Heart Pain: Symptoms, Causes, and When to Seek Help

Chest pain?

Doctor, last Thursday while I was taking a nap, I suddenly woke up feeling like I was being pressed down by a ghost.
At that moment, I felt a tightness in my chest and experienced tinnitus.
Since that day, I've been experiencing health anxiety, feeling tense every day with my heart rate exceeding 100 beats per minute.
On Monday, I visited National Taiwan University Hospital for a check-up, where I had an electrocardiogram, an echocardiogram, and blood tests.
There didn't seem to be any major issues, but the echocardiogram showed a trace of mitral regurgitation.
Over the past week, I've googled a lot about heart-related diseases and have been very worried about the possibility of a myocardial infarction or aortic dissection.
While researching, I found that I have several features similar to Marfan syndrome, but I also have many symptoms resembling autonomic nervous system dysfunction.
I will have a follow-up appointment next Monday to better understand the doctor's examination report.
In the last two or three days, I've suddenly experienced pain in my upper left back (around the scapula) and occasional sharp pains in my heart (occurring several times a day), but each episode lasts only a short time.
I would like to know if it is possible that there is indeed a heart problem.

Harry, 10~19 year old female. Ask Date: 2022/09/18

Dr. Wu Xueming reply Cardiology

Due to your young age and lack of chronic diseases, your risk of developing heart disease is low.
Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is advisable to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is still recommended to visit a hospital for further evaluation.

Reply Date: 2022/09/18

More Info

Understanding heart pain can be a complex issue, especially when considering the various symptoms and potential causes. Based on your description, it seems you have been experiencing a range of symptoms that are causing you significant anxiety. Let's break down your situation and provide some insights into what might be happening.

Firstly, the sensation of tightness in your chest, combined with ear ringing (tinnitus), can often be linked to anxiety or panic attacks. These episodes can lead to physical symptoms such as increased heart rate (tachycardia), which you mentioned reaching over 100 beats per minute. This is a common response to stress or anxiety, and while it can feel alarming, it is not always indicative of a serious heart condition.

You also mentioned that you underwent several tests, including an electrocardiogram (ECG), echocardiogram, and blood tests, which did not reveal any significant issues. The finding of mild mitral valve regurgitation (backflow of blood through the mitral valve) is relatively common and often does not cause symptoms or require treatment unless it is severe. Many individuals live with mild mitral valve regurgitation without any complications.

Your concerns about conditions like myocardial infarction (heart attack) or aortic dissection are understandable, especially given the prevalence of information available online. However, it is important to remember that these conditions typically present with more severe and persistent symptoms, such as prolonged chest pain, shortness of breath, and other systemic signs. The brief episodes of sharp pain you are experiencing, especially if they are fleeting and not accompanied by other alarming symptoms, are less likely to be related to a serious cardiac issue.

The left upper back pain you described, particularly around the shoulder blade area, could also be related to muscular tension or stress rather than a direct heart problem. Stress and anxiety can lead to muscle tightness and discomfort in various areas of the body, including the back and chest.
Given your history of emotional distress and the recent triggering event of waking up feeling "pressed down," it is possible that your symptoms are more related to anxiety and stress rather than a primary cardiac issue. Conditions like panic disorder can manifest with physical symptoms that mimic heart problems, leading to a cycle of worry and increased anxiety.

It is crucial to follow up with your healthcare provider for further evaluation and to discuss your ongoing symptoms. They may recommend a referral to a cardiologist for a more detailed assessment or suggest seeing a mental health professional to address the anxiety component. Cognitive-behavioral therapy (CBT) and other forms of therapy can be very effective in managing anxiety symptoms.

In summary, while it is essential to take any chest pain seriously, the combination of your test results and the nature of your symptoms suggests that your heart is likely functioning well. However, addressing the underlying anxiety and stress is equally important for your overall health and well-being. Make sure to communicate openly with your healthcare provider about your concerns, and do not hesitate to seek support for both your physical and mental health.

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