Symptoms: Is It Heart Attack or Autonomic Nervous Disorder?

I'm not sure if it's a precursor to a myocardial infarction or autonomic nervous system dysfunction..?

I am a 28-year-old male (almost 29, as I prefer to refer to myself as 28 due to superstition), with a height of 166 cm and a weight of 58 kg, but I have abdominal obesity with a waist circumference of 89 cm.
I do not exercise and have been working from home for a long time.
I have a history of spontaneous pneumothorax (right side) and moderate to severe scoliosis.
On August 25, due to a long-standing habit of sleeping in the morning, I suddenly experienced a sharp, electric-like pain in my chest area that lasted for several seconds each time (caused by a disrupted day-night cycle from work).
After that, I felt persistent discomfort and sharp pain in my heart every day, and I wanted to switch to sleeping at night, but I suffered from insomnia and had difficulty sleeping.
While lying in bed, I experienced weakness in my legs, breathing difficulties, and would wake up startled, feeling as if my body wasn't my own.
On the night of August 28, unable to bear the lack of sleep, I went to the emergency room due to shortness of breath and chest pain.

In the morning at 8:00, I underwent a series of tests including X-rays, blood pressure checks, two ECGs, and blood tests, all of which the doctor said were normal, with no signs of pneumothorax or myocardial infarction.
After returning home, I was exhausted and slept for 6 hours.
The doctor suspected it might be a neurological issue and arranged for a neurology outpatient appointment.
Over the next two days, I still experienced some sharp, jumping pain in the chest area, but on August 30, I went on a date with my girlfriend and had sexual intercourse, after which I felt no discomfort (only felt particularly nauseous on the bus ride home, which I generally dislike, but the discomfort had intensified in the past few days).

From September 1 to 2, I still felt some discomfort, and my sleep schedule was erratic, waking up automatically at 3 AM after going to bed at 11 PM, and then wanting to sleep again in the afternoon.
Occasionally, I would have that sensation of waking up startled, feeling as if my body wasn't my own.
On September 3, still worried, I visited the cardiology outpatient clinic.
The doctor reviewed my reports and listened to my heartbeat, stating there were no acute symptoms (such as myocardial infarction).
Based on the doctor's demeanor, he almost certainly ruled out these acute conditions, but to reassure me, he scheduled a 24-hour Holter monitor and echocardiogram for September 16 and 17.

On September 5, I suddenly felt a tightness in the center of my chest from morning until afternoon, similar to a feeling of pressure (a constricting sensation), like something was pressing down, with a spherical area of discomfort.
My breathing was not very smooth, but aside from this sensation, I had no other discomfort.
This feeling persisted until I took a nap, after which it briefly subsided but gradually returned.
At night, I experienced the same sensation and woke up automatically at 4 AM.
On September 6, from morning until around 2 PM, I felt tightness again until I slowed my breathing, which alleviated the pressure.
I then took a two-hour nap and went to bed around 11 PM, but I experienced weakness and dizziness upon falling asleep, waking up around 2 AM.
I managed to sleep until around 4 or 5 AM but woke up again.
Currently, I feel mentally fine, but my breathing is still not smooth, and I occasionally have pain points in my chest.

On September 8, I decided to take my motorcycle for a short ride, thinking it would be a mild form of exercise.
I walked up and down three flights of stairs and felt a bit out of breath upon returning home, so I waited for my breathing to normalize before sitting down.
Then, I began to feel nauseous and dizzy, similar to having a fever, but when I checked my temperature with an ear thermometer, it was 36.5°C, indicating no fever.
Although I felt nauseous, I did not actually vomit.
By the afternoon, I returned to a somewhat normal state, with occasional back pain (likely due to scoliosis) and brief sharp pains in the lower left chest.
However, I still have tenderness in my right thumb and intermittent sharp pain in my left pinky.

