Chest Pain: Insights from Cardiovascular Specialists

Hello, Dr. He, regarding our last discussion..?

I previously reported discomfort from the end of August until early October, and the symptoms have persisted.
I experience a tight, pressing sensation in my chest that occasionally occurs, usually easing after about half a day.
However, from late August to early October, this happened approximately three times.
I consulted a cardiologist who performed a 24-hour Holter monitor and an echocardiogram.
Aside from some arrhythmia noted around 11 AM on the day of the test, the cardiologist found no abnormalities in the other recordings.
I believe the arrhythmia was triggered by normal sexual activity I engaged in that morning.
The echocardiogram showed that my heart was functioning normally without any other disease abnormalities.
Nonetheless, I continue to experience sharp chest pains that disrupt me.
Sometimes it occurs in the afternoon or upon waking up, and it is quite noticeable.
The location of the pain varies, but the tight, pressing sensation feels like there is a board stuck in my chest, rather than the 100 kg pressure described in online resources about angina or myocardial infarction, which would likely be unbearable.
I also experience a sensation of chest tightness and shortness of breath, which feels present yet absent at times.
When I have the tightness, I lie down and perform chest expansion exercises, which make me feel a bit of tightness in my chest.
Recently, I have also experienced noticeable sharp pains in my arms and legs, along with occasional strange pulsating pains in my muscles.
I consulted a neurologist, and the electromyography results were normal.
When I asked the doctor about the pulsations, he suggested they might be arterial pulsations.
However, these pulsations are not located where I would typically measure a pulse and are very pronounced, with my skin visibly twitching, but not in a fixed location; sometimes it occurs here, sometimes there.
This has been happening frequently over the past month, affecting both legs, but the main issue remains the sharp pains and pulsations in the chest area, which occur sporadically with unknown triggers, whether during exercise or at rest.
I began to suspect that my symptoms might be related to scoliosis and consulted a rehabilitation specialist.
The specialist found my symptoms ambiguous and attempted to assess for muscle issues through palpation and pressure on my chest.
He asked if the pressure felt similar to my pain, and I replied that it did not, as I experience sharp pain.
The rehabilitation specialist felt my symptoms did not align with his knowledge, and he reviewed my history, noting the arrhythmia from that day at 11 AM.
He mentioned that my cardiologist advised continued observation and that I should return for a follow-up on October 22.
He suggested that the cardiologist might not be able to definitively rule out a cardiac issue and speculated that it could be variant angina, especially since my blood pressure tends to be low, usually around 89/59 mmHg, with a pulse of 86/min.
Additionally, I am quite thin, although I mentioned that I have some fat in my chest and abdomen (waist circumference over 80 cm).
When I asked if this could have an impact, he said it was unlikely; if it did, I probably wouldn't have low blood pressure.
I would like to ask the doctor what further examinations would be advisable for me moving forward.

Chen KUI, 20~29 year old female. Ask Date: 2016/10/12

Dr. He Dongjin reply Cardiology

Hello, you can visit the neurology outpatient clinic to check on the tingling sensations that change locations, as they may resemble neuropathic pain.
Changhua Hospital cares about you.

Reply Date: 2016/10/12

More Info

Understanding chest pain can be a complex and multifaceted issue, especially when considering the various potential underlying causes. Based on the information you've provided, it seems that you have been experiencing persistent chest tightness and pain, along with other symptoms such as palpitations and tingling sensations in your limbs. These symptoms can be concerning and warrant a thorough evaluation to rule out any serious cardiovascular conditions.

Evaluation of Chest Pain
1. Symptom Analysis: The nature of your chest pain is crucial in understanding its origin. You describe it as a tight, pressing sensation rather than the classic "crushing" pain often associated with myocardial infarction (heart attack). This distinction is important, as it may suggest a different etiology, such as musculoskeletal issues, anxiety, or even gastrointestinal problems.

2. Cardiac Risk Factors: Your medical history and risk factors play a significant role in assessing your likelihood of coronary artery disease (CAD). Factors such as age, family history, smoking status, diabetes, and hypertension are critical. You mentioned low blood pressure (89/59 mmHg), which can sometimes be associated with certain heart conditions, but it can also be a benign finding in younger individuals.

3. Diagnostic Tests: You have undergone several tests, including a 24-hour Holter monitor and echocardiogram, which have shown no significant abnormalities apart from occasional arrhythmias. The Holter report indicated sinus bradycardia and occasional premature atrial contractions (PACs), which are generally benign, especially in the absence of other symptoms.

4. Musculoskeletal Considerations: Given that your pain does not correlate with typical cardiac symptoms and considering the physical examination by the rehabilitation specialist, it may be worthwhile to explore musculoskeletal causes. Conditions such as costochondritis or muscle strain can mimic cardiac pain.

5. Anxiety and Stress: Psychological factors can also contribute to chest pain. Anxiety and panic attacks can lead to sensations of tightness and discomfort in the chest, often accompanied by palpitations and shortness of breath. If you have been under stress or experiencing anxiety, this could be a contributing factor.

Next Steps
1. Follow-Up with Cardiology: Since your cardiologist has recommended continued observation, it is essential to keep that appointment. Discuss your ongoing symptoms in detail, including the frequency, duration, and any potential triggers. It may be beneficial to ask about further testing, such as a stress test or cardiac MRI, to evaluate for any ischemic changes that may not have been captured in previous tests.

2. Consider Musculoskeletal Evaluation: If your cardiologist rules out cardiac causes, consider consulting a physical therapist or a specialist in musculoskeletal medicine. They can assess for any underlying issues related to posture, spine alignment, or muscle tension that may be contributing to your symptoms.

3. Lifestyle Modifications: Regardless of the underlying cause, adopting a healthy lifestyle can be beneficial. Regular exercise, a balanced diet, and stress management techniques such as mindfulness or yoga can help improve overall well-being and potentially alleviate some symptoms.

4. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their intensity, and any associated activities or stressors. This information can be invaluable for your healthcare providers in determining the best course of action.

5. Psychological Support: If anxiety or stress is suspected to be a contributing factor, consider speaking with a mental health professional. They can provide strategies to manage anxiety, which may, in turn, help alleviate some of your physical symptoms.

Conclusion
In summary, while your symptoms are concerning, the absence of significant findings on your cardiac evaluations is reassuring. However, it is crucial to continue working with your healthcare providers to explore all potential causes of your chest pain. A comprehensive approach that includes both physical and psychological evaluations may provide the best path forward in understanding and managing your symptoms effectively.

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