Q: I am an average weight, active woman in my early 40s. For the last
six months I have had a crushing pressure over my left breast to the
centre of my chest. Sometimes the pressure can be felt in my throat,
and when I get this pain, I have shortness of breath with it. I only
get this when I have exerted myself extra or run too fast, or dealt
with something excitable or emotional. When I lie down for a few
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minutes it seems to help.
My family doctor did blood tests and an electrocardiogram and said
everything was fine. Should I leave it like this?
A: I will reply to your last sentence first as no, you should never
leave things like this if you are still having symptoms and are
obviously concerned about them. Also, doctors operate largely on the
principle that if you do not return to see them about a particular
problem, then you must be fine. If you go back, he will not complain
about having to investigate your problem further.
After this length of time, I am almost positive that this has nothing
to do with your heart. Pressure in the chest going up to the throat can
be a symptom of angina, but this should have shown up on the tests. It
is unlikely that you have coronary artery problems, since you are a
younger female, although it is not impossible. Similar symptoms can
also be caused by pericarditis, which is an inflammation of the
membrane surrounding the heart, but again, you would be much sicker
than you appear to be, and it would also show up on the ECG.
The two most likely causes are exercise-induced asthma, or anxiety
attacks. The latter can often mimic heart problems and even cause some
people to end up in the emergency department. One way for you to tell
is to check your pulse rate. Even after running, it should not be more
than about 160 beats per minute. If it is faster than that, you may be
having a panic attack.
You can also check how fast you are breathing. The normal number of
breaths in a minute is about 20 when you are relaxed. It might be
easier for someone else to do a count of your breaths.
Hyperventilating, or overbreathing, causes too much carbon dioxide to
be washed out of the blood. That can cause strange bodily symptoms such
as numbness and tingling in the arms and fingers and also aches and
pains.
Your doctor can check for asthma by sending you for lung function
tests, and then he can treat you accordingly.
Q:I am a manic-depressive and have to take medication (lithium), which
I am not allowed to take with milk or dairy products. The problem is
that I love my coffee and always take it with milk. What should I do?
A: Manic depressives, now called people with bipolar disorder, take
lithium carbonate (Carbolith or Duralith) to stabilize their moods.
Bipolar disorder causes the sufferer to get episodes of depression or
highs that can last for weeks or months at a time. Medications such as
lithium will keep the person on an even keel. There are some drawbacks
however, so it is important to get regular blood tests to make sure the
dosage is not too high as to give toxic side effects, or too low that
it is ineffective. It should not be taken with dairy products as you
pointed out, because calcium can combine with the drug, interfering
with its powers.
One solution would be to use artificial cream in your coffee, which
does not have as much calcium as real milk or cream, and drink the
coffee at least an hour before or after taking your pill. There are
also other medications available for the treatment of bipolar disorder.
You may be using coffee as an excuse not to take your medication.
Patients with bipolar disorder often feel fine, especially when they
are high, but insight into your own condition is lacking at these
times. Check with relatives and see if they think you are stable. They
will be more objective.
