Central Chest Pain: When to See a Specialist

Q: Central Chest Pain: When to See a Specialist

Hello： You can first consult with a cardiologist to discuss.

Sharp pain in the center of the chest?

Hello doctor, three days ago I started experiencing intermittent sharp pain in the sternum, similar to a tearing sensation.
Each episode lasts about 2-3 seconds and resolves on its own, but it recurs every few minutes.
I do not feel pain during exercise or when changing positions.
I often experience palpitations, feeling my heart beating strongly.
A few times while climbing stairs, I felt a strong pressure in my chest, accompanied by a sensation of tightness that required me to take deep breaths for relief.
Recently, my breathing rate has also increased.
Should I see a pulmonologist or a cardiologist for these symptoms? Thank you for your help!

Qi Qi, 10~19 year old female. Ask Date: 2020/04/27

Dr. Zhou Ziguang reply Pulmonology

Hello: You can first consult with a cardiologist to discuss.

Reply Date: 2020/04/27

More Info

When it comes to understanding central chest pain, especially with the symptoms you've described, it is crucial to approach the situation with caution. Your symptoms of intermittent sharp pain in the sternum, palpitations, and a sensation of pressure in the chest, particularly when climbing stairs, warrant a thorough evaluation by a healthcare professional. Given the complexity and potential seriousness of cardiac-related issues, it is advisable to consult a cardiologist rather than a pulmonologist (chest specialist) at this stage.

Understanding Your Symptoms
1. Intermittent Sharp Pain: The sharp, tearing-like pain that lasts for a few seconds and resolves on its own could be indicative of several conditions. While it may seem benign, it is essential to rule out any cardiac causes, especially given your history of palpitations and chest pressure.

2. Palpitations: Feeling your heart beating strongly or irregularly can be associated with anxiety, but it can also indicate underlying heart conditions such as arrhythmias or structural heart issues.
3. Chest Pressure: The sensation of pressure, particularly during exertion (like climbing stairs), is a classic symptom of potential cardiac ischemia, where the heart muscle does not receive enough blood flow, often due to coronary artery disease.

4. Increased Respiratory Rate: A faster breathing rate can be a response to anxiety or discomfort, but it can also indicate a more serious condition, especially if it is accompanied by chest pain or pressure.

When to See a Cardiologist
Given the combination of your symptoms—sharp chest pain, palpitations, and pressure during exertion—it is prudent to see a cardiologist. They can perform a comprehensive evaluation, which may include:
- Electrocardiogram (EKG): This test measures the electrical activity of your heart and can help identify arrhythmias or signs of ischemia.

- Echocardiogram: An ultrasound of the heart can assess its structure and function, helping to identify any abnormalities in the heart valves or chambers.

- Stress Testing: This can help determine how your heart performs under physical stress and can reveal issues that may not be apparent at rest.

- Holter Monitor: If palpitations are frequent, a 24-hour Holter monitor can record your heart's rhythm over a day to catch any irregularities.

Conclusion
In summary, your symptoms are concerning enough to warrant a visit to a cardiologist. While some causes of chest pain can be benign, the potential for serious cardiac conditions necessitates a thorough evaluation. Early diagnosis and intervention can significantly improve outcomes, especially if there is an underlying heart condition. It’s always better to err on the side of caution when it comes to heart health. Please make an appointment with a cardiologist as soon as possible to discuss your symptoms and undergo the necessary tests. Your health and peace of mind are paramount.

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