Left Chest Pain: When to Seek Heart or Gastro Care

Left chest pain?

Hello, Doctor! Initially, while watching a movie, I suddenly felt my heart racing and felt lightheaded, as if I might faint.
I stepped out of the theater and gradually felt better.
That day, I experienced rapid heartbeat, some pain in my left chest, and a feeling of nausea.
That night, I went to see a doctor (last Wednesday), who prescribed medication for gastritis (I had eaten fried food the night before and very spicy food two nights prior).
By Saturday, I still had left chest pain and nausea, so I went to the emergency room.
The doctor didn't perform many tests and said it was likely gastritis, prescribing the same medication for me.
By Tuesday of this week, I still felt nauseous and had left chest pain, so I visited a cardiologist.
I underwent an X-ray, an electrocardiogram, and an echocardiogram, and the doctor indicated that there were no significant issues.
On Thursday, I still felt symptoms, so I consulted a gastroenterologist, who prescribed gastritis medication but also mentioned that I might have autonomic nervous system dysregulation.
Today, the nausea has diminished slightly, but I still experience occasional sharp pain in my left chest, especially when I laugh.
I would like to ask which specialist I should see if my symptoms do not improve by Monday.
Thank you.

Xiang, 20~29 year old female. Ask Date: 2017/02/18

Dr. He Dongjin reply Cardiology

Hello, your symptoms are continuously improving, so you can just observe them for now; they are not life-threatening, so there is no need to worry.
It sounds like it could be caused by gastroesophageal reflux.
Changhua Hospital cares about you.

Reply Date: 2017/02/18

More Info

When it comes to left chest pain, especially when accompanied by symptoms such as rapid heart rate, nausea, and persistent discomfort, it is essential to approach the situation with caution. Your experience of sudden left chest pain and a racing heart while watching a movie, followed by feelings of nausea, suggests that there could be multiple underlying causes, including gastrointestinal issues, cardiac concerns, or even anxiety-related symptoms.

Given that you have already consulted with various specialists, including a gastroenterologist and a cardiologist, and have undergone several diagnostic tests such as X-rays, echocardiograms, and electrocardiograms (ECGs), it appears that serious cardiac conditions like myocardial infarction (heart attack) or significant structural heart disease have been ruled out. The tests showing normal results are reassuring, but your ongoing symptoms warrant further exploration.

Understanding Your Symptoms
1. Gastrointestinal Issues: The initial diagnosis of gastritis aligns with your symptoms, especially since you mentioned consuming spicy and fried foods prior to the onset of your symptoms. Gastritis can cause discomfort in the upper abdomen and may radiate to the chest, mimicking heart-related pain. The nausea you are experiencing could also be linked to gastrointestinal distress.

2. Cardiac Considerations: While your cardiac evaluations have returned normal results, it is important to note that some heart conditions can present with atypical symptoms. However, given your age and the normal findings from your tests, the likelihood of a serious cardiac event is low. That said, conditions like anxiety or panic attacks can also manifest with symptoms similar to those of heart problems, including chest pain and palpitations.

3. Autonomic Nervous System Dysfunction: The mention of possible autonomic nervous system dysregulation is significant. This can lead to symptoms such as palpitations, chest discomfort, and gastrointestinal disturbances. Stress and anxiety can exacerbate these symptoms, leading to a cycle of discomfort.

Next Steps
If your symptoms persist or worsen, it would be prudent to follow up with a healthcare provider. Here are some recommendations:
- Follow-Up with a Gastroenterologist: Since gastritis has been suggested, it may be beneficial to revisit a gastroenterologist. They might consider further evaluations, such as an upper endoscopy, to assess the state of your stomach and esophagus more thoroughly.

- Consult a Cardiologist Again: If you continue to experience chest pain, especially if it changes in character or intensity, it may be worth seeing a cardiologist again. They might suggest additional tests, such as a Holter monitor (24-hour ECG) to assess your heart rhythm over a longer period.

- Consider a Mental Health Evaluation: If anxiety or stress is suspected to be contributing to your symptoms, consulting a mental health professional could be beneficial. They can provide strategies to manage anxiety, which may help alleviate some of your physical symptoms.

- Lifestyle Modifications: Pay attention to your diet, avoiding spicy and fried foods that may irritate your stomach. Additionally, practicing stress-reduction techniques such as mindfulness, yoga, or regular exercise can help improve your overall well-being.

Conclusion
In summary, while your initial evaluations have ruled out significant cardiac issues, your ongoing symptoms suggest a multifactorial problem that may involve gastrointestinal and possibly psychological components. If your symptoms do not improve by Monday, consider seeing a gastroenterologist or a mental health professional. It is crucial to address both the physical and emotional aspects of your health to achieve a comprehensive understanding and management of your symptoms. Always listen to your body and seek help when needed.

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