Rapid Heartbeat and Chest Pain: A Comprehensive Guide

Palpitations are very noticeable and the heart is beating rapidly?

Hello Doctor, my condition is as follows: I have a fast heartbeat and pain in the middle or left side of my chest.
I can feel my heartbeat very distinctly, and my body or hands seem to pulse with my heartbeat.
I also feel nauseous, and both the nausea and chest pain have persisted for a month.
During this month, I have visited many departments and have undergone several tests, including an upper gastrointestinal endoscopy, chest X-ray, electrocardiogram (ECG), and echocardiogram.
The endoscopy revealed a gastric ulcer and gastroesophageal reflux disease (GERD).

Yesterday, I was supposed to review my endoscopy report, but before my appointment, I had my blood pressure and heart rate checked.
My heart rate reached 111, which made me quite anxious, especially since I was experiencing significant chest pain and a rapid heartbeat.
This anxiety caused my heart rate to spike to 133, prompting me to switch to the emergency department.
In the emergency room, they performed blood tests, an ECG, and a chest X-ray, all of which returned normal results (at E-Da Hospital).
They prescribed me antiarrhythmic medication, but I have a scheduled exercise ECG next Tuesday.
Will taking this medication affect the test?
I have seen several different hospitals in the past month, but it seems that every doctor thinks that at 21 years old, it is unlikely for me to have a heart condition, so they attribute my symptoms to gastrointestinal issues.
However, I am confused as to how gastrointestinal problems could cause my rapid heartbeat, noticeable heartbeats, and chest pain.
Doctor, what further tests should I consider?

Xiang, 20~29 year old female. Ask Date: 2017/03/17

Dr. Li Han reply Cardiology

Hello, based on your inquiry, "the palpitations have been present for some time," and even after consulting with a specialist, your confusion or situation has not improved.
I personally believe that seeking further advice online may overlook the importance of medical expertise and could be an unproductive approach.
I recommend consulting a second specialist; there may be some rare physiological causes, although the likelihood is low.
It is important to understand that health is not solely a physiological issue but rather a comprehensive coordination of physiological, psychological, and adaptive aspects.
The Changhua Hospital of the Ministry of Health and Welfare cares about your well-being.

Reply Date: 2017/03/17

More Info

Understanding rapid heartbeat and chest pain can be quite complex, especially when multiple symptoms and medical evaluations are involved. Based on your description, it seems you are experiencing a combination of rapid heartbeat (tachycardia), chest pain, and gastrointestinal symptoms, including nausea and a history of gastric issues such as ulcers and gastroesophageal reflux disease (GERD).
Firstly, it’s important to recognize that the heart and gastrointestinal system can be closely linked. Conditions like GERD can lead to chest pain that mimics cardiac issues, as the esophagus is located near the heart. The sensation of heartburn or acid reflux can sometimes be mistaken for heart-related pain, especially if the discomfort is felt in the chest area. Your symptoms of nausea and the feeling of a rapid heartbeat could also be exacerbated by anxiety, which is common when experiencing chest pain and tachycardia.

Given that you have undergone several tests, including an electrocardiogram (ECG), chest X-ray, and echocardiogram, and all have returned normal results, it is reassuring that there are no immediate cardiac issues. However, the fact that you are still experiencing symptoms warrants further investigation.
The rapid heartbeat you experienced, particularly when you were anxious, could be a response to stress or anxiety, which can trigger a fight-or-flight response, leading to increased heart rate and palpitations. This is especially relevant given your age; young adults can often experience anxiety-related symptoms that manifest physically.
Regarding your concern about the medication (heart rhythm medication) and its potential impact on your upcoming exercise stress test, it is crucial to discuss this with your prescribing physician. They can provide specific guidance on whether to continue the medication before the test, as certain medications can affect heart rate and rhythm during exercise testing.

In terms of further evaluations, if your symptoms persist, you might consider discussing the following with your healthcare provider:
1. Holter Monitor: This is a portable device that you wear for 24-48 hours to continuously monitor your heart's rhythm. It can help identify any irregularities that may not be captured during a standard ECG.

2. Stress Test: Since you have an upcoming exercise stress test, ensure that your doctor is aware of all your symptoms and concerns. This test can help assess how your heart responds to physical exertion.

3. Gastroenterology Follow-Up: Given your history of gastric issues, it may be beneficial to have a follow-up with a gastroenterologist to ensure that your GERD or ulcers are being managed effectively. Sometimes, medications for gastric issues can also affect heart rate and overall comfort.

4. Psychological Evaluation: If anxiety is suspected to be a contributing factor, speaking with a mental health professional could provide strategies to manage anxiety, which in turn may alleviate some of your physical symptoms.

5. Lifestyle Modifications: Consider lifestyle changes that can help manage both your gastrointestinal symptoms and anxiety. This includes dietary adjustments, regular exercise, stress management techniques such as mindfulness or yoga, and ensuring adequate sleep.

In conclusion, while your cardiac evaluations have returned normal, the interplay between your gastrointestinal symptoms and anxiety may be contributing to your ongoing issues. It is essential to maintain open communication with your healthcare providers, ensuring they are aware of all your symptoms and concerns. This collaborative approach will help in tailoring a management plan that addresses both your physical and emotional health.

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