Severe Chestpains and fainting

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Submitted by Dr T on December 16, 2010 – 11:16am

I am a 51 year old woman who is fit and healthy, low cholesterol, low fat diet, no food before bedtime, low to average BP and pulse. Grandfather died of heart attack at 53 the other at 73, father died early of trauma, grandmothers died of heart disease in 80s & 90s. Have Raynauds, GERD nexium 40mg daily. long history of fits, faints & funny turns, usually every 2-5 years. rarely witnessed, often found myself on floor awaking from unconscious state with injuries. 3 events over past few years = woken by chest pain in the night, midway between nipple & sternum & ascending. rapid escalation to extreme pain, collapse without warning. rapid recovery, no vague state, nausea, epigastric pain, incontinence. witness said no jerking or twitching. In ED ECG poor R wave progression, no elevated heart enzymes only normal muscle enzymes, normal echocardigram. neuro assessment normal. What could it be? Previously Drs thought it was reflux with vasovagal but I have no residual reflux symptoms after event. My diet & medication should make this a low risk. I have injured my back , neck and front teeth in the recent events. I need a diagnosis and cure. Given the time of year I can’t get to see a cardiologist as an outpatient for ages. What preventative steps can I take? what questions and test should I ask for? I haven’t had a stress test or angiogram. thanks for your help.

Your symptoms are not those of GERD, but if esophageal, rather sound more like spasm. However, neither GERD, nor spasm will cause fainting. For that, in the absence of a heart attack, I am concerned you may have arrhythmias, either too slow or too fast that cause the pump function of your heart to be insufficient. That will decrease the blood flow to your brain, hence fainting.
I would recommend a Holter monitor test, but how that works in Australia I don’t know. It seems to me your symptoms are serious enough to bypass the medical bureaucracy! In the meantime, your best protection is to be with other people. If this occurs again before you see a cardiologist, insist on seeing a cardiologist in the ER!!
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Hope this helps,
Dr T

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