Chest Tightness and Shortness of Breath: When Tests Come Back Normal

Chest tightness and shortness of breath, but examinations are normal?

Hello Doctor: For the past five days, I have been feeling a significant pressure in my chest, as if a heavy stone is pressing down on it.
Initially, it occurred occasionally, but the duration of the discomfort has been increasing.
I also noticed that activities I used to find easy, like quickly going up and down stairs, are still manageable, but I experience more shortness of breath afterward.
Sometimes, when I feel chest tightness, taking a slight breath helps relieve it for a while.
Until the day before yesterday, I went to the hospital for an examination, which included listening to my heart, an ultrasound, blood tests, and a chest X-ray, all of which came back normal.
The doctor at the hospital mentioned it might be a nerve issue and sent me home, but I forgot to ask what to do if the chest pain occurs again.
Should I just ignore it since the results were normal? I saw others mentioning exercise stress tests and echocardiograms; can I request those tests? Would these help identify any potential issues that might have been missed? I apologize for taking up your time, but I have been really worried about this situation.
I found information online about pulmonary hypertension and learned that it is an incurable condition, which made me even more anxious.
Can I rule out pulmonary hypertension since all my tests came back normal?

A Qiang, 20~29 year old female. Ask Date: 2018/07/29

Dr. He Dongjin reply Cardiology

Hello, your heart sounds are normal, and the ultrasound, blood tests, and chest X-ray results are all normal.
You are young, with no risk factors such as hypertension, diabetes, or smoking, which makes the likelihood of angina or pulmonary hypertension low.
You can consider doing an exercise electrocardiogram; just communicate with your physician at the outpatient clinic to arrange it.
Since all the above tests are normal, pulmonary hypertension can be ruled out, and you can disregard any future chest pain.
Just monitor it.
Changhua Hospital cares about you.

Reply Date: 2018/07/29

More Info

Chest tightness and shortness of breath can be distressing symptoms, and it’s understandable that you feel concerned, especially when they persist or worsen. Based on your description, you have undergone several tests, including a physical examination, echocardiogram, blood tests, and chest X-ray, all of which returned normal results. This is a positive sign, as it suggests that there are no immediate life-threatening conditions affecting your heart or lungs.

The sensation of chest tightness and shortness of breath can arise from various causes, not all of which are related to the heart or lungs. Given that your tests have ruled out significant cardiac and pulmonary issues, it is possible that your symptoms may be related to anxiety, stress, or even musculoskeletal issues. Anxiety can manifest physically, leading to symptoms such as chest tightness, shortness of breath, and a feeling of pressure in the chest. This is sometimes referred to as "anxiety-induced chest pain" or "panic attacks."
You mentioned that the tightness feels like a heavy weight on your chest, and that it sometimes improves with certain movements. This could indicate that your symptoms may not be purely physiological but could also involve psychological components. It’s important to address both the physical and emotional aspects of your health.

Regarding your question about further testing, if you continue to experience symptoms or if they worsen, it is reasonable to discuss additional tests with your healthcare provider. An exercise stress test (also known as a treadmill test) can be useful in assessing how your heart responds to physical exertion, and it may help identify any underlying issues that were not apparent during your initial evaluations. Similarly, a repeat echocardiogram or even a Holter monitor (which records your heart's activity over 24 hours) could provide more insight into your heart's function during episodes of discomfort.

As for pulmonary hypertension, while it is a serious condition, your normal chest X-ray and echocardiogram findings make it less likely. Pulmonary hypertension is often associated with specific symptoms and findings, such as elevated pressures in the pulmonary arteries, which are typically assessed through echocardiography or right heart catheterization. Since your tests did not indicate any abnormalities, it is unlikely that you have this condition, but if you have ongoing concerns, discussing them with a specialist in pulmonary medicine may provide additional reassurance.

In the meantime, it is essential to manage your anxiety and stress levels. Techniques such as deep breathing exercises, mindfulness, and cognitive behavioral therapy (CBT) can be beneficial. If you find that your symptoms are significantly impacting your quality of life, consider seeking support from a mental health professional who can help you develop coping strategies.

Lastly, if you experience any new or worsening symptoms, such as severe chest pain, fainting, or persistent shortness of breath, it is crucial to seek immediate medical attention. Your health and well-being are paramount, and it’s always better to err on the side of caution when it comes to symptoms that could indicate a serious condition.

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