Heart Palpitations and Chest Pain: Key Concerns

Increased heart rate and mild pain in the left chest?

Hello, Doctor He! In September 2019, I underwent an examination at a general cardiology clinic, where I was found to have mild hypertension (142/90 mm Hg) and mild diabetes (hemoglobin A1c 7.1).
The doctor prescribed BISO 5 mg, to be taken half a tablet in the morning and half in the evening.
During the examination, an electrocardiogram and echocardiogram were performed, and the doctor stated that there were no issues with myocardial infarction, only mentioning that there was slight hypertrophy of the heart, possibly due to hypertension.
I have been on medication for about a month, but I have recently experienced some unusual symptoms:
1.
Sometimes during breakfast, my heart rate accelerates to around 100 bpm, and on one occasion, my blood pressure reached 150, which decreased quickly after taking medication.

2.
Occasionally, I feel mild pain in the left side of my chest (near the inner side of the breast), along with slight numbness in my left hand.
At times, this leads to weakness and slight tremors in my palm.
(On November 5, I experienced radiating pain in my left shoulder and the inner side of my upper arm, which was more severe in the morning and improved by noon.)
3.
When I perform quick movements or run, I feel a significant load on my heart, and even walking a short distance causes mild shortness of breath.
My movements are slow and weak, and I am unable to perform larger actions.
I would like to ask the doctor if I should be concerned about the risk of coronary artery obstruction or myocardial ischemia.
Thank you for your guidance!

Mr. Zheng, 50~59 year old female. Ask Date: 2019/11/05

Dr. He Dongjin reply Cardiology

Hello, based on your description, it is not possible to determine whether there is coronary artery obstruction or myocardial ischemia.
It is recommended that your physician arrange for a stress electrocardiogram or a self-paid computed tomography scan to better understand the situation.
These symptoms are atypical.
Changhua Hospital cares about your well-being.

Reply Date: 2019/11/05

More Info

Understanding heart palpitations and chest pain is crucial, especially for individuals with a history of hypertension and diabetes, as these conditions can significantly increase the risk of cardiovascular diseases, including coronary artery disease (CAD). Based on your symptoms and medical history, it is essential to consider several factors that may contribute to your current health status.

Firstly, your previous diagnosis of mild hypertension (142/90 mm Hg) and slightly elevated hemoglobin A1c (7.1) indicates that you are at risk for cardiovascular complications. Hypertension can lead to left ventricular hypertrophy (LVH), which you mentioned was noted in your echocardiogram. LVH is a common response of the heart to increased workload and can be a precursor to more serious conditions, including heart failure and arrhythmias.

Your symptoms of palpitations, particularly the episodes where your heart rate spikes to around 100 beats per minute, could be attributed to several factors. Stress, anxiety, and physical exertion can all lead to increased heart rates. However, it is also important to rule out any underlying arrhythmias or structural heart issues, especially given your history of hypertension and diabetes. The fact that you experience chest pain, particularly on the left side, along with left arm numbness and weakness, raises concerns for potential ischemic heart disease. These symptoms could indicate that your heart is not receiving adequate blood flow, possibly due to coronary artery blockage.

The sensation of chest pain, especially if it is accompanied by radiation to the arm or shoulder, should not be taken lightly. It is essential to differentiate between musculoskeletal pain and cardiac-related pain. Given your history and the nature of your symptoms, it would be prudent to undergo further evaluation. This could include a stress test, which can help assess how your heart performs under exertion, and possibly a coronary angiogram if significant blockages are suspected.

Additionally, the episodes of shortness of breath and fatigue during physical activity suggest that your heart may be struggling to meet the demands placed on it. This could be due to a combination of factors, including the effects of hypertension, potential ischemia, and possibly even anxiety or panic attacks, which can mimic cardiac symptoms.

In summary, while your previous evaluations indicated no acute myocardial infarction, the combination of your symptoms, medical history, and risk factors necessitates a thorough re-evaluation. It is crucial to consult with your cardiologist to discuss your symptoms in detail and consider further diagnostic testing. This may include:
1. Electrocardiogram (EKG): To check for any arrhythmias or signs of ischemia.

2. Echocardiogram: To assess heart function and structure, particularly looking for any changes in wall motion or further hypertrophy.

3. Stress Testing: To evaluate how your heart responds to physical stress and to identify any potential ischemic changes.

4. Coronary Angiography: If indicated, to visualize any blockages in the coronary arteries.

Managing your hypertension and diabetes effectively is also critical in reducing your overall cardiovascular risk. Lifestyle modifications, including a heart-healthy diet, regular exercise, and stress management, alongside your prescribed medications, will be essential in improving your heart health.

Please make sure to communicate openly with your healthcare provider about all your symptoms and concerns. Early detection and management of any potential heart issues can significantly improve outcomes and quality of life.

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