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High Blood Pressure

Chest pain

07/30/2007

Question:

I am 35 years of age , and active (145 lbs). I have smoked in my earlier years in life.

Anyways.... I woke up two weeks ago with chest pain , and latter arm was quite sore. Dizzy and Nauseau set in. I went in to the hospital , and had many tests done. EKG , Chest X-ray,CT Scan, VQ, ECHO. Was put on blood thinners. A Cardiologist came in and told me the CT Scan showed that It was showing Chronic Clotting. Had many questions for me in regards to ever experiencing this chest pain before today. The answer was NO. He mentioned that my Pullmonary Artery was showing enlarged, and that pressure was high when the pain seems to come on. They had so many big words I just want to get this all straight. When I don`t have the pain my blood pressure is very low. First is that normal to have very low blood pressure? 100/84 (does that make sense)

They went into questions regarding my legs are they ever swollen , or have pain. Yes to the Pain in my legs, but never swollen.

I am now following up with a Hemotologist and a Respiratory Pullmonary Medicine Doctor. Both appointments I have are in four weeks to follow up on this ordeal. Today , was the first day I have not felt chest pain. Will this come and go. Because When I do have chest pain , I need to take Tylenol #3 to ease the pain and my breathing is hard. And I am usually in bed for the day. Does this sound to you like Hypertension. Can Hypertension symptoms come and than dissappear.

In the past I suffer from Migranes, I have abdormal Vertigo (they thought was Meniers disease never confirmed) My White blood count has always been low, and the Doctors always told me that I was fighting a Virus. I have always have had abdominal pain off and on.

What kind of questions should I be asking for these appointments. Thank you

Answer:

From your story, it appears that the most likely explanation for your chest pain is blood clots in the lung.

Some patients are hypercoagulable, i.e. that they form blood clots even when there is no trauma or bleeding.  These blood clots form usually in the legs, where blood flow is sometimes slow.  These clots cause inflammation (pain) and swelling in the legs.  The clots can break loose and travel up through the large veins and become trapped in the lungs.

Blood clots that are trapped in the lungs can cause shortness of breath and chest pain.  They can also lead to an increase in the blood pressure in the pulmonary artery (pulmonary hypertension).  Because of the partial blocking of the pulmonary artery, your systemic blood pressure can be low (while the pulmonary artery pressure is high).  If untreated, this condition can cause strokes and be life-threatening.

Possible causes of hypercoagulability include protein C and protein S deficiency, antiphospholipid antibody syndrome and others.  If you do have one of those hypercoagulable states, you will need to be on blood thinner (coumadin or warfarin) for life.

Because this condition can be familial, you need to find out if other members of your family had blood clots, especially at an early age.  If so, they may also have to be treated to avoid complications.

You should ask your doctors if they have identified the cause for your blood clots and if this cause is isolated or associated with another disease like lupus.  You need to find out if your relatives needs to be tested, and if the blood thinners need to be taken life-long.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati