Chest Discomfort: When to Consult a Cardiologist

Thoracic issues

Hello, Director: I have some thoracic issues I would like to consult you about.

1.
During the summer, I easily experience a tingling sensation in my chest when climbing stairs or even when at rest.
Due to my asthma, I asked a pulmonologist during my follow-up visit, and the doctor assured me that it should be fine.

2.
Recently, whenever I feel anxious or exert myself, I tend to experience pain in my left chest along with a tingling sensation.
After about 5 to 8 minutes, the pain and tingling spread to my left arm, armpit, and jaw (particularly, the inner side of my left arm and armpit feel sharp and tingly).
After another 5 to 8 minutes, it spreads throughout my entire chest, lasting about 10 to 20 minutes.
Besides the pain and numbness, I also experience shortness of breath and chest tightness, but there is no sweating or cold sweats, and I am still able to walk.

3.
Recently, I become short of breath and feel chest tightness after climbing just one flight of stairs.
I measured my heart rate at 135 beats per minute, while my average resting heart rate is 80 to 85 beats per minute (previously, during some health classes, the instructor mentioned that my heart rate is faster than normal).

4.
I have been experiencing frequent episodes of chest tightness.
Additionally, I used to drink coffee without any issues, but recently, consuming coffee has led to chest tightness and an increased heart rate (111 beats per minute), lasting about 6 to 8 hours.

I am currently a student, my weight is normal, and there is a family history of myocardial infarction (my grandmother died from a myocardial infarction; my uncle had bypass surgery, though I am unsure how many grafts; my grandmother had emergency surgery in August due to a myocardial infarction).
Furthermore, there is a history of hypertension in my family (out of 9 elders, 5 have hypertension, including my father and mother).

Based on the symptoms described above, do you think I need to see a cardiothoracic surgeon? I am worried that I might be overreacting.

Oliver, 20~29 year old female. Ask Date: 2018/08/26

Dr. He Dongjin reply Cardiology

Hello, it is possible that your symptoms are due to asthma causing hyperventilation or a higher likelihood of autonomic nervous system dysregulation.
Although there is a family history of heart disease, the probability of heart issues at your age is very low.
If you still feel unwell and are concerned, it is recommended to visit a cardiology outpatient clinic for further evaluation.
Currently, there is no need to see a cardiac surgeon.
Take care, and Changhua Hospital is here for you.

Reply Date: 2018/08/26

More Info

Based on the symptoms and family history you've described, it is advisable to consult a cardiologist for a thorough evaluation. Here’s a breakdown of your situation and why it’s important to seek further medical advice.

Symptoms Overview
1. Chest Discomfort: You mentioned experiencing a tingling sensation in your chest, particularly when climbing stairs or during periods of inactivity. This could be related to anxiety or asthma, but given your family history, it warrants further investigation.

2. Pain and Numbness: The left chest pain that radiates to your left arm, armpit, and jaw, especially during exertion or stress, is concerning. These symptoms can be indicative of angina, which is a sign of reduced blood flow to the heart muscle. The fact that these symptoms occur with exertion and resolve after a few minutes is particularly noteworthy.

3. Increased Heart Rate: You noted that your heart rate can spike to 135 bpm during exertion, which is higher than average. While some increase in heart rate during physical activity is normal, a resting heart rate of 80-85 bpm is on the higher side, especially for a young person.
4. Family History: Your family history of myocardial infarction (heart attack) and hypertension is significant. With your grandmother having died from a heart attack and other relatives having undergone heart surgery, you may be at increased risk for cardiovascular issues.

5. Response to Caffeine: The recent onset of chest discomfort and increased heart rate after consuming coffee suggests that you may be sensitive to caffeine, which can exacerbate anxiety and lead to palpitations.

When to Consult a Cardiologist
Given the combination of your symptoms and family history, it is prudent to consult a cardiologist for the following reasons:
- Risk Assessment: A cardiologist can perform a comprehensive risk assessment, including a detailed history, physical examination, and possibly diagnostic tests such as an electrocardiogram (EKG), echocardiogram, or stress testing to evaluate your heart's function and structure.

- Diagnostic Testing: Tests like a Holter monitor can help assess your heart rhythm over a 24-hour period, while an exercise stress test can evaluate how your heart responds to physical exertion. Given your symptoms of chest pain and shortness of breath, these tests can provide valuable information.

- Management of Symptoms: If your symptoms are related to anxiety or asthma, a cardiologist can work with you to develop a management plan that may include lifestyle modifications, medication adjustments, or referrals to other specialists as needed.

- Preventive Measures: Given your family history, a cardiologist can help you implement preventive measures to reduce your risk of developing heart disease, including lifestyle changes, dietary recommendations, and possibly medications if indicated.

Conclusion
In summary, your symptoms, particularly the left-sided chest pain radiating to the arm and jaw, combined with your family history of heart disease, suggest that a consultation with a cardiologist is warranted. It’s better to err on the side of caution when it comes to heart health, especially with a family history of cardiovascular issues. Early evaluation and intervention can be crucial in managing potential heart conditions effectively.

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