Fast Heartbeat and Chest Discomfort: When to Seek Help

Palpitations and chest tightness?

Hello Doctor, I was diagnosed with arrhythmia when I was young (but the doctor only recommended observation and no medication).
There is a family history of heart disease (my grandmother and aunt both have it).
In early August of this year, I experienced episodes of rapid heartbeat and palpitations.
After seeing a doctor, they confirmed that my heart rate was indeed elevated, but the ECG did not show significant abnormalities (I did not undergo an echocardiogram).
I was prescribed medication for the rapid heartbeat to keep on hand.
Later, after starting gastrointestinal medication in mid-August, I noticed a decrease in episodes of rapid heartbeat.
However, I still experience persistent chest tightness, and there is pain when pressing on certain points in my chest.
Occasionally, I also feel pain in my back.

I would like to ask:
1.
I read online that back pain and arm pain can occur before a heart attack.
Is the back pain before a heart attack typically a pain that radiates from the chest along the side of the body to the back, or can it be that both the chest and back hurt while the sides of the body do not hurt?
2.
The ECG from early August showed no abnormalities, but since I continue to experience chest tightness, should I see a doctor again now (in October)? Or is it possible that there won't be significant changes in the heart over two months, so I could try to observe for another month or two? I have read that doctors say at my age (28 years) it is unlikely to have heart disease or a myocardial infarction, but I am still a bit concerned due to my family history.
I would appreciate your clarification.
Thank you.

H, 20~29 year old female. Ask Date: 2020/10/07

Dr. He Dongjin reply Cardiology

Hello, during childhood, if you experienced arrhythmia, it is recommended to monitor it, which indicates that it is not serious.
A fast heartbeat and a normal electrocardiogram suggest that everything is fine.
Before a heart attack, symptoms such as back pain and arm pain may occur, but these are not definitive indicators of heart disease.
You can continue to observe for another month or two, and considering the family history of illness is rare at this time.
Try not to overthink or worry too much.
Changhua Hospital cares about you.

Reply Date: 2020/10/07

More Info

It's understandable to feel anxious about your heart health, especially given your family history of heart disease and your own experiences with palpitations and chest discomfort. Let's break down your concerns and provide some guidance.

1. Understanding Chest Pain and Back Pain: You mentioned that you read about back pain and arm pain being potential signs of a heart attack. It's important to note that while chest pain is a common symptom of a heart attack, pain can also radiate to the back, neck, jaw, or arms. The pain associated with a heart attack is often described as a feeling of pressure, squeezing, or fullness in the chest, which may not always be localized to one area. In some cases, individuals may experience discomfort in the back or shoulders without any chest pain. However, not all back pain is related to heart issues; it can also be musculoskeletal in nature. Given your symptoms of chest tightness and localized pain, it would be prudent to discuss these with your healthcare provider, especially since they can vary significantly from person to person.

2. Follow-Up on Your Symptoms: You mentioned that your initial ECG showed no significant abnormalities, and you were prescribed medication for your fast heartbeat. Since you are still experiencing persistent chest discomfort and pain, it is advisable to seek further evaluation. While it’s true that your age (28 years) makes it less likely for you to have a heart attack, family history is a significant risk factor that should not be overlooked. Symptoms like persistent chest tightness, especially if they are new or worsening, warrant a follow-up appointment. Your doctor may recommend further testing, such as an echocardiogram or stress test, to assess your heart function more thoroughly.

3. Managing Anxiety and Symptoms: It’s common for anxiety to exacerbate physical symptoms, especially when it comes to heart-related issues. If you find that your anxiety about your heart health is affecting your daily life, consider discussing this with your healthcare provider. They may refer you to a mental health professional or suggest coping strategies to help manage your anxiety. Techniques such as mindfulness, deep breathing exercises, and regular physical activity can also be beneficial.

4. Lifestyle Considerations: Since you mentioned that you started taking gastrointestinal medication, it's worth considering whether any changes in your diet or lifestyle could be contributing to your symptoms. Caffeine, alcohol, and certain foods can sometimes trigger palpitations or discomfort. Keeping a symptom diary can help identify potential triggers.

5. When to Seek Immediate Help: If you experience severe chest pain, shortness of breath, dizziness, or any other alarming symptoms, do not hesitate to seek emergency medical attention. It's always better to err on the side of caution when it comes to heart health.

In summary, while your age and initial tests may suggest a lower risk for serious heart conditions, your ongoing symptoms and family history necessitate further evaluation. Don't hesitate to reach out to your healthcare provider to discuss your concerns and explore the next steps in your care. Remember, it's important to advocate for your health and ensure that you feel comfortable and informed about your condition.

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