[40F] With chest, neck, and head pain

Patient Description

A 40-year-old female presents with sudden onset chest pain for the past two days, described as a clenching sensation that takes her breath away, rated 8-9/10 in severity. The pain worsens with movement, particularly pushing, pulling, and lifting, and is not relieved by any measures. She reports an irregular heartbeat accompanying the chest pain. Additionally, she has experienced intense, sharp pressure at the base of her skull for a week, rated 10/10, along with a disoriented feeling. There is mild nausea, but no significant dizziness or vision changes. The patient has a family history of heart disease and stroke involving her grandmother, mother, and father. Recently diagnosed with high cholesterol and obesity, she is currently taking ibuprofen (800 mg as needed up to 4 times a day), phentermine (half of 37.5 mg once a day), and lamictal (100 mg once a day) for pain, weight loss, and mood disorder, respectively. She has allergies to Tylenol and naproxen, and reports no side effects from her medications. She consumed 6 shots of liquor the day before the symptoms intensified.

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Arora's Assessment

What might be happening

Based on your symptoms, there are a few serious conditions that could be causing your discomfort:

  1. Heart Attack: The combination of chest pain, irregular heartbeat, and family history of heart disease suggests a possible heart attack. This is a medical emergency that requires immediate attention.

  2. Angina: This is chest pain caused by reduced blood flow to the heart. It can feel like a squeezing or clenching sensation and may worsen with physical activity.

  3. Cervicogenic Headache: The intense, sharp pain at the base of your skull could be related to neck issues, possibly exacerbated by stress or tension.

  4. Hypertensive Crisis: Given your recent diagnosis of high cholesterol and obesity, a sudden increase in blood pressure could cause severe headaches and chest pain.

What you can do

  • Seek Immediate Medical Attention: Please go to the emergency room or call 911 immediately. These symptoms could indicate a life-threatening condition, and prompt medical evaluation is crucial.

  • Avoid Physical Activity: Until you receive medical care, try to rest and avoid any activities that worsen your symptoms.

  • Inform Medical Staff: When you arrive at the hospital, inform them about your symptoms, family history, and current medications.

  • Stay Calm: While waiting for medical help, try to stay as calm as possible to avoid increasing your heart rate and blood pressure.

Remember, it's essential to get evaluated by a healthcare professional to determine the exact cause and receive appropriate treatment.

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2 mo ago

People Also Ask

What are the symptoms of a heart attack in women?

Symptoms of a heart attack in women can include chest pain or discomfort, which may feel like a clenching or squeezing sensation. Other symptoms can include pain in the neck, jaw, or back, shortness of breath, nausea, and an irregular heartbeat. Women may experience these symptoms differently than men, and they can sometimes be more subtle.

How can high cholesterol contribute to heart problems?

High cholesterol can lead to the buildup of fatty deposits in your blood vessels, which can restrict blood flow to your heart and brain. This increases the risk of heart attacks and strokes. Managing cholesterol levels through diet, exercise, and medication can help reduce these risks.

What is a cervicogenic headache and how is it treated?

A cervicogenic headache is a type of headache that originates from the neck. It is often caused by issues with the cervical spine, such as poor posture, stress, or tension. Treatment may include physical therapy, pain management, and lifestyle changes to reduce neck strain.

What should I do if I experience sudden chest pain and an irregular heartbeat?

If you experience sudden chest pain and an irregular heartbeat, it is important to seek immediate medical attention, as these could be signs of a serious condition like a heart attack. Call 911 or go to the nearest emergency room. While waiting for help, try to stay calm and avoid physical activity that could worsen your symptoms.

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