crucial to continue working closely with your healthcare providers to ensure a thorough evaluation and appropriate management plan. Do not hesitate to seek immediate medical attention if your symptoms worsen or if you experience new symptoms such as severe chest pain, fainting, or significant changes in your health status. Your health and well-being are paramount, and timely intervention can make a significant difference.
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