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Chest Pains Could Be Related to Apnea

Dear Dr. Roach: I am 26 years old, 6 feet, 3 inches tall and weigh 290 pounds. About two years ago, I had chest pain and palpitations. I saw a cardiologist, who performed an echocardiogram. It showed mild LVH and mild pulmonary hypertension. I had multiple EKGs, and my doctor says I have a clean bill of health. Are any of the symptoms I have dangerous, or am I overreacting? — J.A.

Answer: Chest pain and palpitations are common concerns that occasionally represent serious heart disease but often don’t. It’s estimated that the average person has 500 or so abnormal heartbeats a day, and these can be felt as palpitations. Chest pain should raise the concern for angina caused by heart blockages, but that would be extremely unusual in a 26-year-old.

The concern I have in hearing about your echo results is that they could represent obstructive sleep apnea. Left ventricular hypertrophy (LVH) is the heart’s response to chronic stress, especially to elevated blood pressure, which is common in sleep apnea. Pulmonary hypertension has many causes, but in someone very overweight (your body mass index, BMI, is 36.2, where “obese” is defined as over 30), I have to be concerned about chronic low oxygen to the lungs. There are many people with sleep apnea who aren’t diagnosed. I would recommend a sleep study. Certainly I recommend careful checking of your blood pressure, and weight loss.

Dear Dr. Roach: I am an 85-year-old woman living in a nursing facility. A little before my arrival here, I began experiencing night sweats. I have seen my doctor regarding this, and he said he cannot help me. I feel weak when I wake in the morning, and I need to constantly change the towels I put under myself. This is a big concern. — A.M.

Answer: I take night sweats seriously. Tuberculosis is the classic cause of night sweats, which is of immense concern in a nursing facility, where most people are tested for TB yearly. But other chronic infections, high thyroid levels and even blood and marrow diseases like lymphoma can show up with night sweats. Most of the time, a chest X-ray and blood tests, along with a careful exam, can make the diagnosis. Other times, it’s harder to find. More often, it goes away as mysteriously as it came. But it is worth another look.

Dear Dr. Roach: From a blood test, how can I tell if I am an insulin-dependent Type 2 diabetic? For instance, what would my insulin or glucose readings have to be?

Secondly, at what point would I have to start taking medications? — E.

Answer: Diabetes is diagnosed with any of the following: hemoglobin A1c of 6.5 percent or higher; fasting blood sugar of 126 or higher; blood sugar during a glucose tolerance test of 200 or greater at two hours; or random glucose of 200 or greater in someone with classic symptoms. In Type 1 diabetes, insulin levels are very low, while in Type 2 they are normal or high.

Not everybody with diabetes needs medication. Many people with Type 2 diabetes can be well-controlled just with dietary modification and often weight loss, and almost everybody with diabetes can improve with a better diet. Medications usually are given if the A1c is much greater than 7 percent and if diet, exercise and weight loss efforts have been so far inadequate.

In addition, medication often can be stopped with better control through lifestyle. Insulin-dependent Type 2 means just that — insulin is being used, along with lifestyle and often non-insulin medications.

Except in very rare instances, everyone with Type 1 diabetes needs insulin.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 3285 3-6475.