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Treatment for light headed, faintness and pain in side of chest.

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Trying to get best direction as to where to go and what tests I should have done. About 3 weeks ago I was driving a car I just bought from FL to NY. About 5 hours into drive I felt lightheaded. Then about an hour later I had a feeling of being flush and like I might faint. My left side was aching and my muscles were twitching. Then next day I went to work. In the afternoon I felt the same symptoms but also cold sweats. I went to ER. Did EKG and blood test (I attached results of blood test). Everything normal. Since then I have felt better each week but still not 100%. I logged all of what I am feeling and what I am not feeling (below). I am 47 years old patientold. Quit smoking 2 1/2 years old patientago, and in the past 6 months lost 50 lbs and am now about 15% bodyfat. Up until this episode I was working out and doing cardio 5 days a week and feeling the best I have felt in 20 years. It figures that I just started a consulting practice and as a result I haven't set up my insurance yet. Of course this is the first time I've ever had to go to a doctor in my adult life. So all of this will be out of pocket. That is why I'm trying to find out what is the most effective course of action.

Symptoms experienced:

Light headed (on and off)
A little weak in the legs when walking (only when feeling light headed)
Consistent Left side aching (Shoulder, arm, upper back) more so when I'm sitting upright. If I get up and move around it goes away. I never experience it when lying down.
Minor Jaw pain (once)
Minor pins and needles (random and occasional). Could be anywhere on my body
Muscle Spasms (less and less as time goes by) but I started taking multivitamin after this started, and increasing healthy vegis (figured I was low on potassium).
Occasional Ringing ears
Tightness in chest (sometimes one side or other, sometimes entire chest, never painful just minor tightness)
Occasional pain upper left side of chest (top left of pecs just below the front delts)
Cold sweats (once)

Interesting Notes:

Almost all pain is gone if I'm moderately active (golfing, driving range, moving around) or after a couple glasses of wine. Also, when I'm lying down and when I sleep I feel perfectly fine and have never experienced pain.

I've never had shortness of breath

I've checked my pulse for consistency and have never had it race or slow down. Always steady no matter how I'm feeling.

Never any headaches

No blurred vision

Thank you very much for your time and assistance,


Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 24 Doctors Online

Hello. Thank you for posting your query at
I understand your concern.
Thank you for your elaborative history. It is great to interact with patients who are so interactive and provide all the necessary details.
I went thorugh your blood reports. Adressing your concerns one by one,
There are several causes of light headedness. The first and the foremost cause is a slight drop in BP, which can happen due to postural changes, on sudden standing from sitting position, and at time the cause can be idiopathic ( no identifiable cause, but there is a drop in BP ). The other causes of sudden light-headedness can be anemia, a possible Coronary Artery Disease leading to heart-attack, stroke or TIA ( Transient Ischemic Attack ), associated with vertigo, alcohol intoxication, low blood sugar ( e.t.c ).
Since you have attached the blood test, anemia can be ruled out, and low blood sugar or elctrolyte imbalances can also be ruled out. The doctor did evaluate you for a possible heart attack, but you troponin was also in normal range. Hence that also is ruled out. Now there is a faint possibility that there could have been a transient ischemic attack in the brain, which led to the light headedness. It is just a lack of blood supply to the brain for some time. Hence if it is possible for you, a CT SCAN of the brain can be taken and a more conclusive test will be MRI.
Next you also complained of a feeling of fainting. That can be associated with the light headedness. Before you took off for the drive, did you have adequate food? Because it is possible that at that point due to fatigue or low blood sugar, you could have manifested all these symptoms. By the time you got the tests done, the sugar value could have auto-corrected. Hence i am asking you this question? Did you have any meal before you started the drive?
The consistent left side aching involving your shoulder and chest area with the tightness may be indicative of muscular spasms. Also since you consistently work out and do cardio, it is possible that the muscles are fatigued and you may want to rest for a few days. You are already in a very good shape and a few days of rest may be beneficial. I will still advise you Tab. Myospas twice daily after food for 5 days, and see if this consistent tightness and spasms are resolving.
The pins and needles mostly indicate a B12 deficiency. It will get better once you take the multivitamin consistently, but more importantly follow a healthy diet.
Can you give me more details about your smoking history? How many cigarettes did you smoke earlier on a daily basis? If you have consistently smoked for more than 10 years, it is better to get a X-RAY of the lungs just to check any restrictive lung condition, which develops due to smoking. That can also lead to some amount of chest tightness.
I will advise you at the end to get your BP monitored, around 3 values at different intervals are required to be able to come to a diagnosis. Mostly you can check your BP once on laying down, once on sudden dtanding from sitting position and once on sitting and send the values. It is also advisable that you get a CT/MRI of the brain done, just to rule out a possibility of TIA at that point. Because once this is ruled out, all the serious issues will be ruled out and all your causes can be attributed to muscle fatigue and a possible hypotension.
Will be eagerly awaiting your reply,
Feel free to discuss further,

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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