Post-Exercise Chest Tightness and Palpitations After Antibiotics: What to Do?

Chest tightness after exercise and lifting heavy objects + palpitations after taking antibiotics?

Hello Doctor, about two years ago, I experienced chest tightness and discomfort after exercising.
After researching online, I decided to visit a cardiologist.
Following a stress echocardiogram, the doctor informed me that my heart rate reaches a level where myocardial ischemia occurs, and advised me to avoid intense exercise, prescribing me medication (Nicorandil).
Over the past two years, I experienced chest tightness after exercise for the second time, but it improved after resting.
However, due to a busy work schedule, I haven't returned for follow-up appointments or routine ECG checks for about six months.

On May 22, 2017, I developed a large abscess under my armpit, about the size of a thumb, which was painful.
After visiting a dermatologist, the doctor treated it and prescribed antibiotics (Cephalexin 500mg).
Since I started taking the antibiotics, I have experienced palpitations daily, with the first day being the most severe, having more than ten episodes, each lasting about 1-2 seconds.
I researched online and found that this might be a side effect of the antibiotics, so I continued taking them.
After completing the seven-day course, as of today, June 13, I still experience palpitations lasting 1-2 seconds at least 7-8 times a day.

Additionally, I recently noticed that when I lift heavy objects, I also feel a tightness in my chest, which resolves after a minute or two, but it is not as uncomfortable as the post-exercise tightness.
I would like to ask the doctor if I need to continue seeing a physician for my condition.
Thank you.

N, 30~39 year old female. Ask Date: 2017/06/13

Dr. He Dongjin reply Cardiology

Hello, your main symptom is palpitations, which may indicate arrhythmia.
It seems that this could be caused by medication side effects.
It is advisable to stop the medication and observe for a while.
If the discomfort persists, it is recommended to follow up with a cardiology clinic.
Changhua Hospital cares about your well-being.

Reply Date: 2017/06/13

More Info

It sounds like you are experiencing a concerning combination of symptoms following your antibiotic treatment and previous episodes of chest tightness and palpitations. Given your history of exercise-induced chest discomfort and the recent onset of palpitations after starting antibiotics, it is essential to approach this situation with caution.

Firstly, let's address the palpitations you are experiencing. Palpitations can be caused by various factors, including anxiety, caffeine intake, dehydration, electrolyte imbalances, and certain medications, including antibiotics. In your case, the antibiotic Cephamycins may have contributed to your symptoms, especially if you have a sensitivity to it or if it has affected your gut flora, leading to other systemic effects. The fact that you are experiencing these palpitations daily, even after completing the antibiotic course, is concerning and warrants further evaluation.

Additionally, your history of exercise-induced chest tightness raises the possibility of underlying cardiovascular issues. The previous assessment indicating myocardial ischemia during exercise suggests that your heart may not be receiving adequate blood flow during physical exertion, which could lead to symptoms like chest tightness and palpitations. The fact that you have experienced these symptoms again, particularly when lifting heavy objects, indicates that your heart may still be under stress.

Given these factors, it is crucial to consult with your healthcare provider as soon as possible. Here are some steps you should consider:
1. Schedule a Follow-Up Appointment: It is important to return to your cardiologist or primary care physician to discuss your ongoing symptoms. They may recommend further diagnostic tests, such as an echocardiogram, a Holter monitor (to record your heart rhythm over 24-48 hours), or even a stress test to evaluate your heart's response to exercise.

2. Medication Review: Discuss the medications you are currently taking, including the Nicorandil and any other prescriptions or over-the-counter medications. Your doctor may need to adjust your treatment plan based on your symptoms.

3. Lifestyle Modifications: While waiting for your appointment, consider reducing strenuous activities that may exacerbate your symptoms. Focus on lighter exercises, such as walking or gentle stretching, and avoid heavy lifting until you have a clearer understanding of your condition.

4. Monitor Symptoms: Keep a detailed log of your symptoms, noting when they occur, their duration, and any associated activities or stressors. This information can be invaluable for your healthcare provider in diagnosing your condition.

5. Consider Stress Management: Since you mentioned feeling overwhelmed with work, incorporating stress management techniques such as mindfulness, yoga, or meditation may help alleviate some of the anxiety that can contribute to palpitations.

In summary, your symptoms of post-exercise chest tightness and palpitations, especially following antibiotic use, should not be ignored. It is essential to seek medical advice promptly to rule out any serious underlying conditions and to ensure that you receive appropriate care. Your health and well-being are paramount, and addressing these symptoms with a healthcare professional is the best course of action.

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