Chest Pain: Heart Issues or Intercostal Neuralgia?

Chest pain near the heart?

Hello Doctor:
1.
I have been experiencing intermittent pain in the left chest area, specifically at the location of the heart, which occurs even during static activities.
I can pinpoint the pain, and it worsens with breathing.
The pain usually resolves within half a minute, but it has lasted over half an hour on some occasions.
I have seen multiple cardiologists, and some tests have shown mild to moderate mitral and tricuspid valve regurgitation, while a few tests returned normal results.
The doctors have indicated that the valve issues should not cause such pain.
The most recent cardiologist diagnosed it as "intercostal neuralgia." Since the pain is located at the heart area, I am understandably concerned about a potential heart issue.
Do you have any valuable suggestions? Thank you!
2.
My blood pressure is usually around 136/82, which is noticeably high for my age.
What measures should I take? Additionally, I often feel fatigued or experience sudden nausea and vomiting while jogging.
I am unsure if this is related to my blood pressure issues.
Thank you very much!

Xiao Chen, 20~29 year old female. Ask Date: 2017/12/06

Dr. Liao Yaopan reply Family Medicine

Cardiac issues should still be evaluated by a cardiologist.
If cardiac causes are ruled out, other factors may be responsible.
The ideal blood pressure is currently defined as not exceeding 120/80 mmHg.
It is important to maintain regular cardiovascular exercise and gradually adapt to it, as well as to monitor blood pressure regularly.
If you experience any discomfort, please follow up at the outpatient clinic.
Please note that online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2017/12/06

More Info

Chest pain can be a concerning symptom, and understanding its origins is crucial for appropriate management. Based on your description, it seems you are experiencing intermittent pain in the left chest area, which is localized and worsens with breathing. You have undergone multiple evaluations, including echocardiograms and assessments for valvular heart disease, which have shown mild mitral and tricuspid regurgitation but no significant heart disease. Your recent diagnosis of intercostal neuralgia suggests that the pain may not be of cardiac origin, but rather related to nerve irritation or musculoskeletal issues.

Intercostal neuralgia is characterized by pain along the intercostal nerves, which run between the ribs. This type of pain can be sharp, stabbing, or aching and may be exacerbated by certain movements, deep breathing, or palpation of the affected area. The fact that your pain resolves relatively quickly (within half a minute to over half an hour) and is reproducible by specific movements or breathing suggests that it is more likely related to nerve irritation rather than a serious cardiac condition.

However, it is essential to remain vigilant about any changes in your symptoms. If you experience new symptoms such as shortness of breath, dizziness, or significant changes in your heart rate, it would be prudent to seek immediate medical attention. Given your history of mild valvular issues, it is also wise to maintain regular follow-ups with your cardiologist to monitor your heart health.

Regarding your blood pressure readings, a consistent reading of 136/82 mmHg is considered to be at the higher end of normal, bordering on stage 1 hypertension. It is important to manage your blood pressure through lifestyle modifications, which can include:
1. Diet: Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing sodium intake can also help manage blood pressure.

2. Exercise: Regular physical activity can help lower blood pressure and improve overall cardiovascular health. Aim for at least 150 minutes of moderate-intensity exercise each week.

3. Weight Management: If you are overweight, losing even a small amount of weight can help lower your blood pressure.

4. Stress Management: Since you mentioned feelings of fatigue and nausea during physical activity, it may be beneficial to incorporate stress-reducing techniques such as mindfulness, yoga, or deep-breathing exercises into your routine.

5. Regular Monitoring: Keep track of your blood pressure at home and report any significant changes to your healthcare provider.

If you continue to experience nausea and vomiting during exercise, it may be worth discussing this with your doctor. These symptoms could be related to your blood pressure or other underlying issues, and further evaluation may be necessary.

In conclusion, while your symptoms may be indicative of intercostal neuralgia rather than a serious heart condition, it is essential to continue monitoring your health and maintain open communication with your healthcare providers. Regular check-ups and lifestyle modifications can significantly contribute to your overall well-being and help alleviate your concerns. If you have any further questions or if your symptoms change, do not hesitate to seek medical advice.

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