Suggest treatment for rapid heart rate , shoulder pain and shortness of breath
Patient: I am a white female, 55 yrs old, mild diabetic, controlled with diet, exercise and metformin, 1,000 mg twice day. I am 5 7 , 180 lbs, I have been walking a mile to 2 a day about 4 days a week minimal. I have begun having rapid heart rate, tachycardia, upon exertion. I don t break out in a sweat or get nauseated, haven t really had arm or shoulder pain, but I do get tight in my chest, and minor shortness of breath. I can sit, and it goes away, until I exert again. I have minor medical knowledge, and know to get to ER if this gets worse and report to the doctor, but...was just wondering...do I need to go sooner than later? Doctor: Hello. Thank you for your question and welcome to HCM. I carefully read your concern. You are a 55-year old woman, which is a borderline age for risk for cardiovascular disease. The pain in the chest you described, which is triggered by effort and goes away when you stop, fulfils some criteria of angina (chest pain caused by narrowing of coronary arteries - the arteries that surround the heart like a crown, hence the name, and supply its muscle with oxygen and nutrients). Of course, in this level of conversation, when none of the test were carried out, this is just an assumption judging by the characteristics of the pain. Therefore, I would strongly recommend you to do a cardiac check-up: EKG, echocardiogram and cardiac stress test. Also, I would recommend you to be put on a 24-hour blood pressure monitor, to determine if there is also high blood pressure (hypertension) or not. As for the rapid heart rate, if it goes up while exerting, and remains regular, then my opinion is that there is nothing to worry about. There is a simple formula for this - the heart rate accepted as normal, at a person that is exercising, is 220-age (165 beats per minute, in your case). My further recommendations would be, that you should do a complete blood count and measure the levels of the following cell derivatives: - glucose - HbA1c - urea and creatinine - AST, ALT, GGT - electrolytes - total cholesterol, LDL- and HDL-fraction, triglycerides I hope I wash helpful and thorough, with my answer. Feel free to contact me again. Take care.