Chest Tightness, Digestive Issues, and Scalp Numbness

Chest tightness, indigestion, and scalp tingling?

Hello, doctor.
Recently, I have occasionally experienced a tingling sensation on the left side of my scalp, similar to goosebumps.
Additionally, over the past two weeks, I have had the following symptoms: 1.
A feeling of tightness in my left chest and upper back, with sharp pain in my left upper arm while sleeping.
2.
Frequent indigestion.
3.
My throat is very dry, and I have noticed blood in my nasal discharge.
4.
Sometimes, this tingling sensation in my scalp accompanies the above symptoms.
5.
I also experience dizziness and moments of blurred vision where I cannot focus.
6.
I usually have mild orthostatic hypotension, but my health check-ups have been normal, and I have no history of heart disease.
I have had an electrocardiogram and thyroid function tests in the past six months, both of which were normal.
I exercise for about an hour every day and sleep for 6-7 hours.
I would like to ask the doctor what diseases these symptoms might indicate, or which specialty clinic would be most appropriate to visit? (I have been taking Ezetimibe, Lisinopril, and Mirtazapine long-term.)

Wang, 20~29 year old female. Ask Date: 2022/03/15

Dr. Liao Yaopan reply Family Medicine

Hello, the symptoms mentioned above are quite non-specific.
Given your long history of medication use, I recommend discussing with your psychiatrist whether these symptoms may be related to the long-term effects of the medications.
Additionally, reassess if you need assistance from other subspecialties.
Please note that online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatments.
Changhua Hospital cares about you.

Reply Date: 2022/03/15

More Info

Hello! Thank you for sharing your concerns regarding the symptoms you’ve been experiencing. It’s understandable to feel anxious when faced with a combination of physical sensations that can be alarming. Based on the symptoms you described, let’s break them down and explore potential causes, as well as recommendations for further evaluation.

Symptoms Overview
1. Left Chest Tightness and Pain: This symptom can be concerning as it may suggest cardiac issues, especially given its location. However, since you have a history of normal heart evaluations (like ECGs) and no prior heart disease, it could also be related to musculoskeletal issues, anxiety, or gastrointestinal problems.

2. Digestive Issues: Frequent digestive discomfort can stem from various causes, including stress, dietary choices, or gastrointestinal disorders such as gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS).

3. Dry Throat and Bloody Nasal Discharge: This could indicate dryness in the environment, allergies, or even a sinus issue. If you’re experiencing frequent nosebleeds, it’s worth investigating further, especially if it’s a new symptom.

4. Scalp Numbness: The sensation of numbness or tingling on one side of the scalp can be related to nerve irritation or compression, possibly due to posture or tension. It’s also important to rule out neurological conditions.

5. Dizziness and Visual Disturbances: These symptoms can be linked to various factors, including low blood pressure, anxiety, or even vestibular disorders. Since you mentioned having a slight history of orthostatic hypotension, this could be a contributing factor.

Potential Causes
Given your symptoms, several conditions could be at play:
- Anxiety and Stress: Chronic stress can manifest in physical symptoms, including chest tightness, digestive issues, and even neurological sensations like tingling. Anxiety can also lead to hyperventilation, which may cause dizziness and visual disturbances.

- Musculoskeletal Issues: Poor posture or muscle tension, especially in the neck and upper back, can lead to referred pain in the chest and arm, as well as numbness in the scalp.

- Gastrointestinal Disorders: Conditions like GERD can cause chest discomfort that mimics heart pain, and digestive issues can lead to a feeling of fullness or discomfort.

- Neurological Concerns: While less likely given your recent evaluations, persistent numbness or tingling warrants a neurological assessment to rule out conditions like multiple sclerosis or other neuropathies.

Recommendations
1. Consult a Healthcare Provider: Given the complexity of your symptoms, it would be prudent to consult with a primary care physician or a specialist in internal medicine. They can perform a thorough evaluation and may refer you to a neurologist or gastroenterologist based on their findings.

2. Monitor Symptoms: Keep a detailed log of your symptoms, noting when they occur, their duration, and any potential triggers (like stress or certain foods). This information can be invaluable for your healthcare provider.

3. Stress Management: Incorporate stress-reducing techniques into your daily routine. Practices such as mindfulness, yoga, or cognitive behavioral therapy (CBT) can help manage anxiety and its physical manifestations.

4. Lifestyle Adjustments: Ensure you’re maintaining a balanced diet, staying hydrated, and getting adequate sleep. Regular exercise is beneficial, but be mindful of how your body responds to different activities.

5. Follow-Up on Medications: Since you are on medications like Ezetimibe, Lurasidone, and Mirtazapine, discuss with your prescribing physician whether these could be contributing to your symptoms or if adjustments are needed.

Conclusion
While your symptoms can be distressing, many of them can be managed effectively with the right approach. It’s essential to seek professional guidance to rule out any serious conditions and to develop a comprehensive plan for managing your health. Remember, you are not alone in this, and there are resources available to help you navigate these challenges. Wishing you the best in your journey toward better health!

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