Chest Pain and Palpitations: When to Seek Heart Care

Suspected angina pectoris?

Hello, doctor: I have been experiencing strong palpitations every time I wake up for the past six months.
After waking up, I cannot go back to sleep because of the persistent palpitations.
Today, I felt an unexplained pain in my left back, followed by chest tightness, shortness of breath, sweating, and a sense of pressure spreading throughout my upper body, as if something heavy was pressing down on me.
I felt weak all over, and these symptoms lasted for about 20 to 30 minutes.
At one point, my blood oxygen level dropped to 85.
Could you please explain why the doctor did not order tests for coronary artery disease?

He Tong, 40~49 year old female. Ask Date: 2022/12/05

Dr. Wu Xueming reply Cardiology

It is recommended that if these symptoms persist and worsen, you should go to the hospital for further examination.

Reply Date: 2022/12/05

More Info

When it comes to understanding chest pain and palpitations, it is crucial to recognize the potential seriousness of these symptoms and when to seek medical attention. Based on your description, you have been experiencing significant palpitations upon waking, accompanied by episodes of chest discomfort, shortness of breath, sweating, and a feeling of pressure in your upper body. These symptoms can be alarming and warrant further investigation.

Firstly, palpitations can be caused by a variety of factors, including anxiety, caffeine intake, dehydration, or underlying heart conditions. The fact that your palpitations occur consistently upon waking suggests that there may be a physiological trigger, such as changes in your body's autonomic nervous system during sleep transitions. However, the additional symptoms you describe—chest pain, shortness of breath, and low oxygen saturation—are concerning and could indicate a more serious condition, such as coronary artery disease or other cardiac issues.

The episodes of pain radiating to your left side and the sensation of pressure can be indicative of angina, which is chest pain caused by reduced blood flow to the heart muscle. This is particularly concerning given your reported history of symptoms lasting 20-30 minutes and the drop in blood oxygen levels to 85%. Normal blood oxygen saturation levels should be between 95-100%, and a drop to 85% is significant and could suggest a respiratory or cardiovascular issue.

It is also important to consider that while your physician may have assessed your symptoms and determined that immediate testing for coronary artery disease was not necessary, your persistent and worsening symptoms should prompt a reevaluation. Diagnostic tests such as an electrocardiogram (ECG), echocardiogram, stress test, or even coronary angiography may be warranted to rule out any serious underlying conditions.

In light of your symptoms, it is advisable to seek a consultation with a cardiologist. They can perform a thorough evaluation, including a detailed history and physical examination, and may recommend further testing to assess your heart's function and structure. It is essential to communicate all your symptoms clearly, including the frequency, duration, and intensity of your palpitations and chest pain, as well as any associated symptoms like sweating and shortness of breath.

In the meantime, consider lifestyle modifications that may help alleviate some of your symptoms. Reducing caffeine intake, managing stress through relaxation techniques, and ensuring adequate hydration can be beneficial. Additionally, keeping a symptom diary to track when your palpitations and chest pain occur, along with any potential triggers, can provide valuable information for your healthcare provider.

In summary, given the nature and persistence of your symptoms, it is crucial to seek further medical evaluation. Do not hesitate to advocate for your health and request the necessary tests to ensure that any potential heart issues are addressed promptly. Your health and well-being are of utmost importance, and early intervention can make a significant difference in outcomes related to heart health.

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