Chest Pain, Dizziness, and Rapid Heartbeat: Possible Causes

Chest tightness, dizziness, and rapid heartbeat?

Hello Doctor, for the past month, I have been experiencing persistent left chest tightness that comes and goes.
Sometimes, I also feel my heart racing, and it feels quite strong, especially when I am sitting.
This is often accompanied by dizziness, but it tends to improve when I stand up and move around.
I have also experienced brief episodes of numbness in my left arm and leg.
Recently, I visited a cardiovascular department at a medical center, where both static and dynamic electrocardiograms showed no abnormalities.
I wore a portable ECG recorder for a week, and the recordings during that week were normal, but I still occasionally experience symptoms.
I had blood tests to check cardiac enzymes (not sure if that’s the correct term), and everything appeared normal.

There is no specific time when I feel chest tightness, but occasionally at night, I feel my heart beating particularly hard; however, when I touch my chest, it feels normal.
I have a regular exercise routine, and my previous health check records (the last one was in October 2020) showed no abnormalities.
I do not smoke and only drink alcohol occasionally (about once a month).
My normal blood pressure and pulse are approximately 110/62 mmHg and 62 bpm, respectively.
When my heart races, it goes up to around 85 bpm.

I suspect there might be an issue with my thoracic cavity or that cerebral vascular compression could be causing these symptoms.
I have also consulted a pulmonologist, had a chest X-ray, lung function tests (spirometry), and a neurologist who performed a CT scan of my brain, all of which showed no abnormalities.
I have heard that gastrointestinal issues, such as gastroesophageal reflux disease, can also cause chest pressure, and I often experience hiccups.
My work schedule usually has dinner around 9 PM, and I rest around midnight after eating.
I sleep about 6 to 7 hours and used to drink coffee during the day, but I stopped after the symptoms started, with little improvement.

Doctor, given the above conditions, what other possibilities could there be? Do you think it could be related to stress, or should I see a gastroenterologist? Thank you for taking the time to answer my questions.

MAG, 30~39 year old female. Ask Date: 2020/12/17

Dr. He Dongjin reply Cardiology

Hello, it is recommended to see a gastroenterologist to rule out gastroesophageal reflux disease (GERD), as it may be related to stress and there is a high likelihood of autonomic nervous system dysfunction.
We pray for your peace and well-being.
Changhua Hospital cares about you.

Reply Date: 2020/12/17

More Info

Based on the symptoms you've described—persistent left chest tightness, episodes of rapid heartbeat, dizziness, and occasional numbness in your limbs—it's understandable that you're concerned about your health. You've already taken significant steps by consulting with specialists in cardiology, pulmonology, and neurology, and undergoing various tests, including electrocardiograms (ECGs), echocardiograms, and imaging studies, all of which have returned normal results. This is reassuring, as it suggests that serious cardiac conditions are less likely.

Possible Causes of Your Symptoms
1. Anxiety and Stress: Given your description of symptoms occurring during periods of rest and the association with feelings of tightness and rapid heartbeat, anxiety could be a significant contributing factor. Stress can lead to physical symptoms such as chest tightness, palpitations, and dizziness. The body's response to stress can trigger the release of adrenaline, which can increase heart rate and cause feelings of anxiety.

2. Gastroesophageal Reflux Disease (GERD): Your mention of frequent belching and late-night eating habits raises the possibility of GERD. Acid reflux can cause chest discomfort that mimics heart pain and can lead to a sensation of tightness in the chest. It can also cause symptoms like dizziness and palpitations, especially if the reflux is severe enough to irritate the esophagus or affect the vagus nerve.

3. Musculoskeletal Issues: Given your history of physical activity and the nature of your work, musculoskeletal pain could also be a factor. Conditions like costochondritis (inflammation of the cartilage connecting the ribs to the sternum) can cause chest pain that may be mistaken for cardiac issues. This pain can be exacerbated by certain movements or positions.

4. Postural Issues: If you spend long hours in a seated position, particularly if your posture is poor, this could lead to tension in the chest and neck area, contributing to feelings of tightness and discomfort.

5. Caffeine and Dietary Factors: Although you've stopped consuming caffeine, if you were previously consuming it regularly, withdrawal could also lead to symptoms like fatigue and dizziness. Additionally, late-night eating can disrupt sleep and lead to discomfort, which may exacerbate feelings of anxiety or stress.

Recommendations
1. Follow-Up with a Gastroenterologist: Given your symptoms and eating habits, it would be prudent to consult a gastroenterologist to evaluate for GERD or other gastrointestinal issues. They may recommend dietary modifications or medications to manage reflux symptoms.

2. Stress Management Techniques: Consider incorporating stress-reduction techniques into your daily routine. Practices such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) can be effective in managing anxiety and stress-related symptoms.

3. Regular Physical Activity: While you mentioned having a regular exercise routine, ensure that it includes both aerobic and strength-training components. Exercise is a powerful tool for managing stress and improving overall cardiovascular health.

4. Monitor Your Diet: Pay attention to your eating habits, particularly the timing of meals. Eating earlier in the evening and avoiding heavy meals close to bedtime may help reduce symptoms of reflux and improve sleep quality.

5. Sleep Hygiene: Aim for consistent sleep patterns and create a restful environment to improve the quality of your sleep. This can help mitigate feelings of fatigue and dizziness during the day.

6. Consider a Holistic Approach: If your symptoms persist despite addressing the above factors, consider a holistic approach that includes alternative therapies such as acupuncture or chiropractic care, which may help with musculoskeletal pain and overall well-being.

Conclusion
While your symptoms are concerning, the comprehensive evaluations you've undergone have not indicated any serious underlying conditions. It is essential to continue working with your healthcare providers to explore all potential causes, including anxiety, gastrointestinal issues, and lifestyle factors. Keeping an open line of communication with your doctors about your symptoms and any changes you experience will be crucial in managing your health effectively.

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