Chest Discomfort and Fatigue: When to Seek Cardiology Help

Physical discomfort?

Hello, doctor.
I have a low body weight (BMI 14) and a relatively large appetite.
My heart rate is somewhat elevated (around 100 beats per minute).
I have undergone echocardiograms and thyroid-related tests at a major hospital, and all reports were normal.
However, occasionally when I get up, I experience a dull pain near my left chest and a feeling of breathlessness.
Sometimes, my limbs feel weaker, and I easily become fatigued.
What could be the issue in this situation? Which specialty should I consult? Thank you.

R, 20~29 year old female. Ask Date: 2022/08/19

Dr. Wu Xueming reply Cardiology

It is recommended to consult a psychosomatic medicine specialist.

Reply Date: 2022/08/19

More Info

Understanding chest discomfort and fatigue can be complex, especially when considering your unique health profile. Given your low BMI (14), elevated heart rate (around 100 beats per minute), and the symptoms you describe—occasional left chest discomfort, difficulty breathing, and fatigue—it's essential to approach this situation with caution and thoroughness.

First, let's break down your symptoms. The left-sided chest discomfort you experience, particularly when getting up, could be indicative of several underlying issues. While your previous cardiac evaluations, including echocardiograms and thyroid tests, returned normal results, it’s important to remember that not all heart conditions can be detected through these tests alone. Conditions such as coronary artery disease (CAD), even in younger individuals, can sometimes present with atypical symptoms, including chest pain and fatigue.

Your elevated heart rate, known as tachycardia, could also contribute to feelings of fatigue and discomfort. Tachycardia can be caused by various factors, including anxiety, dehydration, anemia, or even hyperthyroidism, which might not have been fully ruled out despite normal thyroid tests. Given your low BMI and potential nutritional deficiencies, it’s also possible that your body is not receiving adequate nutrients, leading to fatigue and weakness.

The sensation of tightness or pain in the chest, especially if it’s accompanied by shortness of breath, should not be taken lightly. It could be related to musculoskeletal issues, anxiety, or even gastrointestinal problems such as acid reflux, which can mimic cardiac symptoms. However, given your history and the nature of your symptoms, it is prudent to rule out any cardiac issues.

In terms of seeking help, I recommend scheduling an appointment with a cardiologist. They can perform a comprehensive evaluation, which may include additional tests such as a stress test, Holter monitor (to assess your heart rate over 24 hours), or even advanced imaging techniques if necessary. It may also be beneficial to consult with a primary care physician or an internist who can evaluate your overall health, including nutritional status, and address any potential underlying conditions contributing to your symptoms.

Additionally, considering your low BMI, it might be worthwhile to consult with a nutritionist or dietitian. They can help ensure that you are meeting your nutritional needs, which is crucial for overall health and can impact your energy levels and heart function.

In summary, your symptoms warrant further investigation, particularly with a cardiologist, to rule out any cardiac issues. Given your unique health profile, a multidisciplinary approach involving both cardiology and nutrition could provide a comprehensive understanding of your condition and help you manage your symptoms effectively. Always prioritize your health and seek medical attention if your symptoms worsen or if you experience new symptoms such as severe chest pain, shortness of breath, or fainting.

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