Chest Pain: A Young Woman's Journey with Heart Issues

Cardiac issues

Hello, doctor! I am a 32-year-old female, 164 cm tall and weighing 60 kg.
I have been experiencing chest tightness and pain for the past two years, which has been a recurring issue for me.
The frequent episodes began around August and September of the year before last.
I work as a police officer and used to have irregular shifts, during which I often felt chest tightness and pain, difficulty breathing, and sometimes severe dizziness, as if I might faint at any moment.
My chest pain seems to have a specific point, but it occasionally moves around and sometimes feels sharp.
I also frequently experience soreness in my shoulders, neck, and upper back.
Later, I applied to transfer to a unit with regular hours.
I usually exercise 2-3 days a week, doing activities like brisk walking, jogging, and interval training.
I do not feel chest pain while exercising, but occasionally, after more intense or prolonged activity, I experience some difficulty breathing.
During this time, I have seen several cardiologists, and the most common response I hear is that at my age, there shouldn't be any significant issues.
Some doctors merely listened with a stethoscope and suggested I see a rheumatologist.
More thorough doctors arranged for me to undergo a stress echocardiogram, where some values dropped to -1.
They also scheduled a myocardial perfusion scan, and after reviewing the report, the doctor mentioned that some images showed incomplete circles with gaps, indicating a potential myocardial ischemia issue.
However, they also suggested it might be a false positive and deemed further investigation unnecessary, recommending observation instead and not prescribing any medication.
They provided me with nitroglycerin for emergencies, advising that if I feel significantly uncomfortable and it helps, it indicates a real problem.
I was quite taken aback by this! I also paid for a cardiac ultrasound, which showed mild mitral and tricuspid valve insufficiency, but it was not severe.
I also underwent a CT scan that appeared normal, yet I still feel inexplicably unwell.
I am uncertain whether my discomfort is heart-related, and I suspect I might have autonomic nervous system dysregulation, as I tend to get anxious easily.
The lack of improvement in my condition, combined with the minor issues found during examinations, has made me more anxious.
I would like to ask the doctor what further tests or treatments I should pursue.

Olga, 30~39 year old female. Ask Date: 2018/01/28

Dr. He Dongjin reply Cardiology

Hello, you indeed have issues with autonomic nervous system dysregulation.
Your self-paid CT scan results are normal, so there is no need for further examinations.
It is recommended that you consult a psychosomatic medicine specialist and consider taking some medication.
Changhua Hospital cares about your well-being.

Reply Date: 2018/01/28

More Info

It sounds like you have been experiencing a complex and distressing set of symptoms related to chest pain and discomfort over the past two years. Given your age and the extensive evaluations you've undergone, it’s understandable to feel frustrated and anxious about your health. Let's break down your situation and explore potential avenues for further understanding and management.

Understanding Your Symptoms
1. Chest Pain and Discomfort: Your description of chest pain that varies in intensity and location, along with associated symptoms like shortness of breath and dizziness, can be indicative of several underlying issues. While heart-related problems are a concern, especially given your history of some abnormal findings, many young individuals experience chest pain that is not directly related to cardiac issues. This can include musculoskeletal pain, anxiety-related symptoms, or even gastrointestinal issues.

2. Impact of Stress and Anxiety: Given your profession as a police officer, which can be highly stressful, it's important to consider the role of stress and anxiety in your symptoms. Anxiety can manifest physically, leading to symptoms such as chest tightness, palpitations, and even dizziness. The fact that you mentioned feeling more anxious due to the medical evaluations could create a cycle where anxiety exacerbates your physical symptoms.

3. Physical Activity: You mentioned that you engage in regular exercise, which is excellent for both physical and mental health. However, if you experience discomfort during more intense activities, it might be worth examining your exercise routine and ensuring that you are not pushing yourself too hard, especially if you are feeling unwell.

Evaluations and Findings
You have undergone several diagnostic tests, including an exercise stress test and echocardiogram, which have shown some minor abnormalities but nothing that definitively indicates a serious cardiac condition. The mention of "pseudo-positive" results can be confusing, but it suggests that while there may be some findings of concern, they are not necessarily indicative of significant heart disease.

Recommendations Moving Forward
1. Follow-Up with a Cardiologist: Since you have already seen multiple cardiologists, it may be beneficial to seek a second opinion from a specialist who focuses on young adults or women’s heart health. They might have a different perspective or suggest additional tests that could provide more clarity.

2. Consider Psychological Support: Given the potential role of anxiety in your symptoms, consulting with a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) or other forms of therapy can help manage anxiety and stress, which may, in turn, alleviate some of your physical symptoms.

3. Lifestyle Modifications: Continue with regular exercise, but consider incorporating relaxation techniques such as yoga, meditation, or deep-breathing exercises. These can help reduce stress and improve your overall sense of well-being.

4. Monitor Your Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare providers in understanding your condition better.

5. Further Testing: If your symptoms persist or worsen, you might want to discuss with your doctor the possibility of further testing, such as a Holter monitor (to assess heart rhythm over 24-48 hours) or a referral to a specialist in autonomic disorders if you suspect dysautonomia.

Conclusion
Your situation is complex, and while it is reassuring that serious cardiac conditions are less likely given your age and test results, it is crucial to address both the physical and psychological aspects of your health. Engaging in open conversations with your healthcare providers about your concerns and experiences will be key in finding a path forward that brings you relief and clarity. Remember, you are not alone in this journey, and there are resources and support available to help you navigate these challenges.

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