Question: I am a 40 year-old male. Recently, I have attempted cardiovascular exercise (30-60 minutes on an elliptical machine) several times, resulting in red flushing throughout my body but especially in my arms and legs. This is not unusual for me. I have mast cell activation disorder and have had allergic reactions to heating for many years. However, the last two times I exercised, in addition to turning red and feeling prickly, my left arm swelled up to the extent that it became difficult to bend at the elbow. Compared to the right arm, it appeared 15 to 20 percent larger during the time it was swollen during and following exercise. The swelling went down within an hour of stopping. But (my primary concern at this point) several days after the last time I exercised, my left arm, shoulder and the left side of my neck have been sore and somewhat tight feeling--this has persisted for several weeks without improvement.

Below is more information...I hope this isn't too much info; I thought it might help to give more context of my overall health profile.

Some additional context: This has happened in the past. Once several years ago, I had a strange panicked feeling in addition to the arm, shoulder and neck pain, and my coworkers encouraged me to go to the emergency room. The staff there were somewhat dismissive because of my age, but they performed an EKG and a chest X-ray and said my heart was fine. They dismissed me with a printout of exercises to help a stiff neck.

I had a complete physical three months ago, including an EKG, which again was normal. The A/G ratio was flagged as high at 2.4, but my doctor didn't feel that this is a concern at this time. Now I am wondering if it might be, and I plan to get blood screenings for renal and kidney function. (I rarely drink alcohol today; however, I drank relatively heavily for a period of several years during my mid-30s.)

My LDL cholesterol was also high for the first time at 124, but my doctor said it's not a major worry at this time because the total cholesterol ratio is normal at 4.3 and that we should monitor it, and I should consider modifying my diet and try to get it down before resorting to medication.

Would it be worthwhile as well to get a blood test for heart function? My real concern here, again, is the pain and tightness on the left side that comes and goes, particularly in weeks following cardiovascular exercise.

I walk a mile and a half twice a day with no difficulty breathing or other side effects unless it is hot outside, which causes my skin to turn red and often to break out in hives. I have had slight edema in my legs and arms for at least 10 years, since around age 30--my limbs don't appear swollen, but they hold the imprints of socks and sweaters for over an hour after removing them. (No pitting remains, however, when I simply press my finger into my feet or legs for up to a minute.)

Family history: My father has serious cardiovascular problems: he was diagnosed around age 65 with an abdominal aortic aneurysm and a year later he had a triple bypass. He had experienced angina, which he described as tightness but not pain in his chest; this is part of my concern, as my left arm feels 'tight' in addition to hurting. I have no chest pain or tightness.

My mother passed away at age 67 from suspected ulcerative colitis or Crohn's disease. She had no cardiovascular problems; however, her mother and most women in her family died from strokes.

Thank you! I appreciate the reply and will look into an ultrasound and ecg for peace of mind at least.


One more question: You mentioned the lipid profile isn’t concerning, but just to be clear, does that apply as well to the A/G ratio (2.4) as not concerning?


Thanks again!

Thank you very much. I really appreciate your thoughtful and informed responses. You have been most helpful.