Chest Tightness and Palpitations: Is It Anxiety or Heart Disease?

Chest tightness autonomic nervous system disorder?

Hello, Director.
Recently, I have been experiencing persistent chest tightness and palpitations for the past month, especially while sitting at my office desk.
At times, it becomes so severe that I struggle to breathe and need to go to the hospital immediately.
My blood tests showed cholesterol at 273 mg/dL, LDL at 165 mg/dL, and triglycerides at 309 mg/dL, all marked in red.
The electrocardiogram (ECG) showed no abnormalities, but the ultrasound indicated mild mitral valve prolapse.
The doctor prescribed me Xanax and Inderal, stating that my symptoms are due to excessive stress.
I initially thought everything was fine, but after starting to jog 2 km on the evening of January 13, I felt some improvement in my chest tightness the next day.
However, starting January 15, while at work, I experienced persistent chest tightness and palpitations again.
I thought exercising would help, so I jogged 2.5 km on January 17.
During the run, I felt fine, but after stopping, I began to feel discomfort in my heart.
Walking home, the chest tightness and palpitations worsened, and climbing four flights of stairs left me gasping for breath.
After resting for 10 minutes, the discomfort in my heart and chest tightness intensified, making me feel like I was about to collapse, so I went to the emergency room.
The ECG was normal, and blood tests for myocardial infarction were also normal.
A week later, the symptoms persisted.
Notably, after drinking a cup of cold brew coffee on the weekend, I experienced palpitations (which I hadn’t had before with coffee), along with sweating and cold hands and feet, which was very uncomfortable.
Before the Lunar New Year, to determine the cause of my symptoms, I paid for advanced tests at a hospital health check center: a 640-slice CTA with contrast agent showed only minor plaque in the left anterior descending artery.
The doctor said there was slight obstruction but not serious, and I need to manage it well.
At this point, I felt my heart was likely fine, and perhaps other conditions were affecting my palpitations and chest tightness.
I have read online that it could be due to autonomic nervous system dysfunction.
However, what troubles me is that whenever I walk or shop for 1.5 to 2 km, I start to experience chest tightness, palpitations, and difficulty breathing, which only improves after resting for an hour (it feels like angina symptoms).
Is this indicative of a heart condition? Can I still rely on exercise to alleviate my discomfort? I would appreciate your advice on what kind of unusual illness I might have.
I plan to undergo a stress ECG soon, but if the cause remains undetermined, I will feel quite helpless...
This has severely impacted my work and daily life.

Summary:
Condition: Patient with a history of hyperuricemia, whose uric acid levels were reduced from 10 to 5 after treatment last year.
Cholesterol levels were 287 mg/dL and LDL at 199 mg/dL in 2015, both marked in red.

Examinations: ECG, blood tests, and CTA were normal.

Symptoms: Chest tightness, palpitations, loss of appetite, and difficulty breathing during exercise (walking).
Medications: Recently, I have been taking the new uric acid-lowering medication Febuxostat daily for the past six months.
Taking Xanax helps alleviate chest tightness and palpitations, but I still do not feel the comfort of normal bodily conditions.

Niu, 30~39 year old female. Ask Date: 2019/02/08

Dr. He Dongjin reply Cardiology

Hello, this is a typical symptom of autonomic nervous system disorder.
The CTA is normal, so there is no need to perform an exercise ECG.
Taking Xanax will help alleviate chest tightness and palpitations.
It is advisable to take Xanax and Inderal before work, and you may consider increasing the dosage.
It is recommended to seek further evaluation and treatment from a psychosomatic specialist.
Changhua Hospital cares about you.

Reply Date: 2019/02/08

More Info

Understanding the distinction between anxiety and potential heart disease can be quite challenging, especially when symptoms such as chest tightness and palpitations are involved. Based on your description, it appears that you have been experiencing persistent symptoms of chest tightness and palpitations, particularly during stressful situations or after physical exertion. Your medical history, including elevated cholesterol levels and a slight mitral valve prolapse, adds complexity to your situation.

Distinguishing Between Anxiety and Heart Disease
1. Symptoms:
- Anxiety: Symptoms of anxiety can include chest tightness, palpitations, shortness of breath, and feelings of impending doom. These symptoms often occur during periods of stress or panic and can be exacerbated by caffeine or stimulants.

- Heart Disease: Symptoms related to heart disease may include chest pain (which can feel like pressure or squeezing), shortness of breath during exertion, and fatigue. These symptoms may not necessarily correlate with anxiety and can occur even at rest.

2. Diagnostic Tests:
- Your heart tests, including an electrocardiogram (ECG) and echocardiogram, have shown normal results, which is reassuring. However, the presence of mild plaque in the left anterior descending artery suggests that there is some degree of coronary artery disease, albeit not severe.
- The fact that your symptoms improve with rest and worsen with exertion could indicate that your heart is responding to physical stress, which is a common characteristic of angina (chest pain due to reduced blood flow to the heart).

3. Role of Anxiety:
- Anxiety can indeed manifest with physical symptoms that mimic heart disease. The fight-or-flight response can lead to increased heart rate and blood pressure, causing palpitations and chest discomfort. Your use of medications like Xanax (an anxiolytic) and Inderal (a beta-blocker) suggests that your healthcare provider is considering anxiety as a contributing factor to your symptoms.

Recommendations for Management
1. Lifestyle Modifications:
- Since you have elevated cholesterol levels, it is crucial to adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins while reducing saturated fats and sugars. Regular exercise is also essential, but it should be approached cautiously. Gradually increasing your activity level while monitoring your symptoms can help you find a balance.

2. Stress Management:
- Incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive behavioral therapy (CBT) can be beneficial. These methods can help manage anxiety and potentially reduce the frequency and intensity of your symptoms.

3. Follow-Up Testing:
- You mentioned planning to undergo a stress test. This is an excellent step, as it can provide further insight into how your heart responds to physical exertion. If the stress test is normal, it may help alleviate concerns about heart disease and allow you to focus on managing anxiety.

4. Medication Review:
- Continue to work closely with your healthcare provider regarding your medications. If Xanax helps alleviate your symptoms, it may be worth discussing a longer-term management plan for anxiety. Additionally, if you are experiencing side effects or if your symptoms persist, your doctor may consider adjusting your treatment regimen.

5. Monitoring Symptoms:
- Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

Conclusion
In summary, while your symptoms could stem from anxiety, the presence of mild coronary artery disease necessitates careful monitoring and management. It is essential to maintain open communication with your healthcare provider, adhere to lifestyle changes, and follow through with recommended tests. By addressing both your physical and mental health, you can work towards improving your overall well-being. If your symptoms persist or worsen, do not hesitate to seek further medical evaluation.

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