Left Chest Pain: Heart Issues or Anxiety?

Left chest pain?

Hello Doctor, I am 179 cm tall, weigh 86 kg, and am 35 years old.
I haven't exercised for a while.
In mid-November, I experienced chest tightness and went to see a doctor.
After performing an exercise electrocardiogram, the doctor noted abnormalities indicating vascular obstruction, and my low-density lipoprotein cholesterol was 131, which is also elevated.
The doctor prescribed 100 mg of aspirin, 5 mg of Clopidogrel, 2 mg of Atorvastatin, and 10 mg of Bisoprolol (Cardicor) for me.
Later, I went to another hospital for a CTA, which revealed very mild proximal obstruction in the middle and right vessels, and there was a myocardial bridge located slightly below the middle, but the report stated that everything was normal and not concerning.
I still experience chest tightness, and after undergoing a cardiac ultrasound, the doctor said it was fine, with only mild regurgitation in the tricuspid, mitral, and pulmonary valves.
A 24-hour Holter monitor showed normal results with no arrhythmias; however, my heart rate is generally on the higher side, often around 100-110 bpm in the morning when I go to work.
Recently, I've been experiencing brief, sharp pains in my left chest with a somewhat high frequency, which affects my daily life, often near the left rib area (sometimes in other places as well).
Recently, a different doctor (not the one who performed the exercise electrocardiogram) prescribed 5 mg of Bisoprolol, half a tablet daily, to help lower my heart rate.
I started taking high blood pressure medication in November, specifically 8 mg of Amlodipine, half a tablet daily, and I will continue this for a month.
Additionally, over the past month, I have noticed that my exhalation has become louder and shorter when breathing, and sometimes I feel a bit short of breath.
I also have a deviated septum.

Doctor, I would like to ask you a few questions: Is the sharp pain in my chest related to my heart condition, or could it be caused by my fast heart rate? If it is not heart-related, which specialist should I see? Currently, I am only taking Bisoprolol and Amlodipine (both in the morning).
Are there any side effects from taking these two medications together? Regarding my breathing and chest pain, I have had my thyroid checked and it is normal, and an X-ray showed no pneumothorax.
I feel quite anxious due to my discomfort, and it seems that I was not as uncomfortable before I started taking the medications.
Doctor, could this be a case of autonomic nervous system dysfunction? Also, I have not had a good appetite lately; could this be due to anxiety? Thank you, Doctor.

Alon, 30~39 year old female. Ask Date: 2020/01/10

Dr. He Dongjin reply Cardiology

Hello, anxiety has triggered autonomic nervous system dysregulation, leading to poor appetite and sensations of breathlessness and sharp pain, which are generally not related to the heart.
It is possible that this is due to neuropathic pain from the autonomic nervous system, as the sharp pain in the chest varies in location and does not resemble typical cardiac issues.
It also does not seem to be caused by tachycardia.
You might consider consulting a pulmonologist to check for any issues related to sleep apnea.
Taking both Kang Ken and Kang Nier medications together is not harmful.
You are too anxious; try to engage in some exercise and relaxation activities.
Changhua Hospital cares about your well-being.

Reply Date: 2020/01/10

More Info

It sounds like you are experiencing a complex set of symptoms that could be related to both cardiac issues and anxiety. Given your medical history, including previous heart concerns and recent evaluations, it’s understandable that you would be anxious about your symptoms. Let's break down your situation.

Chest Pain and Cardiac Concerns
You mentioned that you have experienced left chest pain, particularly sharp pain near the rib area, and that this pain has been frequent enough to affect your daily life. Your previous evaluations, including an exercise ECG and CTA, indicated some mild vascular blockage but also noted that your heart's structure appears normal with only mild regurgitation in the tricuspid and mitral valves. The fact that your 24-hour ECG was normal and that you do not have arrhythmias is reassuring.

Chest pain can arise from various causes, including musculoskeletal issues, gastrointestinal problems, and anxiety. Given that your pain is sharp and localized, it could be related to musculoskeletal strain or even costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum. This is particularly common in individuals who may not have been active for a while, as you mentioned.

Anxiety and Its Impact
Your anxiety about your health is palpable, and it can indeed exacerbate physical symptoms. Anxiety can lead to hyperventilation, which may cause a feeling of breathlessness and can also lead to chest discomfort. The fact that your pain seems to increase with tension suggests that anxiety could be a significant factor.
Additionally, you mentioned that your heart rate tends to be elevated, especially in the mornings. This could be due to anxiety or stress, which can cause the body to enter a heightened state of arousal, leading to increased heart rate and blood pressure.

Recommendations
1. Follow-Up with a Cardiologist: Since you have a history of heart issues, it’s essential to maintain regular follow-ups with a cardiologist. They can provide ongoing assessment and management of your heart health, especially considering your elevated LDL cholesterol and blood pressure.

2. Consider a Mental Health Evaluation: Given your symptoms of anxiety, including the impact on your appetite and overall well-being, it may be beneficial to consult with a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective for managing anxiety and its physical manifestations.

3. Lifestyle Modifications: Incorporating regular physical activity, even light exercise such as walking, can help manage both anxiety and cardiovascular health. Additionally, practicing relaxation techniques such as deep breathing, meditation, or yoga can help reduce anxiety levels.

4. Medication Review: You are currently taking medications for hypertension and heart rate control. It’s important to discuss with your doctor any potential interactions or side effects of these medications, especially if you are experiencing new symptoms.
5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their intensity, and any associated factors (like stress or activity levels). This can provide valuable information for your healthcare providers.

6. Breathing Exercises: Since you mentioned changes in your breathing, practicing diaphragmatic breathing can help manage breathlessness and anxiety.

Conclusion
In summary, while your symptoms may have a cardiac component, they are likely influenced significantly by anxiety and stress. It’s crucial to address both aspects of your health—physical and mental. Regular follow-ups with your healthcare providers, combined with lifestyle changes and possibly mental health support, can help you manage your symptoms effectively. Always consult your healthcare provider before making any changes to your medication or treatment plan.

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