Chest Discomfort: Symptoms and Heart Health Concerns

Chest discomfort?

Hello Dr.
Li,
I would like to inquire about three main symptoms.
I apologize for the lengthy description.
A few years ago, I started experiencing sudden discomfort during exercise (I could clearly feel my heart racing and pounding, along with dizziness, similar to symptoms of hypoglycemia).
As a result, I have mostly stopped exercising, except for occasional walks.
I have tried hiking and playing badminton, but there is a high likelihood of experiencing the same symptoms.

Around the same time, whenever I am in crowded, stuffy, or hot enclosed spaces, I feel chest tightness and difficulty breathing.
Over time, I start to break out in cold sweats and my vision becomes blurry (also resembling hypoglycemic symptoms).
The last severe episode occurred two years ago when I took a crowded bus; upon getting off, I was breathless and my vision was completely white, making it hard to see, and I needed assistance.
However, after sitting for a few minutes post-incident, I felt completely fine, as if nothing had happened.
(This situation sometimes occurs when I take a hot shower as well.)
I do not have any phobias and often spend time in enclosed spaces.
Last year, before undergoing surgery, an anesthesiologist noted that my heart rate was too slow, which could indicate myocardial hypoxia.
Since then, I have only been more aware of my heart rate without further examination.
I have measured my heart rate and found it occasionally ranges between 55-60 beats per minute while awake, which I thought was not a major concern.
However, since mid-November last year, when the weather turned cold, my heart rate spikes above 100 with slight movements, then suddenly drops to the 50s, with a few instances of it dropping to 48.

Just the other night, my heart rate briefly reached 196 before quickly returning to 47.
Yesterday, it soared to 218 before dropping back to 49.
These spikes occurred when I woke up feeling hot and uncomfortable.
(Since November, when I started feeling more pronounced heart discomfort, I purchased a Xiaomi wristband to monitor my heart rate, and I have also exchanged wristbands with friends for confirmation.)
On January 17, I visited a cardiologist, but I only mentioned the recommendation for testing for myocardial hypoxia.
The doctor stated that at my age, it is unlikely to have such a problem, and since there were no heart murmurs, they suggested a resting ECG and blood tests for further observation.
Could you please advise on which tests would be most appropriate for the symptoms described above? Should I be concerned about the discomfort I experienced while sleeping these past two days? Thank you, Dr.
Li.

Chen, 30~39 year old female. Ask Date: 2022/01/22

Dr. Li Shengkai reply Cardiology

Hello, first of all, thank you for your detailed description; however, since I have not conducted a direct examination, there may still be discrepancies in my assessment.
Based on your symptoms, age, and gender, the primary concern is not coronary artery disease, but rather some valvular issues; you may have heard of "mitral valve prolapse." This can be confirmed with further echocardiographic examination.
The fact that your heart rate spikes to 200 and then returns to normal may indicate an additional circuit in the heart, leading to "paroxysmal supraventricular tachycardia," which can be diagnosed through an electrocardiogram (either static or 24-hour monitoring).
Due to modern work stress and irregular schedules, many people experience issues related to "autonomic nervous system dysregulation." I recommend that you try to establish a regular routine and manage stress to alleviate your discomfort.
Perhaps you are not ill, but simply fatigued.
I hope this information is helpful to you.

Reply Date: 2022/01/22

More Info

Understanding chest discomfort, especially when accompanied by symptoms like palpitations, dizziness, and shortness of breath, is crucial for maintaining heart health. Based on your description, it seems you have been experiencing a range of symptoms that could be indicative of underlying cardiovascular issues or other health concerns.

Symptoms and Their Implications
1. Palpitations and Dizziness During Exercise: The sensation of your heart racing and feeling faint during physical activity can be alarming. This could be related to several factors, including dehydration, electrolyte imbalances, or even anxiety. However, it can also indicate a more serious condition such as arrhythmias or exercise-induced ischemia, especially if these episodes are recurrent.

2. Chest Discomfort in Crowded or Hot Environments: Feeling chest tightness and difficulty breathing in crowded or warm spaces may suggest anxiety or panic attacks, but it could also be a sign of cardiac issues, particularly if you experience sweating and visual disturbances. These symptoms can mimic those of low blood sugar or even angina, where the heart muscle does not receive enough blood.

3. Bradycardia and Tachycardia Episodes: Your heart rate fluctuations, where it drops to the 40s and spikes to over 200, are concerning. Bradycardia (slow heart rate) can be benign in some individuals, especially athletes, but when combined with symptoms like dizziness and fainting, it warrants further investigation. Tachycardia (rapid heart rate) during sleep or rest, especially if it wakes you up, could indicate an underlying arrhythmia or other cardiac condition.

Recommended Evaluations
Given your symptoms and the history of heart rate irregularities, it would be prudent to undergo a comprehensive evaluation. Here are some tests that may be beneficial:
1. Holter Monitor: This device records your heart's rhythm for 24-48 hours, helping to capture any irregularities that occur during your daily activities, including episodes of tachycardia or bradycardia.

2. Echocardiogram: An ultrasound of the heart can assess the structure and function of your heart, checking for any abnormalities in the heart valves or chambers that could contribute to your symptoms.

3. Stress Test: This test evaluates how your heart performs under physical stress and can help identify exercise-induced ischemia or arrhythmias.

4. Blood Tests: Checking for electrolyte levels, thyroid function, and other markers can help rule out metabolic causes of your symptoms.

5. Electrophysiological Study: If arrhythmias are suspected, this invasive test can help identify the source of abnormal heart rhythms.

Lifestyle Modifications
In addition to medical evaluations, consider the following lifestyle changes to help manage your symptoms:
- Stay Hydrated: Dehydration can exacerbate heart palpitations and dizziness. Ensure you drink enough fluids, especially during exercise or in hot environments.

- Balanced Diet: Eating a well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall heart health. Pay attention to your caffeine and sugar intake, as these can trigger palpitations.

- Regular Exercise: While you may have been hesitant to engage in physical activity due to your symptoms, regular, moderate exercise can improve cardiovascular health. Start slowly and gradually increase your activity level, focusing on low-impact exercises like walking or swimming.

- Stress Management: Techniques such as mindfulness, yoga, or deep-breathing exercises can help manage anxiety and reduce the frequency of panic-like symptoms.

Conclusion
While your symptoms may not immediately suggest a severe cardiac condition, they are concerning enough to warrant further investigation. It is essential to communicate openly with your healthcare provider about your experiences and advocate for the necessary tests to ensure your heart health. Regular follow-ups and monitoring are crucial, especially given your history of fluctuating heart rates and the potential for underlying issues. Always listen to your body, and do not hesitate to seek medical attention if your symptoms worsen or change.

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