Chest pain and fatigue, what else do I need to consider?

[Arcadia]

18 minutes ago, Ann.without.an.e said:

 

tbh I probably met deductible by going to the ER so why not take the time to figure it out 😜

My oncologist ordered a lot of tests for me last year since he knew my out of pocket was already maxed. 
Has a full thyroid panel test been done?

https://www.thyroid.org/thyroid-function-tests/

[cintinative]

51 minutes ago, Ann.without.an.e said:

 

tbh I probably met deductible by going to the ER so why not take the time to figure it out 😜

I'm so glad for you. Our deductible is $6500 a person so it takes a lot to get you there.

[Ann.without.an.e]

1 hour ago, cintinative said:

I'm so glad for you. Our deductible is $6500 a person so it takes a lot to get you there.

 

oh, ours is 6,000 and I assumed ER would be that expensive?

[Ann.without.an.e]

2 hours ago, Arcadia said:

My oncologist ordered a lot of tests for me last year since he knew my out of pocket was already maxed. 
Has a full thyroid panel test been done?

https://www.thyroid.org/thyroid-function-tests/

I have Hashimoto's so thyroid is always checked, haha.

[cintinative]

28 minutes ago, Ann.without.an.e said:

 

oh, ours is 6,000 and I assumed ER would be that expensive?

Hmm. I don't know. It's been a long time since we have been to the ER.  

You could check your Insurance website and see if anything is posted as under review. 

 

[Pawz4me]

29 minutes ago, Ann.without.an.e said:

I have Hashimoto's so thyroid is always checked, haha.

You probably already know this, but having one AI disease increases your risk of having others. They like to run in packs.

[cintinative]

30 minutes ago, Ann.without.an.e said:

I have Hashimoto's so thyroid is always checked, haha.

Goodness. I did not know. Pawz4me is right. All the more reason to get checked for another autoimmune.

When it rains, it pours. Hang in there. This has to be overwhelming. 

[TravelingChris]

5 hours ago, Pawz4me said:

Interstitial lung disease is a fairly common complication of RA, lupus and (I think) several other AI diseases. So that may be something to consider, too?

ANd that is also diagnosed by a CATscan

[Ann.without.an.e]

Saw the cardiologist and he just really doesn't think it is cardiac. He said at my age, stats, labs, ekg, blood pressure, etc. He thinks it is so low chance but he has ordered a stress test for the 12th and an echocardiogram for late august. He basically wants to rule out heart so that I can put my focus elsewhere. 

He said he feels like it is more a pulmonary or rheumatology issue or possibly a pinched nerve? He also said I could try to see if insurance could cover a CT of the heart?  That would rule out a lot.

I have no idea. My primary doesn't want me to see a rheum, she thinks that it is useless that they will just label me with unspecified autoimmune disorder and then want me on a nasty drug that I won't take anyway. 

 

ETA he looked at me and said what every new doctor says to me "you have lupus?"  

I guess I just "have the look" But see I have rosacea so my cheeks are always rosy. 

Edited July 1, 2021 by Ann.without.an.e

[Kassia]

I'm sorry.  It's so frustrating to have something wrong and not have anyone figure out what it is so it can be diagnosed and treated.

[Pawz4me]

17 minutes ago, Ann.without.an.e said:

I have no idea. My primary doesn't want me to see a rheum, she thinks that it is useless that they will just label me with unspecified autoimmune disorder and then want me on a nasty drug that I won't take anyway. 

Solely FWIW -- I've been on three RA medications and none of them have been nasty at all. My side effects have been very, very minimal (to the point that I'm very tempted to write "no side effects at all"). Of course it's your choice to do whatever treatment (or not) that you choose, but in general an AI disease isn't something I'd want to let go untreated. Poor immediate quality of life, plus the potential long term complications of untreated disease are quite scary. To me that's a lose/lose proposition. But if you only have mild symptoms right now I understand why you might feel that way. I was already dealing with fairly severe pain and (especially) fatigue when diagnosed. My QOL was so poor that not starting treatment really wasn't an option. If you're truly not going to treat any disease, then I kinda sorta agree with your primary. Why bother with a diagnosis?

[Catwoman]

36 minutes ago, Ann.without.an.e said:

Saw the cardiologist and he just really doesn't think it is cardiac. He said at my age, stats, labs, ekg, blood pressure, etc. He thinks it is so low chance but he has ordered a stress test for the 12th and an echocardiogram for late august. He basically wants to rule out heart so that I can put my focus elsewhere. 

He said he feels like it is more a pulmonary or rheumatology issue or possibly a pinched nerve? He also said I could try to see if insurance could cover a CT of the heart?  That would rule out a lot.

I have no idea. My primary doesn't want me to see a rheum, she thinks that it is useless that they will just label me with unspecified autoimmune disorder and then want me on a nasty drug that I won't take anyway. 

 

ETA he looked at me and said what every new doctor says to me "you have lupus?"  

I guess I just "have the look" But see I have rosacea so my cheeks are always rosy. 

I think your primary doctor is way out of line.

