Long-Term Chest Pain and Breathing Issues: What to Know

Long-term chest tightness, chest pain, and difficulty breathing?

Hello doctor, I would like to ask about my long-term chest discomfort.
For the past year, I have been feeling a sense of pressure when breathing, and the chest pain has become increasingly noticeable, especially during changes in weather.
I experience a vague pain when breathing, and a sharp pain during deep breaths.
These symptoms have persisted for nearly 45 years.
Initially, I had occasional chest discomfort, but it has recently worsened.
When I first experienced these symptoms in high school, I went to the hospital for a cardiac ultrasound and an electrocardiogram, but the doctors found no abnormalities and eventually diagnosed me with autonomic nervous system dysfunction.
However, as time has passed, the condition has become more pronounced.
What could this possibly be? What tests should I undergo at the hospital?

Lin uni, 20~29 year old female. Ask Date: 2016/04/18

Dr. He Dongjin reply Cardiology

Hello, based on your description, your symptoms have been present for 45 years.
Since you have undergone echocardiography and electrocardiograms with no abnormalities, there may not be a need for continuous testing.
The likelihood of autonomic nervous system dysfunction is high, which could cause discomfort, but it should not pose any life-threatening risks.
If you feel uncomfortable, you may consider taking some medication.
Changhua Hospital cares about you.

Reply Date: 2016/04/18

More Info

Long-term chest pain and breathing issues can be quite distressing, especially when they persist for many years. Based on your description, it seems that you have been experiencing these symptoms for nearly 45 years, with a noticeable increase in severity recently. This situation can be complex, as it may involve various physiological and psychological factors.

Possible Causes of Your Symptoms
1. Musculoskeletal Issues: Chronic chest pain can often stem from musculoskeletal problems, such as costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum. This condition can cause localized pain that may worsen with deep breathing or changes in weather.

2. Gastroesophageal Reflux Disease (GERD): GERD can lead to chest pain that mimics heart-related issues. The acid reflux can irritate the esophagus, causing a sensation of pressure or pain in the chest, especially when lying down or after eating.

3. Anxiety and Stress: Given that you mentioned a diagnosis of autonomic nervous system dysfunction, it’s important to consider the role of anxiety and stress in your symptoms. Chronic anxiety can lead to hyperventilation, which may cause chest tightness and pain. The body’s response to stress can also lead to muscle tension, particularly in the chest and neck area.

4. Pulmonary Issues: Although previous tests like echocardiograms and EKGs showed no heart issues, it might be worthwhile to explore pulmonary conditions. Chronic bronchitis or asthma could lead to a sensation of tightness in the chest, especially if you have a history of respiratory issues.

5. Neurological Factors: Conditions like neuralgia or nerve entrapment can also cause persistent chest pain. This might be related to previous injuries or stress on the nerves in the thoracic region.

Recommended Diagnostic Tests
Given the complexity of your symptoms, it would be prudent to undergo a comprehensive evaluation. Here are some tests and consultations you might consider:
1. Pulmonary Function Tests (PFTs): These tests can help assess lung function and determine if there are any obstructive or restrictive lung diseases contributing to your symptoms.

2. Chest X-ray or CT Scan: While you may have had these tests in the past, a repeat scan can help identify any structural issues in the lungs or chest cavity that may have developed over time.

3. Esophageal Studies: If GERD is suspected, an esophageal pH monitoring test or an upper endoscopy can help evaluate the condition of your esophagus and rule out any reflux issues.

4. Musculoskeletal Evaluation: A physical examination by a specialist in musculoskeletal disorders can help identify any underlying issues related to muscle or joint pain.

5. Psychological Assessment: Since anxiety and stress can significantly impact physical health, consulting with a mental health professional may provide insights into managing stress and anxiety, which could alleviate some of your symptoms.

Conclusion
It is essential to approach your symptoms holistically, considering both physical and psychological factors. While it can be frustrating to deal with long-term symptoms, a thorough evaluation by a multidisciplinary team of healthcare providers can help pinpoint the underlying causes and lead to effective management strategies. Remember, it’s important to communicate openly with your healthcare providers about the severity and nature of your symptoms, as this will aid in tailoring a treatment plan that best suits your needs.

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