Persistent Chest Discomfort: Exploring Causes Beyond High Cholesterol

Q: Persistent Chest Discomfort: Exploring Causes Beyond High Cholesterol

Dear Mr. <br>BD： <br>1. <br>Common differential diagnoses for chest tightness or chest pain include coronary artery disease, hypertension, hyperlipidemia, pulmonary embolism, aortic aneurysm, gastroesophageal reflux disease, gastritis, gastric ulcers, duodenal ulcers, gallstones,

Persistent chest tightness lasting for six months?

Hello Dr.
Hsiao: For the past six months, I have been experiencing a sensation in the center of my breasts, about the size of a fist.
Initially, it felt like a pulsing, but now it is almost a constant dullness without pain, although I occasionally feel a burning sensation.
I previously had a chest X-ray that ruled out lung issues.
Subsequently, I underwent treatment in the cardiology department, where blood tests revealed elevated levels of total cholesterol (CHOL (T) - 269) and LDL cholesterol (LDL-C - 199.6), along with arrhythmia.
The doctor suggested that the chest discomfort might be caused by hyperlipidemia and prescribed Entresto and Rosuvastatin for two months.
However, after one month of medication, the chest discomfort has not improved.
Could there be other causes for my symptoms, or which specialty should I seek assistance from next?

BD, 50~59 year old female. Ask Date: 2019/05/18

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
BD:
1.
Common differential diagnoses for chest tightness or chest pain include coronary artery disease, hypertension, hyperlipidemia, pulmonary embolism, aortic aneurysm, gastroesophageal reflux disease, gastritis, gastric ulcers, duodenal ulcers, gallstones, cholangitis, and pancreatitis, among others.

2.
Your total cholesterol and low-density lipoprotein (LDL) levels are elevated.
Please avoid excessive intake of cholesterol and trans fats, such as margarine, creamers, and animal fats.
Additionally, it is advisable to chew your food thoroughly and eat until you are about 80% full.
After meals, engage in moderate walking and avoid sitting down to work or watching television immediately.
Coffee and tea should be consumed in moderation and not used as a substitute for water to prevent palpitations or acid reflux.

3.
Generally, cardiologists will consider the aforementioned conditions, as well as rarer diseases.
Therefore, it is recommended that you discuss this with your attending physician before making any decisions.

Reply Date: 2019/05/18

More Info

Persistent chest discomfort can be a concerning symptom, especially when accompanied by elevated cholesterol levels and arrhythmias. While high cholesterol is a known risk factor for cardiovascular disease, it is essential to consider other potential causes of your symptoms, especially since you have not experienced improvement after one month of medication.

Possible Causes of Persistent Chest Discomfort
1. Musculoskeletal Issues: Chest discomfort can often arise from musculoskeletal problems, such as costochondritis or muscle strain. These conditions can cause localized pain or discomfort that may feel like pressure or heaviness in the chest.

2. Gastroesophageal Reflux Disease (GERD): GERD can lead to a sensation of chest discomfort, often described as burning or pressure. This occurs when stomach acid flows back into the esophagus, irritating its lining.

3. Anxiety and Stress: Psychological factors can manifest as physical symptoms, including chest discomfort. Anxiety can lead to muscle tension and hyperventilation, which may contribute to feelings of tightness or discomfort in the chest.

4. Cardiac Issues: While you have already been evaluated for heart-related problems, it is crucial to ensure that all potential cardiac causes have been thoroughly investigated. This includes considering conditions such as angina, which can present as chest discomfort due to reduced blood flow to the heart muscle.

5. Pulmonary Issues: Although you mentioned that a chest X-ray ruled out lung problems, conditions such as pleuritis or pulmonary embolism should also be considered, especially if there are risk factors present.

Recommendations for Further Evaluation
Given that your symptoms have persisted despite treatment for high cholesterol, it may be beneficial to seek further evaluation from the following specialists:
- Cardiologist: If you haven't already, a cardiologist can perform additional tests, such as an echocardiogram or stress test, to assess heart function and rule out any underlying cardiac conditions that may not have been detected initially.

- Gastroenterologist: If GERD or other gastrointestinal issues are suspected, a gastroenterologist can perform evaluations such as an upper endoscopy or pH monitoring to assess for acid reflux or other digestive disorders.

- Pulmonologist: If there are any lingering concerns about lung-related issues, a pulmonologist can conduct further tests, such as a CT scan of the chest or pulmonary function tests.

- Psychiatrist or Psychologist: If anxiety or stress is suspected to be a contributing factor, consulting with a mental health professional can provide strategies for managing these symptoms.

Conclusion
Persistent chest discomfort can arise from various causes, and while high cholesterol is a significant risk factor for cardiovascular disease, it is essential to explore other potential underlying issues. Given that your symptoms have not improved with medication, seeking further evaluation from specialists in cardiology, gastroenterology, pulmonology, or mental health may provide additional insights and lead to a more effective treatment plan. Always communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will help guide your diagnostic and treatment journey.

Similar Q&A

Understanding Chest Pain: Causes and Connections to Underlying Conditions

Doctor, could you please explain the causes of chest pain? The pain often occurs after fatigue from work and is felt on both sides of the chest. The patient has a history of elevated uric acid, hepatitis, and has accumulated a significant amount of dust in the lungs. Could these ...

Dr. Chen Jili reply Cardiology
There are many causes of chest pain, ranging from gastroesophageal reflux, neuropathic pain, musculoskeletal pain to cardiac pain. Angina is often related to physical activity, and clinicians typically need to consider risk factors such as smoking and high cholesterol levels. An ...

Understanding Occasional Palpitations and Sleep Disruption: A Cardiac Perspective

Hello Dr. Huang, In the first half of this year, my company's health check revealed a normal chest X-ray. The physical examination indicated "rapid heart rate with heart murmurs" during cardiac auscultation. My total cholesterol was 226, high-density lipoprotein ...

Dr. Huang Yinghe reply Cardiology
Hello Wayne: Generally, if there are no significant abnormalities in the electrocardiogram (ECG), exercise stress test, or echocardiogram, there is no need for regular follow-ups. Given your current age, a follow-up every two to three years should be sufficient unless new symptom...

Understanding Persistent Left Chest Pain: Insights and Next Steps

Hello, Doctor. I have some questions I would like to ask. I have undergone several tests, and here are my basic details: height 177 cm, weight 83 kg, BMI 26.4. My blood pressure, blood lipids (triglycerides, cholesterol, etc.), echocardiogram, X-ray, and electrocardiogram are all...

Dr. He Dongjin reply Cardiology
Hello, if you have been experiencing left chest discomfort for seven years without any serious issues, it should be okay, right? A CT scan is expensive, and the accuracy of a 24-hour Holter monitor and exercise stress test is not 100%. The symptoms are also atypical angina, so it...

Help! Unraveling the Mystery of Persistent Chest Pain Symptoms

These symptoms of chest pain, chest tightness, tinnitus, dizziness, and gradually decreasing physical strength have persisted for several months. Could the hand sweating surgery I had several years ago be the cause? Additionally, I had acute gastroenteritis a few months ago, afte...

Dr. Yang Wenda reply Pulmonology
Hello Penny: If your chest X-ray is normal, it essentially rules out lung and heart diseases. However, I understand that chest pain is still troubling you. Based on my assessment, it is more likely that your chest pain is neuropathic in nature. Stress, disorganization, insufficie...