Chest Tightness, Dizziness, and Rapid Heartbeat: Seeking Further Diagnosis

Chest tightness, dizziness, and rapid heartbeat?

For the past six months, I have frequently experienced chest tightness, dizziness, and a rapid heartbeat.
I have undergone a comprehensive health check-up at my own expense, and everything came back normal.
Additionally, I have had EEG and autonomic nervous system tests, both of which were normal.
However, recently, in addition to the aforementioned symptoms, I have also felt a sensation of something stuck in my throat and have been burping often.
I am unsure which specialist I should consult or what further tests I should undergo.
I would appreciate your professional advice.
Thank you.

Tsai, 30~39 year old female. Ask Date: 2018/11/07

Dr. Jiang Junyi reply Neurology

Hello, based on your description, if you are overweight or experiencing severe snoring, you may want to consider sleep apnea.
This condition is commonly caused by the obstruction of the airway due to soft tissue in the throat, which narrows the upper airway and leads to snoring and breathing cessation.
Abnormalities in the upper airway structure, excessive relaxation of the airway muscles, and obesity are also common triggers.
When blood oxygen levels drop to a certain extent, it can cause interruptions in sleep, leading to vivid dream recall.
I recommend that you consult a sleep medicine specialist to discuss evaluation (including polysomnography) and treatment options.
Wishing you good health and happiness.
Dr.
Tao, concerned about your well-being.

Reply Date: 2018/11/07

More Info

Chest tightness, dizziness, and rapid heartbeat can be concerning symptoms that warrant further investigation, especially considering your history of these issues over the past six months. While you have undergone comprehensive health checks, including EEG and autonomic nervous system evaluations, the persistence of your symptoms suggests that additional diagnostic approaches may be necessary.

Given your symptoms, it is essential to consider both cardiac and non-cardiac causes. The fact that you have experienced chest tightness and rapid heartbeat could indicate potential cardiac issues, such as ischemic heart disease, arrhythmias, or even anxiety-related conditions. However, the normal results from your previous tests provide some reassurance that significant cardiac pathology may not be present.

Recommended Next Steps:
1. Cardiology Consultation: Since you have experienced chest tightness and rapid heartbeat, a follow-up with a cardiologist is advisable. They may recommend further tests such as:
- Holter Monitor: A 24-hour Holter monitor can provide insights into your heart rhythm over an extended period, helping to identify any arrhythmias that may not have been captured during a standard ECG.

- Stress Testing: A treadmill or pharmacological stress test can evaluate how your heart responds to exertion, which can help identify any ischemic changes that might not be evident at rest.

- Echocardiogram: This ultrasound test can assess the structure and function of your heart, looking for any abnormalities in wall motion or valve function.

2. Gastroenterology Evaluation: The sensation of a "lump" in your throat and frequent burping could suggest gastroesophageal reflux disease (GERD) or other gastrointestinal issues. A consultation with a gastroenterologist may be beneficial. They might recommend:
- Upper Endoscopy: This procedure allows direct visualization of the esophagus and stomach, helping to identify any abnormalities such as inflammation or reflux.

- Esophageal pH Monitoring: This test can measure acid exposure in the esophagus, confirming or ruling out GERD.

3. Psychiatric Evaluation: If anxiety or panic attacks are suspected, especially given the physical symptoms you describe, a referral to a mental health professional could be helpful. They can assess for anxiety disorders, which can manifest with physical symptoms such as chest tightness and rapid heartbeat.

4. Lifestyle Modifications: In the interim, consider lifestyle changes that may alleviate some symptoms:
- Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage anxiety.

- Dietary Adjustments: If GERD is a concern, avoiding spicy or acidic foods, eating smaller meals, and not lying down immediately after eating may help.

- Regular Exercise: Engaging in regular physical activity can improve cardiovascular health and reduce anxiety.

5. Follow-Up Testing: If your symptoms persist despite these evaluations, further testing may be warranted, including advanced imaging studies or even a cardiac catheterization if indicated by your cardiologist.

Conclusion:
Your symptoms of chest tightness, dizziness, and rapid heartbeat should not be ignored, and it is crucial to pursue a comprehensive evaluation. A multidisciplinary approach involving cardiology, gastroenterology, and mental health can provide a clearer picture of your health status and guide appropriate treatment. It is essential to communicate openly with your healthcare providers about your symptoms and concerns to ensure that you receive the most effective care.

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