Frequent Chest Discomfort: Causes and Solutions

I can't stand the chest tightness and chest pain anymore?

Hello Doctor: For the past 3 to 4 months, I have been experiencing frequent chest tightness in the area of my heart on the left side, to the point where it has become unbearable.
Each time I feel this tightness, I start to worry and panic, which is often accompanied by a sensation of mild shortness of breath.
I have also experienced hyperventilation due to this.
Additionally, during these episodes of chest tightness, I often feel weakness in my left arm.
I have previously visited a cardiologist, and my electrocardiogram was normal.
An echocardiogram showed mild mitral valve prolapse.

Here are some observations regarding my chest tightness and discomfort:
1.
I experience chest tightness during arguments or disputes, which can last for 2 to 3 hours.
2.
Recently, I have been waking up with chest tightness that lasts for 1 to 2 minutes in the morning before alleviating.
3.
I often feel palpitations or shortness of breath for no apparent reason.
4.
The frequency of chest tightness can occur 2 to 3 times a day.
5.
I am also prone to chest tightness when feeling nervous, agitated, or anxious.
I work as a software engineer and would like to seek your advice, as this issue has severely impacted my daily life and work.
The cardiologist prescribed me Xanax and Inderal.
Currently, I only use the medication when I cannot tolerate the discomfort to avoid dependency.
I understand that Inderal is used to reduce heart rate.
I carry a heart rate monitor with me, and each time I experience chest tightness, I check my heart rate, which usually ranges between 70 and 85 beats per minute, not particularly fast.

Is there a positive correlation between the symptoms of mitral valve prolapse and heart rate? Is it still appropriate for me to take Inderal? Additionally, are tension and anxiety considered different emotional responses? From my understanding, tension should cause an increased heart rate, while anxiety may not.
However, both can lead to chest tightness; is my understanding correct?
Lastly, I often see that mitral valve prolapse can lead to such symptoms.
I would like to ask if experiencing chest tightness 2 to 3 times a day, lasting from 0.5 hours to 2 hours, is a normal symptom of mitral valve prolapse? I want to know if it is common for individuals with mitral valve prolapse to experience such high frequency and prolonged symptoms.

I apologize for the lengthy and complex questions.
I am becoming increasingly worried about this issue, and despite having seen a cardiologist several times, I have never experienced this before.
The frequency of these episodes over the past 2 to 3 months has caused me significant distress and discomfort.
Thank you for taking the time to read my concerns, and I appreciate your guidance!

Feichang danxin de ren, 30~39 year old female. Ask Date: 2017/06/06

Dr. He Dongjin reply Cardiology

Hello, your symptoms are caused by anxiety and panic, leading to autonomic nervous system dysregulation.
Taking those two medications is appropriate; their purpose is to stabilize the autonomic nervous system without the risk of addiction, so you don't need to worry about taking them excessively.
This is a normal response.
Symptoms of mitral valve prolapse are indeed associated with autonomic nervous system dysregulation, and it is suitable to take Inderal and Xanax for these conditions.
Mitral valve prolapse can lead to such symptoms, and you are not an exception.
Changhua Hospital is concerned about your well-being.

Reply Date: 2017/06/06

More Info

Frequent chest discomfort, particularly in the context of your symptoms, can be quite distressing and may significantly impact your quality of life. Understanding the underlying causes and potential solutions is crucial for managing your condition effectively.

Causes of Chest Discomfort
1. Anxiety and Panic Attacks: Given your description of symptoms that occur during stressful situations, such as arguments or feelings of anxiety, it is possible that your chest discomfort is related to anxiety or panic attacks. These episodes can manifest as chest tightness, shortness of breath, and even palpitations. The body's fight-or-flight response can lead to hyperventilation, which further exacerbates feelings of breathlessness and discomfort.

2. Mitral Valve Prolapse (MVP): You mentioned having mild mitral valve prolapse, which can sometimes be associated with symptoms like chest pain or discomfort, palpitations, and even anxiety. While MVP is often benign, it can cause symptoms in some individuals, particularly when combined with anxiety or stress.

3. Musculoskeletal Issues: Sometimes, chest discomfort can stem from musculoskeletal problems, such as muscle strain or costochondritis, especially if the pain is reproducible with palpation or certain movements.

4. Cardiac Issues: Although your previous cardiac evaluations (ECG and echocardiogram) were normal, it’s essential to consider that some cardiac conditions can present with atypical symptoms. However, given your normal heart rate during episodes of discomfort and the absence of significant findings in your previous tests, this is less likely.

Solutions and Management
1. Medication: You are currently taking Xanax (an anti-anxiety medication) and Inderal (a beta-blocker). Inderal can help manage symptoms of anxiety and palpitations by slowing down the heart rate. Since your heart rate is typically within the normal range during episodes of discomfort, it may be beneficial to discuss with your doctor whether continuing Inderal is necessary, especially if you are not experiencing significant tachycardia.

2. Cognitive Behavioral Therapy (CBT): Engaging in therapy, particularly CBT, can help address the underlying anxiety and panic symptoms. Learning coping strategies to manage stress and anxiety can significantly reduce the frequency and intensity of your chest discomfort.

3. Lifestyle Modifications: Incorporating regular physical activity, practicing relaxation techniques (such as deep breathing exercises, yoga, or meditation), and ensuring adequate sleep can help manage anxiety and improve overall well-being.

4. Regular Follow-ups: Given the frequency of your symptoms, it is essential to maintain regular follow-ups with your healthcare provider. They may recommend further evaluations, such as a Holter monitor to assess your heart rhythm over a more extended period, or even a referral to a cardiologist specializing in MVP if symptoms persist.

Understanding Your Symptoms
Regarding your questions about the relationship between MVP and your symptoms, it is indeed possible for individuals with MVP to experience frequent chest discomfort, although the severity and frequency can vary widely among individuals. It is not uncommon for anxiety to amplify the perception of these symptoms, leading to a cycle of worry and discomfort.

In terms of the frequency of your symptoms (2-3 times a day lasting from 30 minutes to 2 hours), while this may be concerning, it is essential to consider the context of your overall health and any accompanying symptoms. Normal individuals with MVP may not experience such frequent symptoms, but anxiety can certainly exacerbate the situation.

Conclusion
In summary, your frequent chest discomfort is likely multifactorial, involving anxiety, potential MVP symptoms, and possibly musculoskeletal factors. It is crucial to work closely with your healthcare provider to develop a comprehensive management plan that addresses both the physical and psychological aspects of your symptoms. Regular monitoring and adjustments to your treatment plan can help alleviate your discomfort and improve your quality of life.

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