Chest Tightness and Pain: When to Seek Help - Cardiology

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Chest tightness and chest pain?


Hello, Doctor: For the past two or three nights, I have occasionally experienced a sensation of heaviness on my chest before falling asleep.
During these times, I feel a strong urge to take deep breaths, and I also notice my heart rate increasing, although I'm not entirely sure about it.
Changing positions helps alleviate the discomfort, but I need to turn over periodically; otherwise, the uncomfortable feeling returns.
However, once I actually fall asleep, I have no issues until I wake up, and I can sleep normally.
Upon waking, I feel fine, but I'm unsure if this is psychological in nature.
Today during the day, I also experienced slight chest tightness, but I'm hesitant to confirm whether it's genuine chest discomfort or just influenced by my mood.
I hope you can assist me.
Additionally, I visited Mackay Memorial Hospital's thoracic department in October and November due to discomfort.
I underwent an electrocardiogram, X-rays, blood tests, and other examinations, all of which showed no issues.
The doctor suggested it might be related to my mood and lifestyle.
After the doctor pressed on my chest, I was referred to a breast surgeon, and I had a breast examination that revealed some cysts.
The doctor advised a follow-up in two to three months, as I expect my menstrual period to start next week.
Therefore, I'm uncertain if this chest tightness is related to my upcoming menstruation or if there might be another underlying issue.
I would like to consult you, Doctor!

Xiao Mi, 20~29 year old female. Ask Date: 2021/01/21

Dr. He Dongjin reply Cardiology


Hello, it seems that your autonomic nervous system disorder is caused by anxiety.
It is recommended to visit a psychosomatic medicine specialist for medication adjustment.
We pray for your peace.
Changhua Hospital cares about you.

Reply Date: 2021/01/21

More Info


Chest tightness and pain can be concerning symptoms, and it's important to understand when to seek medical help. Based on your description, it seems that you are experiencing a sensation of pressure on your chest, particularly at night, which is accompanied by a desire to take deep breaths and a feeling of increased heart rate. You mentioned that changing positions helps alleviate the discomfort, and that once you fall asleep, you do not experience any issues until you wake up. Additionally, you have noted some mild chest discomfort during the day, but you are unsure if it is related to your emotional state or if it is a physical issue.

Firstly, it's important to recognize that chest tightness can have various causes, ranging from benign to serious. Given that you have already undergone several tests, including an electrocardiogram (ECG), chest X-ray, and blood tests, and that these results were normal, it is less likely that your symptoms are due to a serious cardiac condition. However, it is still essential to consider other potential causes.

One possibility is that your symptoms may be related to anxiety or stress. Anxiety can manifest physically in many ways, including chest tightness, rapid heartbeat, and difficulty breathing. The fact that your symptoms improve when you change positions and that they do not persist throughout the night may suggest that they are not due to a structural issue but rather a response to stress or anxiety. It's also worth noting that hormonal changes related to your menstrual cycle can affect your body and may contribute to feelings of discomfort or tightness in the chest.

Another consideration is the possibility of musculoskeletal issues. Sometimes, tightness in the chest can be caused by muscle strain or tension, particularly if you have been under stress or have changed your physical activity levels. Poor posture, especially during sleep, can also lead to discomfort in the chest area.

Given your history and the fact that you have already consulted with a healthcare provider, it may be beneficial to explore the psychological aspects of your symptoms further. If you suspect that anxiety or stress is playing a role, consider speaking with a mental health professional who can help you develop coping strategies and techniques to manage your symptoms. Cognitive-behavioral therapy (CBT) is one effective approach that can help address anxiety-related symptoms.

In terms of when to seek help, if you experience any of the following, it is crucial to seek immediate medical attention:
1. Severe chest pain or pressure that lasts more than a few minutes or goes away and comes back.

2. Pain that radiates to your arms, back, neck, jaw, or stomach.

3. Shortness of breath, especially if it occurs suddenly or is accompanied by sweating, nausea, or lightheadedness.

4. Any new or worsening symptoms that cause you concern.

In summary, while your symptoms may be related to anxiety or stress, it is essential to remain vigilant and seek medical advice if your condition changes or worsens. Maintaining open communication with your healthcare provider about your symptoms and any emotional factors that may be contributing to them is key to finding an effective management plan. Remember, your health and well-being are paramount, and seeking help is a proactive step towards understanding and addressing your symptoms.

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