[39F] With severe head and neck pain, shortness of breath, and fluid retention

Patient Description

A 39-year-old female presents with severe throbbing and aching pain in the head and neck, which has been ongoing for a week and is tender to touch. The pain started after an incident involving the right shoulder pinching an artery four months ago. She also reports shortness of breath for the past two days, varying from mild to moderate depending on activity and talking, with no relief from her inhaler. Additionally, she has a history of hypertension for almost 10 years, with recent readings as high as 235/115. She has experienced chest pain that felt like swelling or fluid on the left side, throbbing in her back, and large pockets of fluid on her head, neck, and back. She feels her heart beating strongly, almost like an earthquake, and has slight dizziness, fatigue, and hot flashes. There is no swelling in her legs or ankles, fever, chills, or changes in vision. Her right ear and head have felt somewhat clogged for a year, despite doctors saying everything looks fine. She feels the pressure might be coming from her neck and nasal cavity. She has a history of asthma and hypertension and recently stopped taking amoxicillin for a UTI and kidney swelling because she ran out and needs a refill. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you’ve provided, several serious conditions could be contributing to your symptoms:

  1. Hypertensive Crisis: Your blood pressure reading of 235/115 is extremely high and could be causing severe headaches, chest pain, and other symptoms. This is a medical emergency that requires immediate attention to prevent complications like stroke or heart attack.
  2. Infection: Given your history of a UTI and kidney pain, it's possible that the infection has spread, leading to a kidney infection (pyelonephritis). This can cause fever, chills, back pain, and fatigue.
  3. Cardiovascular Issues: The feeling of your heart beating strongly, chest pain, and shortness of breath could indicate a cardiovascular problem, such as heart failure or a heart attack. The swelling and fluid retention you described could also be related to this.
  4. Thrombosis or Vascular Issues: The swelling and tenderness in your neck and the bulging veins could indicate a blood clot or other vascular issue, especially given your history of a pinched artery.
  5. Substance Use Complications: Daily meth use can lead to severe cardiovascular and neurological issues, including high blood pressure, heart problems, and increased risk of stroke.

What you can do

  1. Seek Immediate Medical Attention: Given the severity and combination of your symptoms, you should seek immediate medical attention. Go to the nearest emergency room or call 911. Do not drive yourself; have someone else take you or call for an ambulance.
  2. Monitor Symptoms: While waiting for medical help, monitor your symptoms closely. If you experience worsening chest pain, severe shortness of breath, confusion, or loss of consciousness, call 911 immediately.
  3. Medication Management: Continue taking your baby aspirin and ibuprofen as prescribed. Do not take any more amoxicillin until you have consulted with a healthcare provider.
  4. Avoid Strenuous Activity: Rest as much as possible and avoid any strenuous activities that could exacerbate your symptoms.
  5. Stay Hydrated: Drink plenty of water, but avoid caffeine and alcohol, which can increase blood pressure and dehydration.

Remember, I am not a doctor, and this advice is based on the information you have provided. It is crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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4 mo ago

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People Also Ask


What are the symptoms of a hypertensive crisis?

Symptoms of a hypertensive crisis can include severe headache, chest pain, shortness of breath, nosebleeds, severe anxiety, and confusion. It is a medical emergency that requires immediate attention to prevent complications like stroke or heart attack.


How can a pinched artery affect my health?

A pinched artery can lead to reduced blood flow, which may cause pain, swelling, and tenderness in the affected area. It can also increase the risk of blood clots, which can lead to serious conditions like stroke or heart attack if not treated promptly.


What are the risks of untreated kidney infections?

Untreated kidney infections can lead to serious complications such as kidney damage, sepsis, or the spread of infection to other parts of the body. Symptoms may include fever, chills, back pain, and fatigue, and it requires prompt medical treatment.


How does methamphetamine use impact cardiovascular health?

Methamphetamine use can significantly impact cardiovascular health by increasing blood pressure, heart rate, and the risk of heart attack or stroke. It can also lead to long-term damage to the heart and blood vessels, increasing the risk of cardiovascular disease.


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