[21F] Experiencing severe chest pain, dizziness, and swelling

Patient Description

A 21-year-old female has been experiencing severe chest pain since 2018, which worsens with physical activity and deep breaths. The pain is located above her left breast, radiating to her left rib, back, shoulder, and neck, and is described as a sharp pain that sometimes feels like her heart is about to give up. The pain does not respond to over-the-counter medications or prescribed naproxen. Additionally, she has been dealing with dizziness since January, swelling in her hands and legs, and a reddish-purple coloration on her legs and arms. She also suffers from constant migraines. Her medical history includes an irregular heart rate, hypertension, and pre-diabetes, with a family history of heart issues and clotting disorders. She is currently taking ibuprofen, Tylenol, and naproxen for pain management but reports no relief from these medications. She has an allergy to Norco, which causes a rash. No recent fever, cough, or coughing up blood has been reported, but she experiences shortness of breath.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possibilities:

  • Angina: This is chest pain that occurs when your heart muscle doesn't get enough oxygen-rich blood. It's often described as pressure or squeezing in your chest. The discomfort can also occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. It can be triggered by physical exertion and relieved by rest or medication.

    • Treatment usually involves lifestyle changes, medication, and sometimes, surgery.
  • Pericarditis: This is an inflammation of the pericardium, the sac-like covering around your heart. It can cause sharp or dull pain that usually starts in the center or left side of your chest. The pain may also radiate to your neck and shoulders. It often intensifies when you cough, lie down or inhale deeply.

    • Treatment usually involves medication to reduce inflammation and relieve pain.
  • Costochondritis: This is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone. The pain is usually located in the front of the chest, but can radiate to the back or abdomen. It can cause a sharp, stabbing pain that's usually on the left side of your chest. It often gets worse when you take a deep breath or move your upper body.

    • Treatment usually involves pain relievers and rest.
  • Pulmonary embolism: This is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from your legs or, rarely, other parts of your body (deep vein thrombosis). It can cause shortness of breath, chest pain, and swelling in your legs.

    • Treatment is aimed at keeping the blood clot from getting bigger and preventing new clots from forming.

Please note that these are just possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider for a proper evaluation.

What you can do

  1. Seek immediate medical attention. Chest pain, especially when combined with other symptoms like shortness of breath and swelling in your legs, should be evaluated as soon as possible.
  2. Try to rest and avoid exertion as it might worsen your chest pain.
  3. Keep track of your symptoms and any triggers, this can help your healthcare provider in diagnosing your condition.

What you should look out for

  • If your chest pain becomes severe or is accompanied by other symptoms such as shortness of breath, sweating, nausea, or fainting, seek immediate medical help.
  • If your swelling worsens or you notice a change in color or temperature in your legs or arms, seek medical attention.
  • If you experience sudden or severe headaches, vision changes, or difficulty speaking, these could be signs of a serious condition and you should seek immediate medical help.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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10 mo ago

People Also Ask


What could be causing my severe chest pain that worsens with physical activity and deep breaths?

Severe chest pain that worsens with physical activity and deep breaths could be caused by conditions such as angina, pericarditis, costochondritis, or even a pulmonary embolism. Each of these conditions affects the chest area differently and requires medical evaluation for a proper diagnosis.


Why might I be experiencing dizziness, swelling in my hands and legs, and a reddish-purple coloration on my skin?

Dizziness, swelling in the hands and legs, and a reddish-purple coloration on the skin could be related to circulatory issues, such as a potential clotting disorder or heart-related problems. These symptoms should be evaluated by a healthcare provider to determine the underlying cause.


What are the potential risks of having an irregular heart rate, hypertension, and pre-diabetes?

Having an irregular heart rate, hypertension, and pre-diabetes increases the risk of cardiovascular diseases, including heart attacks and strokes. These conditions can also lead to complications such as kidney damage and vision problems if not managed properly.


Why am I not finding relief from over-the-counter medications for my chest pain and migraines?

Lack of relief from over-the-counter medications for chest pain and migraines may indicate that the underlying cause of the pain is not being addressed by these medications. It is important to consult with a healthcare provider to explore other treatment options and identify the root cause of the symptoms.


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2 Comments


Janice#4034

10 mo ago

Chest pain that worsens with activity and breathing is a red flag in medical care because it can be related to heart or lung issues as listed in your assessment, but as a young woman you're at very low risk. Also it's been going on for the last 4 years. But overall would go checked out at a hospital. An EKG and X-ray/CT could help

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Madelyn#4031

10 mo ago

Have you seen any doctors for this set of symptoms? Curious what it might be, mostly because they've been going on since 2018

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