I have read online about the phenomenon of "pseudonormal" symptoms in myocardial infarction, and since my outpatient doctor scheduled me for the 24-hour Holter monitor and echocardiogram on September 16 and 17, I am concerned about atypical presentations or conditions that might not show up on the ECG or blood tests at that time.
However, I currently have no discomfort, just some symptoms from a few days ago.
I would like to ask what acute symptoms indicate a myocardial infarction and what my current symptoms might suggest.
Although I found information indicating autonomic nervous system dysregulation and myocardial infarction symptoms are quite similar, myocardial infarction tends to be more severe.
The tightness in my chest on September 5 made me cautious (as it seems to be a primary symptom of myocardial infarction).
However, it is possible that this sensation has persisted for a long time, almost a day, only disappearing during sleep and resting, and continuing into the next day.
I have managed to adjust my sleep schedule back to a more normal time.

Additionally, for the 24-hour Holter monitor, is it necessary to engage in some physical activity, such as the stair climbing I did today? If both the Holter monitor and echocardiogram show no issues, does that mean my heart is fine? The duration of my discomfort has been two weeks.

Chen KUI, 20~29 year old female. Ask Date: 2016/09/08

Dr. He Dongjin reply Cardiology

Hello, the symptoms are due to autonomic nervous system dysfunction, not a myocardial infarction.
If it were, I would have been in serious trouble by now.
I haven't been sleeping well these past few days, which can lead to the symptoms mentioned above.
There's no need to worry; don't overthink it and scare yourself.
Changhua Hospital cares about you.

Reply Date: 2016/09/08

More Info

Based on your detailed description of symptoms and medical history, it seems you are experiencing a complex interplay of physical and psychological issues. Your symptoms, including chest pain, shortness of breath, feelings of weakness, and sleep disturbances, can indeed be concerning and may lead one to wonder whether they are indicative of a serious condition like a heart attack or if they stem from an autonomic nervous system disorder.

Understanding Your Symptoms
1. Chest Pain and Discomfort: The sensation of chest pain or tightness, particularly if it feels like a "pressure" or "electric shock," can be alarming. However, given that multiple medical evaluations (including X-rays, blood tests, and ECGs) have returned normal results, it is less likely that you are experiencing a heart attack. Heart attacks typically present with severe, persistent chest pain, often accompanied by other symptoms such as sweating, nausea, or radiating pain to the arm or jaw.

2. Autonomic Nervous System Dysfunction: Your symptoms may align more closely with an autonomic nervous system disorder, which can manifest as palpitations, dizziness, and feelings of unreality or detachment from one's body. Conditions like Postural Orthostatic Tachycardia Syndrome (POTS) or generalized anxiety can cause similar symptoms, particularly in individuals who have a history of anxiety or panic attacks.

3. Sleep Disturbances: The sleep issues you describe, including waking up suddenly and feeling like your body isn't your own, can be linked to anxiety or stress. Sleep deprivation can exacerbate feelings of anxiety and lead to a cycle of poor sleep and increased physical symptoms.

4. Physical Symptoms: The sensations of weakness in your legs and arms, as well as the tingling or pain in your fingers, could be related to anxiety, hyperventilation, or even musculoskeletal issues stemming from your scoliosis.

Recommendations
1. Follow-Up Testing: Since your doctors have recommended a 24-hour Holter monitor and echocardiogram, it is essential to follow through with these tests. They will help rule out any underlying cardiac issues that may not have been evident in your previous evaluations.

2. Mental Health Support: Given the psychological components of your symptoms, it may be beneficial to consult with a mental health professional. Cognitive Behavioral Therapy (CBT) can be particularly effective for managing anxiety and panic symptoms. Medication may also be an option if your symptoms are significantly impacting your quality of life.

3. Lifestyle Modifications: Incorporating regular physical activity, maintaining a balanced diet, and practicing good sleep hygiene can help improve both your physical and mental health. Techniques such as mindfulness, meditation, or yoga may also help manage anxiety and improve your overall well-being.

4. Monitoring Symptoms: Keep a detailed log of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

5. Emergency Situations: If you experience severe chest pain, shortness of breath, or any other alarming symptoms, do not hesitate to seek immediate medical attention. It's always better to err on the side of caution when it comes to potential cardiac issues.

Conclusion
While your symptoms are undoubtedly distressing, the likelihood of them being caused by a heart attack seems low given your normal test results. Instead, they may be related to anxiety or an autonomic nervous system disorder. Continued follow-up with your healthcare providers, along with a focus on mental health support and lifestyle changes, will be crucial in managing your symptoms and improving your quality of life. Remember, you are not alone in this, and seeking help is a positive step towards recovery.

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