Managing Fast Heart Rate and Chest Pain: Key Questions for Your Cardiologist

Continuing from 151996?

Dear Dr.
He,
Thank you for your previous response.
I have a few more questions to ask you.
During my follow-up appointment with the cardiologist on February 6, I was informed that my heart rate is still elevated (measured at 95 bpm the first time and 85 bpm the second time).
The chest pain may be related to this.
My medication dosage for Concor was adjusted from 5 mg to half a tablet every other day to one tablet daily (prior to the adjustment, my blood pressure was mostly around 110/60).
I was also prescribed Concor 8 mg, half a tablet daily for blood pressure, but I have been measuring my blood pressure at home (usually in the morning and evening, sometimes in the afternoon) and it has mostly been in the 90s/50s.
I often experience headaches and dizziness, so I have stopped taking Concor on my own.
My blood pressure remains similar (sometimes it goes back to just over 100/60).
I would like to ask if I need to adjust my medication.
Additionally, I frequently experience pain in my left chest (sometimes a feeling of pressure), and recently my left shoulder has also been sore.
I have discomfort near the left scapula for the past month or two, and it feels slightly protruded when I touch it.
Could this be referred pain from the heart? (In late November, I had a CTA done, which reported very mild stenosis in the proximal left coronary artery and the proximal left circumflex artery; echocardiography showed mild regurgitation in the mitral, tricuspid, and pulmonary valves; and a 24-hour Holter monitor was normal).
I have followed your advice and have been walking for half an hour to an hour daily when it hasn't rained and I am not in pain.
My weight has decreased from 86 kg last month to 83 kg this month.
I am 179 cm tall and 36 years old.
Do I need to undergo any further examinations?
Thank you for your patience in reading this.

Alon, 30~39 year old female. Ask Date: 2020/02/15

Dr. He Dongjin reply Cardiology

Hello, a blood pressure of 95/85 is slightly elevated, and medication adjustment may not be necessary.
A reading of 90/50 is too low and could cause discomfort.
Since you have had a cardiac ultrasound and a CTA with no issues, the likelihood of heart problems is extremely low.
It is advisable to reduce medication and monitor your condition with exercise.
Changhua Hospital cares about your well-being.

Reply Date: 2020/02/15

More Info

Managing fast heart rate and chest pain can be quite concerning, and it's important to address these symptoms with your cardiologist. Based on your description, it seems you are experiencing a combination of tachycardia (fast heart rate), chest pain, and low blood pressure, which can be indicative of several underlying issues.

Firstly, regarding your heart rate, a resting heart rate of 95 to 85 beats per minute can be considered elevated, especially if you are experiencing symptoms like chest pain and dizziness. It’s crucial to monitor your heart rate regularly and report any significant changes to your healthcare provider. The adjustment of your medication, specifically the increase in the dosage of your blood pressure medication (康肯), is an important step in managing your symptoms. However, if you are consistently experiencing low blood pressure readings (90s/50s), this could be a reason for your dizziness and headaches. It’s advisable to discuss these symptoms with your cardiologist, as they may need to adjust your medication further or explore alternative treatments.

The chest pain you are experiencing, particularly on the left side, along with the discomfort in your left shoulder, could be related to several factors. While it is essential to rule out any cardiac issues, such as angina or myocardial ischemia, it is also possible that these symptoms could be musculoskeletal in nature, especially if you have been experiencing them for a prolonged period. Given that you had a CTA (Computed Tomography Angiography) that showed only mild narrowing of the coronary arteries and a normal echocardiogram, it seems less likely that your symptoms are directly related to significant coronary artery disease. However, the presence of mild regurgitation in your heart valves could also contribute to some discomfort.

Your proactive approach to exercise is commendable, as regular physical activity can help improve cardiovascular health and manage weight. Losing weight from 86 kg to 83 kg is a positive change, and continuing to engage in physical activity, such as walking, can further benefit your overall health. However, if you notice that your symptoms worsen during or after exercise, it would be prudent to discuss this with your cardiologist.

In terms of further evaluations, if your symptoms persist or worsen, additional tests may be warranted. These could include a stress test to assess how your heart responds to exertion, or possibly a Holter monitor to evaluate your heart rhythm over an extended period. Given your history of symptoms and the adjustments in your medication, it may also be beneficial to have a thorough review of your medication regimen to ensure it is optimized for your current health status.

Lastly, it’s important to maintain open communication with your healthcare team. If you experience any new symptoms, such as increased chest pain, shortness of breath, or significant changes in your heart rate, seek medical attention promptly. Your health and well-being are paramount, and ensuring you have the right support and treatment plan is essential in managing your condition effectively.

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