Your doctor should be encouraging you to follow up on every possibility, so you can get a proper diagnosis. At that point, after hearing all of the information and weighing all of your options, you will be able to make an educated decision about a treatment plan. If you end up deciding against taking any medications, that will be up to you, but you should still have a definite diagnosis so you know what you are dealing with.

[Arcadia]

41 minutes ago, Ann.without.an.e said:

Saw the cardiologist and he just really doesn't think it is cardiac. He said at my age, stats, labs, ekg, blood pressure, etc. He thinks it is so low chance but he has ordered a stress test for the 12th and an echocardiogram for late august. He basically wants to rule out heart so that I can put my focus elsewhere. 

There are many studies on young women and heart attacks now.

E.g. https://www.ucihealth.org/blog/2019/07/scad-heart-attack

”

Heart attacks aren’t supposed to happen to younger people, especially women under age 50 who are physically fit with no prior indication of heart problems. 

However, there is one heart condition that strikes younger women: spontaneous coronary artery dissection, or SCAD.  

SCAD, which is a tear in the innermost layer of an artery wall, is the leading cause of heart attacks in younger women. This rare condition often affects pregnant women, new mothers and otherwise healthy athletes. Most of the time, the tear in the artery may heal on its own. 

But if left undiagnosed, SCAD can cause severe damage to the heart and lead to death.

“Just as many women have heart attacks as men, and up to 25% to 30% of those cases can be due to SCAD,” says UCI Health interventional cardiologist Jin K. Kim, MD, PhD, who specializes in heart disease, noninvasive cardiovascular imaging and women’s heart health.

Causes of SCAD

Whereas a classic heart attack is usually caused by blockage due to atherosclerosis, or plaque buildup, a SCAD heart attack is due to a different type of blockage, one that results from a tear in the innermost layer of an artery wall. 

As blood flows into the torn layer, a blockage forms, interrupting blood flow to the heart and causing a heart attack.

Who is at risk for SCAD?

SCAD most commonly affects:

• Young women who do not have the normal risk factors for heart disease
• Female athletes who perform intense exercise
• Pregnant women and new mothers

In many cases, the cause of SCAD is unidentifiable, making diagnosis particularly challenging. 

“SCAD can happen in a normal artery,” Kim says. “It is very hard to determine who will develop this condition. The exact mechanism of SCAD is not really known at this point. We know how it happens — a tearing of two layers of the walls that make up the blood vessel in the coronary artery — but why it happens is really not clear.”

…

 

Symptoms of an arterial dissection

Women diagnosed with SCAD experience symptoms similar to stress, anxiety, panic attacks, acid reflux or other life-threatening conditions. Because of this, the condition is often misdiagnosed.

Other symptoms include:

• Chest pain or uncomfortable pressure in the chest
• Light headedness, fainting
• Nausea, vomiting
• Pain that radiates to the shoulders, neck, or arms
• Palpitations
• Shortness of breath

If you are having chest discomfort, shortness of breath, or pain in your neck or jaw — symptoms that you have not experienced before — Kim recommends contacting your primary care physician or cardiologist immediately. 

Diagnosing SCAD

If you or your doctor suspects you are having a heart attack, a blood test should be administered to detect blood damage and diagnostic imaging may be performed. 

To help diagnose SCAD, Kim and other UCI Health interventional cardiologists also perform optical coherence tomography (OCT), a noninvasive diagnostic imaging technique that is not widely available elsewhere.”

https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-attack/heart-attacks-striking-younger-women

“Younger women are having more heart attacks, says a recent study. Researchers were surprised to find that while the heart attack rate has decreased among older adults, it's risen among those ages 35-54, especially women. The Atherosclerosis Risk in Communities study reviewed more than 28,000 hospitalizations for heart attacks in four cities.

"This observational study found a trend in young women," says Virginia Colliver, M.D., cardiologist with Johns Hopkins Community Physicians-Heart Care in Bethesda, Maryland. "But the research doesn't provide insight into why the uptick in heart attacks is happening to younger people. I suspect it has to do with more people having risk factors for heart disease at an earlier age."”

[Ann.without.an.e]

19 minutes ago, Pawz4me said:

Solely FWIW -- I've been on three RA medications and none of them have been nasty at all. My side effects have been very, very minimal (to the point that I'm very tempted to write "no side effects at all"). Of course it's your choice to do whatever treatment (or not) that you choose, but in general an AI disease isn't something I'd want to let go untreated. Poor immediate quality of life, plus the potential long term complications of untreated disease are quite scary. To me that's a lose/lose proposition. But if you only have mild symptoms right now I understand why you might feel that way. I was already dealing with fairly severe pain and (especially) fatigue when diagnosed. My QOL was so poor that not starting treatment really wasn't an option. If you're truly not going to treat any disease, then I kinda sorta agree with your primary. Why bother with a diagnosis?

 

That was true a few years ago when we talked about it but this is highly affecting my QOL. This isn't something that I'm willing to sit on. I am hardly functioning level of exhaustion and pain. 

