Chest Pain: Possible Causes and When to Seek Help

Suspected angina pectoris?

Hello, may I ask why since the beginning of this year, after receiving antihistamines from the emergency doctor, I often experience sudden heart rates exceeding 100 beats per minute? For example, when I squat down.
Additionally, whenever I have heavy menstrual bleeding, I feel like I'm on the verge of collapsing, lying in bed all day, struggling to breathe, with my heart racing.
(In the past, I only needed to eat a little to feel better.) Why is it that recently, whenever I eat or get up quickly, I experience palpitations and chest tightness that can last all day? I also have cold sweats and sometimes feel so breathless that I feel weak, as if my blood is about to explode.
My entire body feels extremely hot, to the point where it feels like my blood is rushing to the top of my head and about to burst.
I am now afraid to exercise or eat.
What could be the reason for this? My blood pressure has been around 132, sometimes reaching 159 (two years ago, my blood pressure was around 120 and rarely exceeded 130).
Is my condition somewhat similar to "vasospasm" causing angina? If I want to determine the cause, would a coronary CT scan be necessary? How can I explain to the doctor that I do not have autonomic nervous system dysfunction? The doctors at the hospital tend to dismiss my condition as autonomic nervous system dysfunction without providing any diagnosis.

He Tong, 40~49 year old female. Ask Date: 2022/12/08

Dr. Wu Xueming reply Cardiology

It is recommended to adjust your daily routine and engage in regular exercise.
However, if symptoms persist, it is advisable to visit a hospital for further evaluation, such as a myocardial perfusion scan or a coronary computed tomography (CT) scan.

Reply Date: 2022/12/08

More Info

Chest pain can be a concerning symptom, and understanding its potential causes is crucial for determining when to seek medical help. Based on your description, it seems you are experiencing a range of symptoms including palpitations, shortness of breath, and chest discomfort, particularly during specific situations such as menstruation or after eating. These symptoms can be indicative of various underlying conditions, and it’s essential to approach them with caution.

Firstly, the symptoms you describe, such as rapid heart rate (tachycardia), chest tightness, and shortness of breath, can be associated with several factors. One possibility is that they may be related to hormonal changes during your menstrual cycle, especially if you are experiencing heavy bleeding and subsequent anemia. Anemia can lead to decreased oxygen delivery to tissues, which may cause fatigue, weakness, and increased heart rate as your body attempts to compensate for the lack of oxygen. This could explain why you feel particularly unwell during your menstrual periods.

Additionally, the mention of antihistamines and their potential side effects is important. Some antihistamines can cause drowsiness or affect heart rhythm, which might contribute to feelings of palpitations or increased heart rate. If you have recently started or changed any medications, it’s worth discussing this with your healthcare provider.

Your concern about experiencing symptoms like cold sweats and a feeling of heat or pressure in your head could also be related to anxiety or panic attacks, especially if these symptoms arise in conjunction with stress or after certain activities. However, it’s crucial to rule out any cardiac issues, particularly if you have a history of elevated blood pressure readings.

Regarding your question about coronary artery spasms, also known as Prinzmetal's angina, it is indeed a condition that can cause chest pain due to temporary tightening (spasm) of the muscles in the artery walls, leading to reduced blood flow to the heart. This can result in symptoms similar to those you are experiencing, especially if they occur at rest or during periods of stress.

To accurately diagnose your condition, it would be advisable to undergo a thorough evaluation. This may include tests such as an electrocardiogram (ECG), echocardiogram, or even a coronary CT angiogram to assess the condition of your coronary arteries. It’s essential to communicate your symptoms clearly to your healthcare provider, emphasizing the frequency, triggers, and nature of your chest pain and associated symptoms.

When discussing your symptoms with a doctor, you might say something like, "I've been experiencing episodes of rapid heart rate, chest tightness, and shortness of breath, especially during my menstrual cycle or after eating. I’m concerned that these could be related to my blood pressure or possibly something like coronary artery spasms. I would like to explore diagnostic tests to rule out any serious conditions."
In summary, while your symptoms could be related to hormonal changes, anxiety, or medication side effects, it’s crucial to rule out any serious cardiovascular issues. Seeking a comprehensive evaluation from a healthcare professional, preferably a cardiologist, can help clarify the underlying causes of your symptoms and guide appropriate management. Remember, it’s always better to err on the side of caution when it comes to chest pain and related symptoms.

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