Chest Tightness and Fainting: Could It Be Autonomic Dysfunction?

Chest tightness followed by numbness in the hands, suddenly fainting, and waking up a few minutes later?

Hello doctor, my mother has recently been experiencing sudden chest tightness and shortness of breath, followed by numbness in her right hand, and then she fainted.
After a few minutes, she regained consciousness but felt very tired and weak.
We went to the hospital for an ECG, blood tests, and X-rays, but everything came back normal, and no cause was found.
Could this be related to autonomic nervous system dysfunction?

JX, 10~19 year old female. Ask Date: 2021/10/07

Dr. Jiang Junyi reply Neurology

Dear Miss JX,
You mentioned experiencing sudden chest tightness and shortness of breath, followed by numbness in your right hand and then fainting.
First, we need to consider the symptoms of syncope.
The most common causes are reflex syncope, which can occur due to excessive stimulation of the vagus nerve, leading to bradycardia and decreased cardiac output.
This can happen when transitioning from a lying to a standing position, standing up suddenly after squatting, certain medications causing hypotension, significant blood volume reduction, peripheral vasodilation in a hot environment, or peripheral neuropathy.

Cardiac syncope should also be considered, which may be due to arrhythmias, valvular heart disease, cardiac myxoma, acute myocardial infarction, or coronary artery spasm leading to irregular heart rates and decreased blood pressure.
Metabolic causes of syncope, such as hypoglycemia or hyperventilation, should also be distinguished from seizures and vertigo.
You mentioned undergoing an electrocardiogram, blood tests, and X-rays.
These are standard emergency evaluations.
Further investigations may include a 24-hour Holter monitor, echocardiogram, electroencephalogram (EEG), and carotid ultrasound, among others.

I recommend accompanying your mother to follow-up appointments with a neurologist and cardiologist.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new pandemic prevention measures before and after medical visits.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you and your mother good health and safety.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/10/07

More Info

Chest tightness and fainting can indeed be concerning symptoms, especially when they occur suddenly and are accompanied by other signs such as shortness of breath and numbness. Your mother's experience of chest tightness, difficulty breathing, and subsequent fainting spells raises important questions about her cardiovascular and autonomic nervous system health.

Autonomic dysfunction, also known as dysautonomia, refers to a disorder of the autonomic nervous system (ANS), which controls involuntary bodily functions such as heart rate, blood pressure, digestion, and respiratory rate. When the ANS is not functioning properly, it can lead to a variety of symptoms, including those your mother is experiencing.

The symptoms of autonomic dysfunction can include:
1. Orthostatic Hypotension: This is a condition where blood pressure drops significantly when a person stands up, leading to dizziness or fainting. If your mother experiences lightheadedness or fainting upon standing, this could be a sign of orthostatic hypotension.

2. Palpitations: An irregular heartbeat or a feeling of the heart racing can be a symptom of autonomic dysfunction. This could explain the sensation of chest tightness and shortness of breath.

3. Sweating Abnormalities: Some individuals with autonomic dysfunction may experience excessive sweating or a lack of sweating, which can contribute to feelings of discomfort.

4. Gastrointestinal Symptoms: Dysautonomia can also affect digestion, leading to symptoms such as bloating, constipation, or diarrhea.

5. Fatigue: The feeling of being very tired or weak after an episode, as you described, can be associated with autonomic dysfunction.

Given that your mother's initial tests (ECG, blood tests, and X-rays) did not reveal any acute cardiac issues, it is essential to consider other potential causes for her symptoms. Autonomic dysfunction can be primary (idiopathic) or secondary to other conditions such as diabetes, autoimmune diseases, or even certain medications.

It would be prudent for your mother to follow up with a healthcare provider who specializes in autonomic disorders. They may recommend additional tests, such as:
- Tilt Table Test: This test evaluates how the body responds to changes in position and can help diagnose orthostatic hypotension.

- 24-hour Holter Monitor: This device records the heart's rhythm over a day to detect any irregularities that might not be evident during a standard ECG.

- Autonomic Function Tests: These tests assess how well the autonomic nervous system is functioning.

In the meantime, lifestyle modifications may help manage symptoms. Encouraging your mother to stay hydrated, avoid sudden changes in position, and engage in gentle physical activity can be beneficial. Additionally, stress management techniques such as deep breathing exercises or mindfulness may help alleviate some symptoms.

In conclusion, while the symptoms your mother is experiencing could be related to autonomic dysfunction, a thorough evaluation by a specialist is necessary to determine the underlying cause and appropriate management. It’s essential to keep an open line of communication with her healthcare providers and report any new or worsening symptoms promptly.

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