Thank you for your query at doctorspring.com.
Please help me with answers to following questions -
Could you please describe your chest pain? Is it dull or sharp. Does it radiate from chest to somewhere else. Is itmore on rst or exertion.
Do you have breathlessness on exertion?
Does the chest pain come along with sweating or vomiting?
How long does the vision loss last?
Do you have blackout sensation or giddiness or dizziness with vision loss?
Does vision loss comes along with palpitations?
Does the neck pain or the carotid pain accompany the chest pain?
Does the neck pain accompany vision loss?
Do you have pain just in front of the ears?
Kindly elaborate on these questions.
Dr Vivek Mahajan
Patient replied :
Gradual general pain across chest and adjacent left shoulder blade in back with sharp pain in inner/upper arm and wrist.Often comes on when I wake in morning and eases with gentle exertion. Anxiety can cause it.It will leave me feeling weakened for whole day following above average exertion previous day.
Do you have breathlessness on exertion? YES
Does the chest pain come along with sweating or vomiting? YES
How long does the vision loss last? 30 MINUTES
Do you have blackout sensation or giddiness or dizziness with vision loss? WILL FAINT AS PAIN INCREASES- SOMETIMES BLACKOUT AND DAUGHTER TELLS ME EYES BECOME GLAZED YET OPEN.
Does vision loss comes along with palpitations? SOMEWHAT
Does the neck pain or the carotid pain accompany the chest pain? YES and comes on with walking too quickly or uphill.
Does the neck pain accompany vision loss? YES
Do you have pain just in front of the ears? YES
Thank you for the details.
Your pain description is like angina however it is not exactly like angina. You have syncopal attacks with palpitations and the chest and neck pain.
Few possibilities come forth. One is that it may be coronary artery disease and angina occurring at rest with syncopal attacks. However the history isn't typical.
Second important possibility is severe aortic stenosis and it can have syncope with chest discomfort and angina. Third is aortic disease like aortic dissection which can again give similar symptoms. Neurological illnesses like syringomyelia or brachial neuritis may cause similar symptoms but the Presyncope is rare.
And finally, temporal arteritis is another important possibility.
So firstly get a resting ecg and blood tested for esr (for temporal arteritis) and a chest xray(to look for aortic aneurysm).
Second test would be a 2d echo examination (would be useful to rule out aortic vslve disease and aortic dissection in proximal aorta. Also the ejection fraction could be ascertained from echo. Coronary angiography to look for blockages and holter examination for the syncope may be done. A carotid doppler is valuable study.
If everything is well you could see a neurologist to rule out neurological causes.
Hope this helps, please feel free to discuss further.
Dr Vivek Mahajan