Heart Symptoms: When to Seek Further Medical Advice

Please, doctor..?

Hello, doctor.
I am 24 years old.
I often exercise (since childhood).
I do not have high blood pressure (I had slightly elevated blood pressure in the past, but it is normal now).
I suspected I had heart disease two years ago.
After a vigorous workout, I experienced discomfort a few hours after going to bed.
It felt like my heart was beating faster and weak (similar to being startled).
This symptom lasted all night, preventing me from sleeping.
However, by morning, the symptoms disappeared.
I thought it was due to excessive exercise, as I occasionally experience similar sensations, but they only last a few seconds.
After several instances of very intense exercise, I experienced prolonged discomfort again, so I decided to see a doctor.
I visited three hospitals: Longtan Min-Sheng Hospital, Taichung Armed Forces General Hospital, and Taipei Veterans General Hospital.
The diagnoses were mild coronary artery stenosis (they even prescribed nitroglycerin), elongated mitral valve, and mitral valve prolapse.
I later believed the diagnosis of mild mitral valve prolapse (congenital) from the Veterans General Hospital because I underwent an electrocardiogram and ultrasound examination.
The doctor advised me to exercise regularly and drink plenty of water, prescribed some calming medication, and said it would not affect my daily life.
However, I currently have three questions:
1.
The symptoms have not improved.
Although I rarely experience all-night discomfort anymore, I still have intermittent episodes that last a few seconds, which make me uncomfortable.
I often feel my heart is heavy and weak.
After being startled by loud noises or an earthquake, my heart feels extremely weak, as if it is beating heavily and struggling, which never happened before I turned 20.
Should I seek another opinion from a different doctor? Perhaps they might diagnose a different condition.
2.
Since it is congenital mitral valve prolapse, why did I not experience any discomfort in my heart before I turned 20?
3.
I would like to know if non-structural heart issues can also cause heart discomfort, such as psychological problems.
I often worry that my heart disease is severe, which naturally leads to feelings of chest tightness and weakness.
Could it also be related to endocrine issues, such as thyroid or adrenal problems, or even asthma or lung issues? I had asthma as a child, and I might still have it because I often take deep breaths but feel like I am not getting enough air to feel comfortable.
I have not checked for asthma issues.
Should I consult another specialty? I apologize for writing so much.
Please help clarify my concerns.
Thank you very much.

Wu, 20~29 year old female. Ask Date: 2002/09/18

Dr. Chen Guifeng reply Cardiology

Mitral valve prolapse is usually just a constitutional condition and does not cause discomfort.
Symptoms such as chest tightness, chest pain, shortness of breath, and feelings of asthma typically occur only during periods of high psychological stress, excessive tension, fatigue, or emotional instability.
Generally, cardiac function is normal, but it is often associated with psychoneurosis.
If there is excessive concern, it is advisable to consult with a psychiatrist.

Reply Date: 2002/09/18

More Info

When it comes to heart symptoms, understanding when to seek further medical advice is crucial, especially for someone like you who is young and active. Based on your description, it seems you have experienced a range of symptoms that can be concerning, particularly given your history of suspected heart issues and the diagnoses you've received.

1. Persistent Symptoms and Seeking Further Medical Attention
You mentioned that you still experience discomfort, particularly after intense exercise, and that this discomfort can last for extended periods, sometimes even throughout the night. While it is reassuring that your previous evaluations did not indicate severe heart disease, the persistence of your symptoms warrants further investigation. It is essential to communicate any changes or ongoing issues with your healthcare provider. If your symptoms are affecting your quality of life or causing you significant anxiety, it is reasonable to seek a second opinion or consult a cardiologist again.

2. Congenital Mitral Valve Prolapse
Regarding your diagnosis of mitral valve prolapse (MVP), it is indeed a common condition and often benign. Many individuals with MVP live without any significant symptoms. However, it is possible for symptoms to develop later in life due to various factors, including stress, anxiety, or changes in physical condition. The fact that you did not experience discomfort before the age of 20 does not rule out MVP; it may simply mean that your body has begun to react differently to the condition as you age or as your lifestyle changes.

3. Non-Cardiac Causes of Heart Discomfort
You raised an important point about the potential for non-cardiac issues to cause heart discomfort. Psychological factors, such as anxiety and stress, can significantly impact how you perceive physical symptoms. Anxiety can lead to sensations of palpitations, chest tightness, and feelings of heart discomfort. Additionally, endocrine issues, such as thyroid dysfunction, can also manifest as heart-related symptoms. Given your history of asthma and breathing difficulties, it is also plausible that respiratory issues could contribute to your sensations of breathlessness or discomfort.

Recommendations
1. Consult a Specialist: If your symptoms persist or worsen, consider consulting a cardiologist for a thorough evaluation. You might also benefit from seeing a psychologist or psychiatrist to address any anxiety or stress that may be contributing to your symptoms.

2. Lifestyle Modifications: Continue to engage in regular physical activity, but listen to your body. If certain exercises exacerbate your symptoms, it may be wise to modify your routine. Ensure you stay hydrated and maintain a balanced diet.

3. Monitor Your Symptoms: Keep a detailed log of your symptoms, including when they occur, their duration, and any associated activities or stressors. This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

4. Consider Comprehensive Testing: If you have not already, you might want to discuss with your doctor the possibility of undergoing additional tests, such as a Holter monitor to assess your heart rhythm over a longer period or pulmonary function tests to evaluate your respiratory health.

5. Address Psychological Factors: If you suspect that anxiety is playing a role in your symptoms, consider cognitive-behavioral therapy (CBT) or other forms of counseling that can help you manage anxiety and improve your overall well-being.

In summary, while your previous evaluations have indicated that your heart condition is likely not severe, the persistence of your symptoms and the impact they have on your life justify further investigation. It is essential to advocate for your health and seek the appropriate care to ensure that any underlying issues are addressed.

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