Possible Cardiac problems

History: 51 yr. old F, healthy(slightly overweight). Runner/jogger since 1998. Last Sunday during  a Half Marathon developed pain in chest left side directly under collar bone did not radiate down arm. Severe nausea, dizziness, lightheaded, & tired. Continued nausea for next 2 hours after race. HR too high the first 5 miles (162-174bpm)slowed down to 154-161bpm. Mile 8 to 13 is when the pain developed and got worse if anything other than a walk was attempted. Have had same symptoms in the past did EKG/Stress Test all was normal (4 yrs. ago). Current Dr. visit same routine EKG/Chest X-Ray & Stress Test (still waiting for results/ appointment). If all comes back normal should I request a visit to a cardiologist to be safe? None of this is normal for me, heart rate has been higher as slower paces, going up stairs sometimes feels like I just did a short sprint, extreme fatigue. But all could be related to something else? Paternal grandfather passed from heart attack under the age of 40 don't know if that makes a difference. My Triglycerides were a little high last testing about 4 years ago more concerned about a possible blocked or partially blocked artery. Thank you in advance for your time.
Hi Suzanne,
Your symptoms are very suggestive of angina and coronary artery disease, but why do you ask for an opinion before the results of these tests are available? They will give you a much better answer than anything I can guess from here!
While I don't know of course what is your situation, the most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:
  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These signs and symptoms are often more subtle than the obvious crushing chest pain often associated with heart attacks.

Even if negative, and depending on your cardiac risk factors (and you have some), it is as good a time as any to start living a heart healthy lifestyle if you are not yet.

Hope this helps,
Dr T


At this point I am not convinced you have coronary artery disease, but I also don't this has been disproven or that these are just anxiety attacks.

These O2 sats=80% are very abnormal and not explained either. I would have looked for other causes besides your heart, including a pulmonary embolism.

Re: microvascular disease and coronary spasms (Prinzmetal’s angina), the diagnosis is usually made with an ECG (electrocardiogram or EKG) during an episode of chest pain and is usually found in patient otherwise at risk for CAD.  A PET scan is not the way to diagnose either one, but rather a stress test (it doesn't sound like you were "stressed" during the Lexiscan), while an cardiac catherization would have shown "mcrovascular disease". 

Thus I agree with you that you should continue try to find out what is going and that the investigation is incomplete at this point. 

Hope this helps,

Dr T


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