<s>[INST] I am 55 and have been under great stress of caregiving for 3 years.  My own health is deterioating.  BP goes from 89/50  to 145/125.  I feel awful when my bp is out of whack  Last night I had the 145/125 spike after an arguement..My chest was very heavy, Pain in my L shoulder area and today woke with a dull fog and lingering headachel  The heaviness in my chest waxes and wanes.  At what point does it get called an emergency [/INST] Hello! Welcome and thank you for asking on Chat Doctor! Regarding your concern, I would explain that the heaviness in your chest may be related to high blood pressure. But, I would recommend consulting with your attending physician for a physical exam and some tests to exclude other possible causes of chest pain and uncontrolled blood pressure: - a chest X-ray study- a resting ECG-complete blood count for anemia-kidney and liver function tests-thyroid hormone levels for possible dysfunction- blood electrolytes for possible imbalance-fasting glucose-blood lipid profile for dyslipidemia.  A cardiac stress test is needed to exclude possible coronary artery disease. Meanwhile, I would recommend some tips to help maintain a normal blood pressure: - avoid salt and caffeine intake-perform a lot of physical activity (aerobics, walking). - try to lose some pounds if you are overweight. Stress seems to play an important role in your symptoms. Yoga and meditation may help in this regard. Hope to have been helpful! Kind regards,  </s>