Unexplained Chest Tightness
A 47-year-old woman reports a troubling sensation of tightness in the center of her chest. Over the past few days, she has experienced what feels like pressure on her heart, with episodes lasting between 30 to 45 seconds. Occasionally, these episodes occur multiple times within a 45-minute period. This unfamiliar sensation has not been part of her previous experiences with anxiety or the emotional pain of losing a loved one to death, which she is well-acquainted with. Recently, she has been under significant stress, more than usual. In addition to the chest tightness, she encounters periods of marked fatigue throughout the day. Although this tiredness can sometimes lift, it often feels overwhelming in its persistence. With a fitness routine that includes exercise four times a week, a balanced diet rich in protein and healthy fats with moderate carbohydrates, and consistently good blood pressure readings, her overall health appears robust. Routine blood tests also yield normal results. While she is currently experiencing perimenopause, she manages related symptoms effectively with progesterone and estrogen patches. Given her situation, she is questioning whether her symptoms warrant concern or if they might be manifestations of psychological stressors.
Answers (1)
6/21/2025, 2:40:36 AM
OpenHealth AI
It's understandable to feel concerned about experiences of chest tightness, especially given the recent stress you've been under. The sensations you describe, including pressure and fatigue, could be related to various factors, including anxiety or physiological responses to stress, particularly as you're navigating perimenopause. However, it’s important to approach this situation with care.
Explanation
Chest tightness can arise from many causes, ranging from stress-related tension, anxiety, or panic attacks, to physical issues like muscle strain, gastrointestinal reflux, or cardiac concerns. The good news is that your overall health indicators, such as your regular exercise routine and normal blood tests, suggest you may be in good physical shape. However, persistent or unusual chest symptoms should always be taken seriously.
Next Steps
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Monitor Symptoms: Keep a detailed diary of your chest tightness, noting when it occurs, its duration, any accompanying symptoms (like fatigue or shortness of breath), and your stress levels. This can help identify if there’s a pattern related to stress or anxiety.
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Practice Stress Management: Given your increased stress levels, consider incorporating relaxation techniques such as deep breathing exercises, meditation, or yoga into your routine. These practices can help reduce feelings of anxiety and may alleviate physical symptoms.
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Stay Hydrated and Rested: Ensure you are drinking enough water and getting adequate sleep. Fatigue can often be alleviated with proper hydration and rest, which helps manage stress as well.
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Review Lifestyle Factors: Continue to maintain your balanced diet and exercise routine, as these are protective factors for your overall well-being. If you notice that foods or certain activities seem to aggravate your symptoms, take note of this.
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Urgent Signs: If you experience more intense symptoms such as significant discomfort, shortness of breath, lightheadedness, or if the episodes increase in frequency or duration, seek immediate medical attention.
By following these steps and being mindful of your health, you can better understand your symptoms and how they may relate to your stress and hormonal changes. If your symptoms persist or worsen, consider seeking medical advice for further evaluation. Remember, you deserve to feel well and understand what's happening with your body.
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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.