Persistent Chest Discomfort After Heart Surgery: What to Know

There is a dull, tight pain in the middle of my clavicle?

There is a dull, tight pain located 3 centimeters down and 3 centimeters to the left from the middle of my clavicle.
I discovered I had an atrial septal defect at the age of 21 in 2015, and I underwent a catheterization procedure at National Taiwan University Hospital to insert a closure device.
Since then, I have returned annually for echocardiograms and electrocardiograms.
After the surgery, I have consistently felt a dull tightness, which sometimes improves after a while but then returns.
Each time I visit the doctor, they say everything is fine.
However, in the past six months, this sensation has become increasingly severe.
In December of last year, I had an electrocardiogram and echocardiogram, both of which showed no issues.
In April, feeling quite anxious, I went to a larger hospital closer to home for further examination.
The doctor performed a stress test, chest X-ray, and blood tests, all of which came back normal.
I am puzzled as to why I continue to experience this dull tightness.
Based on my observations, lying on my left side for an extended period makes the sensation more pronounced, and it also occurs when sitting for long periods at work.
Standing alleviates the tightness.
Recently, I have started to experience not only tightness but also occasional sharp pains.
Since the doctors have assured me that my heart is fine, I am unsure where to investigate further.
I am very concerned that it could be something serious, such as aortic dissection or another life-threatening condition.
😰

Niming, 20~29 year old female. Ask Date: 2021/06/09

Dr. Cai Guiqin reply Cardiology

It is recommended that you discuss the above situation further with your attending physician to determine if any additional examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2021/06/09

More Info

Persistent chest discomfort after heart surgery can be concerning, especially when previous evaluations have not revealed any significant issues. Given your history of atrial septal defect (ASD) closure and the ongoing symptoms you describe, it is essential to consider various potential causes for your discomfort.

Firstly, it is important to note that post-surgical patients can experience a range of sensations in the chest area, including tightness, pressure, or discomfort, which may not always indicate a serious underlying problem. These sensations can be attributed to several factors:
1. Post-Surgical Changes: After heart surgery, the body undergoes significant changes as it heals. Scar tissue formation around the heart and surgical site can lead to sensations of tightness or discomfort. This is often benign and may improve over time.

2. Musculoskeletal Issues: The chest wall, including the muscles and ribs, can be a source of pain or discomfort. Activities such as lying on your side or prolonged sitting can exacerbate musculoskeletal pain. Conditions like costochondritis (inflammation of the cartilage connecting the ribs to the sternum) can also cause similar symptoms.

3. Anxiety and Stress: Psychological factors can play a significant role in how we perceive pain. Anxiety about your health, especially after heart surgery, can lead to heightened awareness of bodily sensations and discomfort. It is not uncommon for individuals to experience chest discomfort related to anxiety, which can mimic cardiac symptoms.

4. Gastroesophageal Reflux Disease (GERD): Sometimes, discomfort in the chest can be related to gastrointestinal issues, such as acid reflux. This can cause a sensation of tightness or pressure in the chest, particularly when lying down or after eating.

5. Cardiac Considerations: Although your recent tests (echocardiogram, ECG, exercise stress test, and chest X-ray) have not indicated any significant cardiac issues, it is still essential to monitor your symptoms. If the discomfort worsens or is accompanied by other symptoms such as shortness of breath, palpitations, or significant changes in your health status, further evaluation may be warranted.

Given your concerns about serious conditions like aortic dissection, it is crucial to communicate openly with your healthcare provider. If you feel that your symptoms are not being adequately addressed, consider seeking a second opinion or asking for a referral to a cardiologist who specializes in post-operative care. They may recommend additional imaging studies, such as a cardiac MRI or CT angiography, to evaluate the heart and surrounding structures more thoroughly.

In the meantime, keeping a symptom diary can be helpful. Note when the discomfort occurs, its intensity, duration, and any associated activities or positions. This information can provide valuable insights for your healthcare provider.

Lastly, lifestyle modifications such as stress management techniques, regular physical activity (as tolerated), and avoiding positions that exacerbate your symptoms may also be beneficial. Engaging in relaxation exercises, such as deep breathing or mindfulness, can help alleviate anxiety and improve your overall well-being.

In summary, while persistent chest discomfort after heart surgery can be distressing, it is essential to explore all potential causes, including musculoskeletal issues, anxiety, and gastrointestinal factors. Continuous communication with your healthcare provider and thorough evaluations can help ensure that any underlying issues are identified and managed appropriately.

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