Heaviness in chest
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These studies suggest that heaviness in the chest can be associated with various conditions including acute coronary syndrome, Wolf-Parkinson-White syndrome, Hodgkin lymphoma, coronary artery anomalies, pseudoaneurysms, hypereosinophilic syndrome, and ischemic heart disease.
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Understanding Heaviness in the Chest: Causes and Diagnostic Approaches
Cardiac Causes of Chest Heaviness
Acute Coronary Syndrome (ACS) Chest heaviness can be a symptom of acute coronary syndrome (ACS), which includes conditions such as myocardial infarction. A case study of a 38-year-old man with central chest heaviness revealed elevated troponin levels and normal echocardiography, leading to a diagnosis of ACS after coronary angiography. Similarly, a 66-year-old man experienced chest heaviness with associated arm tingling, which was suggestive of coronary artery disease despite unremarkable initial evaluations.
Coronary Artery Anomalies Anomalous coronary arteries can also present with chest heaviness. For instance, a 39-year-old man with an anomalous right coronary artery from the proximal left anterior descending artery reported exertional chest heaviness and mild shortness of breath, which was relieved with rest. Another case involved a 60-year-old man with exertional chest heaviness, where coronary angiography revealed a split circumflex coronary artery.
Non-Ischemic Cardiomyopathy Hypereosinophilic syndrome (HES) can lead to non-ischemic cardiomyopathy, presenting with chest heaviness among other symptoms. A 66-year-old woman with HES experienced chest heaviness, shortness of breath, and weight loss, highlighting the cardiac involvement in this rare disorder.
Non-Cardiac Causes of Chest Heaviness
Hodgkin Lymphoma Chest heaviness can also be a symptom of non-cardiac conditions such as Hodgkin lymphoma. A 26-year-old man presented with chest heaviness, and subsequent imaging revealed mediastinal enlargement. A biopsy confirmed the diagnosis of Hodgkin lymphoma, demonstrating that chest heaviness can be an initial symptom of this malignancy.
Pseudoaneurysms A rare cause of chest heaviness is a pseudoaneurysm. A 69-year-old woman with no significant medical history presented with chest heaviness, and imaging revealed a large paracardiac mass, diagnosed as a giant right coronary artery pseudoaneurysm.
Diagnostic Tools and Techniques
Electrocardiography (ECG) ECG is a primary diagnostic tool for evaluating chest heaviness. In a case of a 56-year-old man with daily chest heaviness, a 24-hour Holter monitor showed multiple episodes of T-wave inversions, which were inconsistently associated with his symptoms. This patient had a known diagnosis of Wolf-Parkinson-White syndrome, complicating the interpretation of his chest heaviness .
Echocardiography and Stress Testing Echocardiography and stress tests are crucial in assessing structural heart disease and functional capacity. For example, the 56-year-old man mentioned above had an echocardiogram showing no structural heart disease and a normal exercise nuclear stress test.
Coronary Angiography Coronary angiography remains a definitive diagnostic tool for identifying coronary artery disease and anomalies. It was instrumental in diagnosing ACS in the 38-year-old man and identifying coronary artery anomalies in other cases .
Conclusion
Chest heaviness is a symptom with a broad differential diagnosis, encompassing both cardiac and non-cardiac causes. Acute coronary syndrome, coronary artery anomalies, non-ischemic cardiomyopathy, Hodgkin lymphoma, and pseudoaneurysms are some conditions that can present with chest heaviness. Diagnostic tools such as ECG, echocardiography, stress testing, and coronary angiography are essential in evaluating and identifying the underlying cause. Understanding the diverse etiologies and appropriate diagnostic approaches is crucial for effective management and treatment.
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