Palpitations and Associated Symptoms: A Cardiovascular Perspective

Palpitations and systemic symptoms?

Hello, doctor.
I am currently in the ninth grade.
I first noticed my heart racing suddenly while at rest when I was in the seventh grade, but I didn't pay much attention to it.
Now, I have frequent pain in my lower jaw and teeth, along with lower back pain, shoulder and neck stiffness, and tinnitus in one ear.
After eating, I feel very bloated, as if my chest is being compressed.
My breathing feels a bit labored, but this sensation goes away after digestion.
My sleep is not affected, but after exercising, I feel pain in my left shoulder (though I do not experience chest pain).
Occasionally, I have sharp pains in my chest.
I tend to get anxious, and when I relax, I notice my heart racing (but there are no skipped beats).
My mother mentioned that there is a family history of heart valve stenosis, but when I researched symptoms online, I found that they resemble those of a myocardial infarction.
Could you please tell me what kind of condition I might have? I am really troubled by this constant worry.

Mr. Wang, 10~19 year old female. Ask Date: 2020/09/29

Dr. He Dongjin reply Cardiology

Hello, don't overthink it.
If you're worried, please visit a cardiology clinic for further evaluation.
At your age, it's unlikely to be a myocardial infarction; the symptoms are more likely caused by mitral valve prolapse.
Changhua Hospital cares about you.

Reply Date: 2020/09/29

More Info

Palpitations, or the sensation of a rapid or irregular heartbeat, can be concerning, especially when accompanied by other symptoms such as jaw pain, back pain, shoulder discomfort, tinnitus, gastrointestinal issues, and anxiety. Given your description, it’s essential to consider several potential cardiovascular and non-cardiovascular causes for your symptoms.

Cardiovascular Considerations
1. Palpitations: These can arise from various factors, including anxiety, stress, caffeine intake, or underlying heart conditions. In your case, the fact that you experience palpitations during periods of relaxation may suggest a heightened state of anxiety or stress rather than a direct cardiac issue. However, it’s crucial to rule out any structural heart problems, especially given your family history of valvular heart disease.

2. Family History: A family history of heart valve stenosis raises the possibility of inherited conditions that could affect your heart's function. Valvular heart disease can lead to symptoms like palpitations, chest discomfort, and even heart failure if significant. It would be prudent to have a thorough evaluation by a cardiologist, including an echocardiogram, to assess the structure and function of your heart valves.

3. Chest Pain and Discomfort: The intermittent chest pain you describe, particularly after eating, could be related to gastrointestinal issues such as gastroesophageal reflux disease (GERD) or esophageal spasms, which can mimic cardiac symptoms. However, it’s essential to differentiate these from true cardiac pain, which is often associated with exertion or stress.

4. Jaw and Shoulder Pain: The pain in your jaw and left shoulder could be musculoskeletal or referred pain from the heart. In some cases, cardiac issues can present with atypical pain patterns, particularly in younger individuals.
5. Anxiety and Stress: Anxiety can significantly exacerbate the perception of palpitations and other physical symptoms. The body’s stress response can lead to increased heart rate and muscle tension, which may explain your symptoms of tightness and discomfort.

Recommended Actions
1. Consult a Cardiologist: Given your symptoms and family history, a comprehensive evaluation by a cardiologist is warranted. This may include an electrocardiogram (ECG), echocardiogram, and possibly a Holter monitor to assess your heart rhythm over 24 hours.

2. Lifestyle Modifications: Reducing caffeine intake, managing stress through relaxation techniques, and ensuring adequate sleep can help mitigate palpitations. Regular physical activity, within your comfort level, can also be beneficial.

3. Gastrointestinal Evaluation: If your chest discomfort is related to meals, consider discussing this with a gastroenterologist. They may recommend dietary changes or medications to manage reflux or other gastrointestinal issues.

4. Mental Health Support: If anxiety is a significant factor in your symptoms, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) and relaxation techniques can be effective in managing anxiety and its physical manifestations.

Conclusion
While your symptoms may be concerning, they do not necessarily indicate a severe cardiac condition. However, due to your family history and the nature of your symptoms, it is crucial to seek medical evaluation to rule out any underlying heart issues. Early intervention and management can significantly improve your quality of life and alleviate your concerns. Remember, it’s essential to communicate openly with your healthcare provider about all your symptoms and concerns.

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