Chest Tightness and Unusual Heart Sensations: When to Seek Help

Recently, I have been experiencing chest tightness and an unusual sensation in my heartbeat?

I had a cardiac ultrasound, chest X-ray, and 24-hour Holter monitor in early March this year, and all the tests were normal.
It was suspected that my initial left-sided chest pain might have been due to gastroesophageal reflux.
In early August, I felt unwell again and went to the emergency room, where I had another chest X-ray.
The emergency physician said everything looked fine, but due to my existing scoliosis, my heart appeared slightly shifted to the right.

Recently, I have been experiencing occasional chest tightness, and sometimes, due to a change in posture, I feel a strange sensation in my heart, as if it suddenly expands, accompanied by a momentary difficulty in breathing (a sensation of breath interruption).
This can happen when I transition from standing to lying down or when I sit down suddenly.
Occasionally, it also occurs while walking.
These sensations typically last no longer than 1 to 2 seconds, after which my breathing returns to normal, but the chest tightness can persist for a longer duration.

Could you please advise what these symptoms might indicate and whether I should go to the hospital for a more detailed examination?

Zhang Xiansheng, 20~29 year old female. Ask Date: 2016/10/24

Dr. He Dongjin reply Cardiology

Hello, you may be experiencing paroxysmal arrhythmia.
It is recommended that you visit a cardiology clinic for further evaluation, such as a 24-hour Holter monitor.
Changhua Hospital cares about your health.

Reply Date: 2016/10/24

More Info

Based on your description, it seems you are experiencing episodes of chest tightness, unusual heart sensations, and shortness of breath, particularly when changing positions or after physical activity. Given your previous cardiac evaluations, including echocardiograms and 24-hour Holter monitoring, which showed no significant abnormalities, it is understandable that you may feel concerned about your symptoms.

Firstly, it is important to recognize that chest tightness and unusual heart sensations can stem from various causes, not all of which are cardiac in nature. In your case, the episodes of chest tightness and the sensation of your heart beating unusually could be related to several factors:
1. Gastroesophageal Reflux Disease (GERD): As you mentioned, your left-sided chest pain was initially thought to be related to GERD. This condition can cause chest discomfort that mimics cardiac pain, especially when lying down or after eating. The tightness you feel could be related to acid reflux irritating the esophagus.

2. Musculoskeletal Issues: Given your history of scoliosis, it's possible that musculoskeletal pain could be contributing to your symptoms. Changes in posture can lead to muscle strain or discomfort, which may feel like tightness in the chest.

3. Anxiety and Panic Attacks: Anxiety can manifest physically, leading to sensations of tightness in the chest, rapid heartbeats, and shortness of breath. If you have a history of anxiety, this could be a significant factor in your current symptoms.

4. Autonomic Nervous System Dysregulation: The autonomic nervous system controls involuntary bodily functions, including heart rate and breathing. Dysregulation can lead to symptoms such as palpitations, feelings of breathlessness, and unusual heart sensations, especially during position changes.

5. Cardiac Considerations: While your previous tests were normal, it is essential to remain vigilant. Conditions such as mitral valve prolapse or other structural heart issues could potentially cause intermittent symptoms. However, given your recent evaluations, the likelihood of a significant cardiac issue seems low.

Given the complexity of your symptoms and their impact on your daily life, it would be prudent to seek further evaluation from a healthcare provider, particularly a cardiologist or a specialist in internal medicine. They may recommend additional tests, such as a repeat echocardiogram, stress testing, or even a referral to a gastroenterologist if GERD is suspected.
In the meantime, consider keeping a symptom diary to track when these episodes occur, their duration, and any associated activities or stressors. This information can be invaluable for your healthcare provider in determining the underlying cause of your symptoms.

In conclusion, while your previous cardiac evaluations were reassuring, the persistence of your symptoms warrants further investigation. It is always better to err on the side of caution when it comes to heart health. Seeking a thorough evaluation will help clarify the cause of your symptoms and guide appropriate management.

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