[Ann.without.an.e]

14 minutes ago, Arcadia said:

There are many studies on young women and heart attacks now.

E.g. https://www.ucihealth.org/blog/2019/07/scad-heart-attack

”

Heart attacks aren’t supposed to happen to younger people, especially women under age 50 who are physically fit with no prior indication of heart problems. 

However, there is one heart condition that strikes younger women: spontaneous coronary artery dissection, or SCAD.  

SCAD, which is a tear in the innermost layer of an artery wall, is the leading cause of heart attacks in younger women. This rare condition often affects pregnant women, new mothers and otherwise healthy athletes. Most of the time, the tear in the artery may heal on its own. 

But if left undiagnosed, SCAD can cause severe damage to the heart and lead to death.

“Just as many women have heart attacks as men, and up to 25% to 30% of those cases can be due to SCAD,” says UCI Health interventional cardiologist Jin K. Kim, MD, PhD, who specializes in heart disease, noninvasive cardiovascular imaging and women’s heart health.

Causes of SCAD

Whereas a classic heart attack is usually caused by blockage due to atherosclerosis, or plaque buildup, a SCAD heart attack is due to a different type of blockage, one that results from a tear in the innermost layer of an artery wall. 

As blood flows into the torn layer, a blockage forms, interrupting blood flow to the heart and causing a heart attack.

Who is at risk for SCAD?

SCAD most commonly affects:

• Young women who do not have the normal risk factors for heart disease
• Female athletes who perform intense exercise
• Pregnant women and new mothers

In many cases, the cause of SCAD is unidentifiable, making diagnosis particularly challenging. 

“SCAD can happen in a normal artery,” Kim says. “It is very hard to determine who will develop this condition. The exact mechanism of SCAD is not really known at this point. We know how it happens — a tearing of two layers of the walls that make up the blood vessel in the coronary artery — but why it happens is really not clear.”

…

 

Symptoms of an arterial dissection

Women diagnosed with SCAD experience symptoms similar to stress, anxiety, panic attacks, acid reflux or other life-threatening conditions. Because of this, the condition is often misdiagnosed.

Other symptoms include:

• Chest pain or uncomfortable pressure in the chest
• Light headedness, fainting
• Nausea, vomiting
• Pain that radiates to the shoulders, neck, or arms
• Palpitations
• Shortness of breath

If you are having chest discomfort, shortness of breath, or pain in your neck or jaw — symptoms that you have not experienced before — Kim recommends contacting your primary care physician or cardiologist immediately. 

Diagnosing SCAD

If you or your doctor suspects you are having a heart attack, a blood test should be administered to detect blood damage and diagnostic imaging may be performed. 

To help diagnose SCAD, Kim and other UCI Health interventional cardiologists also perform optical coherence tomography (OCT), a noninvasive diagnostic imaging technique that is not widely available elsewhere.”

https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-attack/heart-attacks-striking-younger-women

“Younger women are having more heart attacks, says a recent study. Researchers were surprised to find that while the heart attack rate has decreased among older adults, it's risen among those ages 35-54, especially women. The Atherosclerosis Risk in Communities study reviewed more than 28,000 hospitalizations for heart attacks in four cities.

"This observational study found a trend in young women," says Virginia Colliver, M.D., cardiologist with Johns Hopkins Community Physicians-Heart Care in Bethesda, Maryland. "But the research doesn't provide insight into why the uptick in heart attacks is happening to younger people. I suspect it has to do with more people having risk factors for heart disease at an earlier age."”

 

I think he ruled this out because I don't have nausea/vomiting and I really don't have palpitations at all? The ER dr mentioned this now that you say it. He said it was a possibility but I would have to go to a cardiologist. It does usually present with a normal ecg. 

 

Edited July 1, 2021 by Ann.without.an.e

[ktgrok]

I really think this could be something in your back/neck. It would explain the weakness and pain, and pain would explain fatigue. Also, have your B12 levels been checked? Low B vitamins can lead to neuropathy - as well as mouth sores. 

[ktgrok]

And I'd see a chiro, personally. I had horrid weird chest/back pain after giving birth (from grabbing onto something and pulling while pushing the baby out). It was a messed up rib! I suffered for days not wanting to leave the house after giving birth, but he fixed it in seconds! It was this non specific pain that wasn't in a particular spot but kept me from getting a deep breath. 

But mostly, you need imaging. I mean, what if you have a freaking tumor pressing on something? Not saying that is likely, but with no other answer it is worth checking out!

[cintinative]

@Ann.without.an.e it's been awhile. How are you feeling?  Have you found any answers? 

[Ann.without.an.e]

On 8/19/2021 at 8:38 PM, cintinative said:

@Ann.without.an.e it's been awhile. How are you feeling?  Have you found any answers? 

 

Sorry, I haven't been back on the boards in a while. Life has been a little crazy.

I'm feeling much better. Other than a little tiredness, I am a-ok. The chest pain subsided and they think it was pericarditis because of the length of time and symptoms. Thanks for asking and sorry for the absence.