Chest Pain, Shortness of Breath, and Dizziness in Young Adults

Q: Chest Pain, Shortness of Breath, and Dizziness in Young Adults

Dear Mr. <br>Yang：<br>1. <br>When a clinician addresses the issue of chest pain, the first four critical conditions to rule out are myocardial infarction, pulmonary embolism, pneumothorax, and aortic dissection. <br>If none of these conditions are present, differential diagnoses

Chest pain, chest tightness, difficulty breathing, and dizziness?

Hello doctor, I am 21 years old.
Every morning when I wake up, I almost always experience chest tightness, and sometimes I feel sharp pain in the left side of my chest or in the center.
Even when I am sitting still, I feel like I can't get enough air, and after walking a short distance, it becomes severe.
My shoulders and arms feel sore, and I also experience dizziness.
Previously, I had an exercise electrocardiogram that indicated myocardial ischemia, but after undergoing cardiac catheterization, the results were normal.
A chest X-ray also came back normal.

Yang, 20~29 year old female. Ask Date: 2023/04/29

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Yang:
1.
When a clinician addresses the issue of chest pain, the first four critical conditions to rule out are myocardial infarction, pulmonary embolism, pneumothorax, and aortic dissection.
If none of these conditions are present, differential diagnoses should be considered based on the chief complaint and symptoms, including lung tumors, lung abscess, pneumonia, tuberculosis, arrhythmias, congenital heart disease, myocardial ischemia, coronary artery spasm, pericardial issues, gastroesophageal reflux disease, esophageal tumors, esophageal structural abnormalities, musculoskeletal problems, and neuropathies, among others.
Additionally, anxiety disorders, hypochondriasis, and psychoneurosis should also be considered.
2.
I recommend that you consult with your original cardiologist to further analyze the issue.
3.
Furthermore, I personally suggest that you reduce your intake of tea, coffee, milk tea, or other caffeinated beverages or foods.

Reply Date: 2023/04/29

More Info

Chest pain, shortness of breath, and dizziness can be concerning symptoms, especially in young adults. Given your age and the symptoms you've described, it's essential to consider various potential causes, both physiological and psychological.

Firstly, let's address the physical aspects. You mentioned experiencing chest tightness and pain, particularly on the left side, along with shortness of breath and shoulder pain. These symptoms can sometimes be related to musculoskeletal issues, such as muscle strain or tension, particularly if you have been under stress or have changed your physical activity levels. Anxiety and stress can lead to muscle tension, which may manifest as chest pain or discomfort.
Moreover, you noted a previous diagnosis of myocardial ischemia (oxygen deficiency in the heart muscle) during an exercise stress test, but subsequent cardiac catheterization showed normal results. This is a positive sign, indicating that there may not be significant blockages in your coronary arteries. However, it is crucial to continue monitoring your heart health, especially if you have a family history of heart disease, as you mentioned your father underwent coronary artery bypass surgery.

Your symptoms of dizziness and feeling like you cannot get enough air could also be linked to anxiety or panic attacks. Young adults often experience anxiety, which can lead to hyperventilation—rapid or deep breathing that can cause a sensation of breathlessness and chest discomfort. This is particularly relevant if you find that your symptoms worsen during stressful situations or when you are feeling anxious.

Additionally, conditions such as gastroesophageal reflux disease (GERD) can cause chest pain that mimics cardiac pain. Acid reflux can irritate the esophagus and lead to discomfort in the chest area, especially after eating or when lying down.
Given that your chest X-ray and cardiac evaluations have returned normal results, it may be beneficial to explore other avenues. Consider consulting with a pulmonologist to rule out any respiratory issues, especially since you mentioned feeling short of breath while sitting still and after walking short distances. Conditions like asthma or other chronic respiratory issues could contribute to your symptoms.

In terms of management, it would be wise to adopt stress-reduction techniques, such as mindfulness, yoga, or regular physical activity, which can help alleviate anxiety and improve overall well-being. If you suspect that anxiety is a significant factor, speaking with a mental health professional could provide you with coping strategies and possibly therapeutic interventions.

In conclusion, while your symptoms are concerning, the normal results from your previous cardiac evaluations are reassuring. It is essential to continue monitoring your symptoms and maintain open communication with your healthcare providers. If your symptoms persist or worsen, do not hesitate to seek further evaluation to ensure that all potential causes are thoroughly investigated.

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