How to Differentiate Between Anxiety and Cardiovascular Issues in Chest Pain? - Cardiology

How can one distinguish whether chest tightness is due to emotional issues or cardiovascular problems?

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About a month ago, I started noticing a sensation of chest tightness.
Here is a record of my medical visits: The next day, I went to a cardiology clinic for an electrocardiogram (ECG).
The doctor noted that my pulse was a bit fast but indicated there was no major issue (medication was prescribed, but I was told it was okay not to take it unless I felt really uncomfortable).
Two days later, I visited a large hospital's pulmonology department for an X-ray and pulmonary function tests (which involved breathing exercises), and again, no issues were found (no medication was prescribed).
Three days later, I went to a gastroenterology clinic for an abdominal ultrasound, which revealed gastrointestinal bloating and signs of inflammation, and medication was prescribed for treatment.
Five days later, I visited the gastroenterology department at a large hospital; after the consultation, the doctor believed I had mild acute gastritis and irritable bowel syndrome, advising me not to worry and just to take the medication (however, I was still taking the medication prescribed by the previous clinic and did not combine medications).
Six days later, I returned to the gastroenterology clinic for a follow-up, where I underwent an endoscopy and biopsy.
It confirmed inflammation in the stomach but no bleeding, and I was prescribed a proton pump inhibitor and other medications for gastritis.
One week and six days later, I had a follow-up at the gastroenterology clinic.
Two weeks and six days later, I returned to the gastroenterology clinic, at which point the previous biopsy report indicated no Helicobacter pylori infection, a small area of inflammation, and slight traces of a gastric ulcer.
Three weeks and a few days later, due to persistent chest tightness, I visited the cardiology department at a large hospital again.
After an ECG, the doctor listened to my pulse and concluded there was no major issue, advising me to go home (no medication was prescribed).
Three weeks and six days later, I returned to the gastroenterology clinic.
Additionally, I have been attending counseling sessions at my school, but so far, the chest tightness has not significantly improved.
-------------------------Lifestyle Habits--------------------------
I have been vegetarian since birth, currently weighing 65 kg and standing 174 cm tall, and I generally do not eat eggs.
My exercise habits are irregular, but my physical condition is acceptable; during this period, I have jogged 1.5 kilometers on a treadmill without feeling dizzy or faint.
My sleep schedule has been irregular, often going to bed around 2 to 3 AM.
After the chest tightness began, I experienced a few nights of sleeplessness due to excessive worry, but I have since adjusted to napping during the day.
Currently, I follow my doctor's advice and generally go to bed before midnight.
I have a history of gastrointestinal issues, often experiencing diarrhea, especially when I am anxious about exams (my father and grandfather have similar issues).
There is a family history of depression and panic disorders, but I do not feel suicidal; rather, I am more likely to panic about my health.
Recently, I have not encountered any major life changes.
There is a family history of gastric perforation, which has since healed.
-------------------------Chest Tightness and Other Issues--------------------------
1.
I cannot determine if the chest tightness is related to anxiety; it is somewhat difficult to define.
I would say that since I became aware of the chest tightness, I have been quite anxious, leading to a sort of chicken-and-egg situation.
2.
The chest tightness is most pronounced after dinner, with few occurrences during the day, even after exercise.
It often happens at night.
3.
During a blood pressure measurement at the large hospital, a rapid pulse was noted, with rates ranging from 90 to 101.
My blood pressure was recorded at 81/133.
The doctor advised me not to worry too much, stating that fluctuations are quite normal.
Three days later, my blood pressure was measured at 74/118, with a pulse of 97.
Should I continue to follow up with cardiology, or is there another course of action I should take?
4.
Each time I become aware of the chest tightness, I feel the urge to perform chest expansion exercises and deep breathing.
5.
How can I distinguish whether the chest tightness is due to excessive stress or anxiety, or if it is genuinely related to a heart issue? Is there a clear method for differentiation? Under what circumstances should I return to the hospital for further examination?
6.
Initially, the chest tightness was accompanied by a burning sensation, which disappeared immediately after taking the proton pump inhibitor, but the tightness remained.
The gastroenterologist suggested that it could be due to bloating pressing against the diaphragm, leading to chest tightness.
7.
Should the doctor recommend that I consult other specialties or undergo additional tests (such as thyroid testing)? I have provided as much detail as possible about my condition, and I appreciate your response.

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Matsu, 20~29 year old female. Ask Date: 2020/03/22