Chest Discomfort: Causes and When to Seek Help

Cool sensation in the chest?

A while ago, I suddenly experienced pain in my chest around the heart area while sleeping (around 4 or 5 AM, about a month ago).
Since then, I occasionally have some chest pain (usually on the left side, sometimes on the right), but it has subsided recently.
Lately, I have had phlegm in my throat (mostly white, with a small amount of light yellow), and sometimes it feels like I can't clear it, leading to discomfort in my throat for several days.
My throat has been dry, so I visited an ENT specialist who diagnosed me with inflammation.
He advised that if I experience severe coughing, I should return for a follow-up, but I only cough occasionally (for several hours at a time).
I have been taking the medication prescribed by the doctor, and recently the phlegm has decreased significantly, and my throat is not as dry.

In recent years, I have visited doctors more frequently; two years ago, I had a gastric ulcer and gastroesophageal reflux (which has been somewhat recurrent, but I feel it is improving lately).
I have a history of nasal allergies and tend to have a runny nose, but that has also suddenly decreased.
The doctor mentioned that I have some anxiety and advised me to relax.
However, these past few days have been quite strange; I don't know when it started, but sometimes I feel a cool sensation in my chest, similar to having eaten a mint candy, which is different from the burning sensation associated with gastroesophageal reflux.
I have scheduled an X-ray for next week, but I would like to know if any additional tests are necessary.
I do not have a fever, cough, or dizziness.

Xiao Hei, 30~39 year old female. Ask Date: 2020/03/14

Dr. Chen Junwei reply Pulmonology

I recommend that you discuss the above situation further with your attending physician to determine if any additional tests are necessary.
Thank you, and wishing you good health!

Reply Date: 2020/03/14

More Info

Understanding chest discomfort can be complex, as it may stem from various causes, ranging from benign to serious conditions. Based on your description, it seems you have experienced a range of symptoms, including chest pain, throat discomfort, and a history of gastrointestinal issues. Here, I will outline potential causes of your symptoms, when to seek help, and what further evaluations might be necessary.

Potential Causes of Chest Discomfort
1. Musculoskeletal Issues: Chest pain can often be due to muscle strain or inflammation of the cartilage connecting the ribs to the breastbone (costochondritis). This type of pain is usually localized and can be reproduced by pressing on the affected area.

2. Gastroesophageal Reflux Disease (GERD): Given your history of acid reflux and a gastric ulcer, it’s possible that your chest discomfort is related to GERD. This condition can cause pain that mimics heart-related issues, often described as a burning sensation in the chest, but can also present as sharp pain.

3. Anxiety and Stress: Anxiety can manifest physically, leading to sensations of tightness or discomfort in the chest. Your mention of feeling anxious and the doctor’s advice to relax could indicate that stress is contributing to your symptoms.

4. Cardiac Issues: While your symptoms may not strongly suggest a cardiac event, any new or unusual chest pain, especially if it occurs at rest or is associated with other symptoms (like shortness of breath, sweating, or nausea), should be evaluated promptly to rule out conditions like angina or myocardial infarction.

5. Respiratory Conditions: Your throat discomfort and phlegm production could indicate a respiratory infection or inflammation. Conditions like bronchitis or pneumonia can cause chest discomfort, especially if there’s associated coughing or difficulty breathing.

When to Seek Help
You should seek immediate medical attention if you experience any of the following:
- Severe Chest Pain: If the pain is intense, sudden, or feels like pressure or squeezing, especially if it radiates to the arms, neck, jaw, or back.

- Shortness of Breath: If you have difficulty breathing or feel like you cannot catch your breath.

- Other Symptoms: If you experience symptoms like dizziness, fainting, sweating, or nausea alongside chest pain.

- Persistent Symptoms: If your chest discomfort persists or worsens, or if you develop new symptoms.

Recommended Evaluations
Since you have already scheduled an X-ray, that is a good first step. Depending on the findings, your doctor may recommend additional tests, such as:
- Electrocardiogram (ECG): To assess your heart's electrical activity and rule out any cardiac issues.

- Echocardiogram: An ultrasound of the heart to evaluate its structure and function.

- Stress Test: To see how your heart performs under physical stress.

- Upper Endoscopy: If gastrointestinal issues are suspected to be the cause of your symptoms, this can help visualize the esophagus and stomach.

Conclusion
Given your symptoms and medical history, it is essential to remain vigilant and proactive about your health. While many causes of chest discomfort are benign, it is crucial to rule out serious conditions, especially given your previous gastrointestinal issues. Continue to monitor your symptoms, follow up with your healthcare provider as recommended, and do not hesitate to seek immediate care if your condition changes or worsens. Remember, your health is paramount, and understanding your body’s signals is key to maintaining it.

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