Heart Discomfort: When to Seek Further Cardiac Evaluation

Discomfort in the heart?

First, I would like to thank the doctor for taking the time to respond despite their busy schedule.
About two years ago, I began to frequently experience chest tightness and episodes of my heart suddenly racing.
After seeking medical attention, I underwent an electrocardiogram (ECG), and the doctor noted abnormalities in the ECG (it seemed to be an issue with the electrical activity?).
Consequently, I had a cardiac ultrasound, chest X-ray, and wore a Holter monitor for 24 hours.
All results were normal, so the doctor advised me to pay attention to my lifestyle and to avoid stimulants.
The symptoms have remained relatively consistent over the past two years.

However, about two months ago, in addition to the increased frequency of the aforementioned symptoms, I began experiencing another issue: I would suddenly wake up just before falling asleep, feeling my heart racing, and experiencing a cool sensation in my chest, along with a bit of shortness of breath and weakness in my limbs.
After seeking medical attention again, I had another ECG, and the doctor mentioned that it looked similar to the one from two years ago, thus recommending that I consult a psychiatrist.

After consulting with the psychiatrist, I have been taking the prescribed medications regularly, but my symptoms have not improved, and the frequency of episodes has increased.
The psychiatrist has changed my medications several times, but there has been little change.
I would like to ask the doctor if it is necessary for me to undergo another detailed cardiac examination.

P.S.
My past medical history includes being a carrier of hepatitis B, mild fatty liver, and slightly elevated cholesterol levels.

Fang, 30~39 year old female. Ask Date: 2017/09/29

Dr. He Dongjin reply Cardiology

Hello, this sounds like typical autonomic nervous system dysfunction.
You may simply need to consult a psychiatrist for a medication adjustment, and there should be no need for another cardiac examination.
Pingan Changhua Hospital cares about you.

Reply Date: 2017/09/29

More Info

When it comes to understanding heart discomfort and determining when to seek further cardiac evaluation, it is essential to consider a variety of factors, including the nature of your symptoms, your medical history, and the results of previous tests. Based on your description, you have been experiencing episodes of chest tightness and palpitations for over two years, with an increase in frequency and the emergence of new symptoms such as waking up suddenly with a rapid heartbeat and feelings of breathlessness.
Given your history of abnormal ECG findings and the fact that you have undergone several tests (echocardiogram, chest X-ray, and 24-hour Holter monitoring) that returned normal results, it is understandable that you might feel uncertain about the next steps. However, the persistence and worsening of your symptoms warrant further investigation.

Key Considerations for Further Evaluation:
1. Nature of Symptoms: The symptoms you describe—especially the episodes of rapid heartbeat upon waking and feelings of breathlessness—are concerning. While anxiety and stress can manifest physically, the combination of these symptoms with a history of abnormal ECG findings suggests that a more thorough cardiac evaluation may be necessary.

2. Risk Factors: Your past medical history includes being a carrier of Hepatitis B, mild fatty liver, and slightly elevated cholesterol levels. While these conditions may not directly indicate heart disease, they can contribute to overall cardiovascular risk. It is crucial to manage these conditions effectively, as they can influence heart health.

3. Previous Test Results: Although your previous cardiac evaluations returned normal results, the fact that your symptoms have intensified suggests that there may be underlying issues that were not detected in earlier tests. Sometimes, conditions like microvascular disease or arrhythmias may not be evident in standard tests but can still cause significant symptoms.

4. Consultation with a Cardiologist: Given your ongoing symptoms and the changes in their frequency and intensity, it would be prudent to consult a cardiologist for a comprehensive evaluation. This may include repeat ECGs, echocardiograms, or even advanced imaging techniques like cardiac MRI or CT angiography to assess for any structural or functional abnormalities that may have developed since your last evaluation.

5. Consideration of Other Factors: It is also important to consider non-cardiac causes of your symptoms. Conditions such as anxiety disorders, panic attacks, or even gastrointestinal issues can mimic cardiac symptoms. A multidisciplinary approach involving both cardiology and mental health professionals may provide a more holistic understanding of your condition.

Conclusion:
In summary, while your previous tests were normal, the worsening of your symptoms and their impact on your daily life suggest that further cardiac evaluation is warranted. It is essential to address both the physical and psychological aspects of your health. A thorough assessment by a cardiologist, possibly followed by additional testing, can help clarify the situation and guide appropriate management. Remember, it is always better to err on the side of caution when it comes to heart health, so do not hesitate to seek further evaluation.

Similar Q&A

Understanding Heart Symptoms: When to Seek Further Cardiovascular Evaluation

Hello Dr. Huang, I have been experiencing chest tightness and palpitations for the past 3 to 4 years. I underwent electrocardiograms, X-rays, and blood tests at Chang Gung and Keng Hsin, all of which showed no abnormalities. However, my symptoms have persisted over these years: (...

Dr. Huang Guosheng reply Cardiology
Hello: Angina can cause discomfort in the chest, but this discomfort typically occurs during physical activity or when going up and down stairs, lasting for a few minutes, and improves with rest. If your chest discomfort is similar to the symptoms described above, you may want to...

Understanding Chest Pain: When to Seek Further Heart Evaluation

Hello Dr. Bu, I have been experiencing heart pain since middle school, which I believe is caused by academic pressure. My symptoms include irregular heartbeats, a stabbing pain in the heart area, and a tight sensation in the back where the heart is located. I often feel weakness ...

Dr. Bu Shiyun reply Cardiology
Chest pain is not uncommon in young people, but most of the time it is not caused by heart problems. Sometimes it can be due to neuromuscular pain, and stress can also have an impact. It is advisable to engage in more physical activity to relax, maintain a regular lifestyle, ensu...

Chest Discomfort: When to Seek Further Medical Evaluation?

Last week, I visited a clinic due to chest tightness. I underwent an electrocardiogram (ECG) and a chest X-ray. After reviewing the results, the doctor said there were no significant issues and advised me to monitor my condition without prescribing any medication. Subsequently, t...

Dr. He Dongjin reply Cardiology
If you are still feeling unwell, it is advisable to visit a cardiology clinic for further examination. Changhua Hospital cares about your well-being.

Understanding Sudden Heart Pain: When to Seek Further Evaluation

Hello Doctor, I would like to ask you about my condition. I started experiencing intermittent chest pain about three to four years ago. When measured by the school nurse, it was noted that when my heart rate was very fast (around 120 bpm), my blood oxygen levels were adequate. Wh...

Dr. Wu Xueming reply Cardiology
Due to your young age and the absence of chronic diseases, your risk of developing heart disease is very low. However, if symptoms persist, it is still advisable to visit a hospital for further evaluation.