Chest Pain and Breathing Issues: When to Seek Medical Help

Chest pain, shortness of breath when going up and down stairs, and throat pain?

I have been experiencing pain for the past six months, feeling like I can't catch my breath.
The pain is located in the chest, from the middle to the right side (not near the heart), and my throat also hurts.
At night, when I try to sleep, the pain becomes severe, and I have to stand up straight to adjust my breathing and alleviate the symptoms before I can fall asleep.
I have seen a cardiologist who performed an ultrasound and an electrocardiogram, both of which showed no issues.
A chest X-ray was done by a pulmonologist, and there was no pneumothorax.
The doctor suggested it might be muscle pain, but taking pain relievers does not alleviate my symptoms at all.
Recently, I have experienced sudden pain even while walking, accompanied by difficulty breathing, and going up and down stairs is excruciating.
I am unsure which specialist to consult next.
Please help me.
Thank you.

Zong Li, 40~49 year old female. Ask Date: 2017/02/24

Dr. Chen Taicheng reply Family Medicine

● Initial evaluations by cardiology and pulmonology should rule out common cardiopulmonary diseases.
Pain when climbing stairs indicates that the discomfort may be exercise-induced, potentially stemming from muscular or orthopedic issues.
Possible causes include fibromyalgia (there is an educational article from National Taiwan University’s neurology department at https://goo.gl/qKUOpn), polymyalgia rheumatica, dermatomyositis, chronic pain syndrome (which may present with muscle pain, sore throat, cognitive difficulties, and extreme fatigue), or pain resulting from neurological issues.
Other conditions such as liver and gallbladder diseases (gallstones), esophageal ulcers, and gastroesophageal reflux disease may also cause discomfort in the right chest, shortness of breath, back pain, or sore throat.
● It is recommended to first visit a major hospital's cardiology and pulmonology departments for a thorough examination.
If no conclusions are reached, please consult rheumatology, neurology/psychiatry, or gastroenterology for further evaluation.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you~

Reply Date: 2017/02/24

More Info

Experiencing chest pain and breathing difficulties can be alarming, especially when these symptoms persist despite numerous medical evaluations and tests showing no significant abnormalities. Your situation, characterized by pain in the chest, difficulty breathing, and throat discomfort, suggests a complex interplay of potential physical and psychological factors.

First and foremost, it’s essential to recognize that chest pain can arise from various sources, including musculoskeletal issues, gastrointestinal problems, and psychological conditions. Since you have already consulted with cardiologists and pulmonologists, and tests such as echocardiograms and chest X-rays have returned normal results, it may be time to consider other avenues.

1. Musculoskeletal Pain: Given that your doctors have suggested muscle pain, this could indicate conditions like costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum. This condition can cause sharp pain that worsens with certain movements or deep breaths. If pain medications have not alleviated your symptoms, it might be worth exploring physical therapy or other pain management strategies.

2. Gastroesophageal Issues: Sometimes, chest pain can be referred from gastrointestinal problems such as acid reflux or esophagitis. The fact that you experience throat pain and that certain positions relieve your discomfort could suggest that your symptoms are related to your digestive system. Consulting a gastroenterologist for further evaluation, including tests for acid reflux, could be beneficial.

3. Anxiety and Stress: Psychological factors can significantly impact physical health. Anxiety can manifest as chest pain and difficulty breathing, often leading to a cycle of fear and hyperventilation. Given the stressors you mentioned, such as work and personal concerns, it may be helpful to explore stress management techniques. Cognitive-behavioral therapy (CBT), mindfulness practices, or even medication for anxiety could provide relief.

4. Pulmonary Considerations: Although your lung function tests and imaging have been normal, if you continue to experience shortness of breath, it might be worth revisiting a pulmonologist. Conditions like exercise-induced bronchoconstriction or atypical asthma could be considered, especially if symptoms worsen with physical activity.

5. Further Evaluation: If your symptoms persist, consider seeking a multidisciplinary approach. A pain specialist, for example, could help manage chronic pain, while a psychologist or psychiatrist could address any underlying anxiety or stress. Additionally, a comprehensive evaluation by a rheumatologist may help rule out autoimmune conditions that can cause chest pain and respiratory symptoms.

In summary, while your previous medical evaluations have not identified a clear cause for your symptoms, it’s crucial to continue advocating for your health. Keep a detailed symptom diary, noting when pain occurs, its intensity, and any associated factors (like stress or dietary habits). This information can be invaluable for healthcare providers in diagnosing and treating your condition. Remember, it’s essential to seek help when symptoms are severe or worsening, especially if they interfere with your daily activities or quality of life.

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