Chest Pain, Shortness of Breath, and Heart Palpitations

Chest tightness, pain, shortness of breath, numbness in hands, palpitations?

Hello Doctor, I am 22 years old and have a low body weight (BMI of 16-17).
Since the beginning of this year, I have been experiencing shortness of breath when climbing stairs, along with occasional chest pain and tightness.
I initially thought it was just due to a lack of exercise or stress, but recently I find that even walking briskly causes my heart to race and my breathing to become very labored.
I feel increasingly breathless, and even speaking makes me feel out of breath.
My exercise tolerance has been declining, and the elderly people I engage in activities with do not experience similar issues.
I also frequently experience numbness in my hands and feet, or a sensation that blood is not reaching my brain, leading to dizziness and headaches.
Until May of last year, I had a habit of exercising vigorously at least three times a week for about five years (my exercise volume drastically decreased after May due to the pandemic).
During one year, I smoked and drank alcohol; I smoked no more than five cigarettes a day and did not smoke every day.
I drank alcohol approximately once every one to two weeks, and the amount was not significant.
However, I would feel palpitations after smoking or drinking.
About one or two years ago, while studying abroad, I tried marijuana a few times, taking only two or three puffs each time, and only experienced mild effects until one time when I took a puff and suddenly felt a strong effect, with my heart rate jumping to around 200 beats per minute.
It took about 15 minutes of rest for my heart rate to gradually return to normal, and I did not feel particularly unwell afterward.
Recently, I have undergone an electrocardiogram, chest X-ray, echocardiogram, and multiple blood tests, all of which did not reveal any abnormalities (the blood tests included thyroid function tests and heart failure markers, among others).
Doctor, could my symptoms be related to cardiovascular issues or neurological problems? Is it possible that a single episode of tachycardia could cause heart damage? Would a chest MRI be able to identify any heart issues? Thank you in advance for your response!

Dora, 20~29 year old female. Ask Date: 2022/11/06

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 consumption of caffeinated beverages.
It is recommended to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is advisable to visit a hospital for further evaluation.

Reply Date: 2022/11/06

More Info

Understanding chest pain, shortness of breath, and heart palpitations can be quite complex, especially for someone as young as you, who is experiencing these symptoms. Given your age (22 years) and the fact that you have undergone various tests such as an electrocardiogram (ECG), chest X-ray, echocardiogram, and blood tests without any abnormalities, it is essential to consider both cardiovascular and non-cardiovascular causes for your symptoms.

Possible Causes of Your Symptoms
1. Anxiety and Stress: Given your description of feeling breathless and experiencing palpitations, anxiety could be a significant factor. Anxiety can lead to hyperventilation, which causes shortness of breath and a racing heart. The physical symptoms of anxiety can often mimic those of heart problems, leading to a cycle of worry and increased symptoms.

2. Deconditioning: You mentioned that your physical activity has decreased significantly since the pandemic. A sudden drop in physical activity can lead to deconditioning, where your body becomes less efficient at handling physical exertion. This could explain why you feel breathless and experience chest discomfort when engaging in activities that you previously managed well.

3. Respiratory Issues: Conditions such as asthma or exercise-induced bronchoconstriction can cause shortness of breath and chest tightness, especially during physical exertion. If you have a history of respiratory issues or allergies, this could be a contributing factor.

4. Cardiovascular Concerns: While your tests have shown no abnormalities, it is still essential to consider that some heart conditions may not be easily detectable through standard tests. However, given your age and the absence of risk factors (like smoking heavily, a family history of heart disease, etc.), the likelihood of a significant cardiovascular issue is low.

5. Neurological Factors: The symptoms of numbness in your hands and feet, along with dizziness and headaches, could suggest a neurological issue. Conditions such as migraines or even transient ischemic attacks (though rare at your age) could cause these symptoms.

Addressing Your Concerns
1. Heart Damage from Tachycardia: Experiencing a rapid heart rate (tachycardia) occasionally, especially in response to stress or substances like marijuana, is generally not harmful for a healthy heart. However, if such episodes are frequent or prolonged, they could lead to issues like atrial fibrillation or other arrhythmias. It’s crucial to monitor your heart rate and seek medical advice if you experience significant changes.

2. MRI for Heart Issues: A chest MRI can provide detailed images of the heart and surrounding structures, potentially revealing issues that other tests might miss. However, it is usually reserved for specific indications, such as suspected structural heart disease or cardiomyopathy.

3. Lifestyle Modifications: Given your symptoms, consider gradually reintroducing physical activity into your routine. Start with low-intensity exercises, such as walking or yoga, and gradually increase the intensity as your fitness improves. Additionally, managing stress through mindfulness or therapy could help alleviate anxiety-related symptoms.

4. Follow-Up: Since you have already undergone extensive testing, it may be beneficial to follow up with a cardiologist or a primary care physician who can evaluate your symptoms in the context of your overall health. They may recommend further testing or refer you to a specialist if necessary.

Conclusion
In summary, while your symptoms are concerning, the absence of significant findings in your tests suggests that they may not be due to a severe cardiovascular issue. However, anxiety, deconditioning, or even mild respiratory issues could be contributing factors. It’s essential to maintain open communication with your healthcare provider, continue monitoring your symptoms, and consider lifestyle changes to improve your overall well-being. If your symptoms persist or worsen, do not hesitate to seek further medical evaluation.

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