Chest Pain and Discomfort: When to Seek Medical Help

Q: Chest Pain and Discomfort: When to Seek Medical Help

Hello, gentleman： I understand that you have seen many doctors and hospitals and undergone numerous tests. <br>If there is still no definitive diagnosis, at least it can be confirmed that it is not a common or serious illness. <br>Chest tightness and palpitations are subjective d

Please ask your question?

Hello.
I have a few questions to ask.
Recently, I often feel chest tightness and chest pain.
The pain is not always in the same place; sometimes it's on the right side, sometimes on the left.
Generally, the pain subsides quickly.
The area that hurts the most is below the left breast.
Sometimes I also feel a bit of difficulty breathing.
I have allergic rhinitis, so I often experience nasal congestion and tend to breathe through my mouth.
However, recently, I have also experienced some difficulty breathing through my mouth.
I also have palpitations.
When I feel palpitations, I check my heart rate, which is mostly around 105 beats per minute, sometimes reaching up to 120 beats per minute.
I am 188 cm tall and weigh 125 kg.
I started experiencing symptoms at the end of last year and have been undergoing examinations until May, but no cause has been found.
Later, there was some improvement, and the symptoms became less noticeable, so I stopped the examinations.
The tests I have undergone include X-rays, echocardiograms, thyroid tests, gastroscopy, abdominal ultrasound, kidney function tests, electrocardiograms, and 24-hour Holter monitoring.
I have visited larger hospitals such as National Taiwan University Hospital, Chang Gung Memorial Hospital, and Cathay General Hospital.
Aside from my blood pressure being at the high end, everything else seems fine.
I would like to know if it is necessary to undergo further examinations since I have started feeling uncomfortable again, or if I should switch to a different specialty.
Which specialty should I consult? When I was treated at the Sanchong County Hospital, Dr.
Lin Liang-Yu referred me to National Taiwan University Hospital.
Are you that Dr.
Lin?

gentleman, 20~29 year old female. Ask Date: 2003/12/18

Dr. Lin Liangyu reply Cardiology

Hello, gentleman: I understand that you have seen many doctors and hospitals and undergone numerous tests.
If there is still no definitive diagnosis, at least it can be confirmed that it is not a common or serious illness.
Chest tightness and palpitations are subjective descriptions; some people experience chest tightness when they are emotionally unstable or have poor sleep.
The causes of chest pain are not necessarily heart-related; sometimes it can be due to nerve or muscle pain.
Based on your weight and height, it is clear that you are overweight, and with your blood pressure at the high end, you should be cautious of having insulin resistance.
Individuals with this condition may experience obesity, hypertension, diabetes, and hyperlipidemia as they age, and the incidence of cardiovascular diseases may also increase.
I believe the best approach is: 1.
Pay attention to your diet; avoid foods that are too oily, sweet, or salty, and eat more fruits and vegetables.
2.
Use exercise and dietary control to lose weight.
3.
Maintain a regular lifestyle and avoid staying up late.
Currently, some medications are being developed for this condition, but large-scale studies have yet to confirm their efficacy.
As long as you adhere to these points, I believe your symptoms should improve.
Additionally, I am Dr.
Lin from Tri-Service General Hospital.

Reply Date: 2003/12/18

More Info

Chest pain and discomfort can be concerning symptoms, and it's essential to understand when to seek medical help. Based on your description, it seems you have been experiencing intermittent chest pain, primarily located under the left breast, along with feelings of breathlessness and palpitations. Given your history of allergic rhinitis, which can lead to nasal congestion and mouth breathing, it's understandable that you might experience some discomfort in your chest area.

Firstly, it's important to clarify that chest pain can arise from various causes, some of which may be benign, while others can be serious. The fact that you have undergone multiple tests, including X-rays, echocardiograms, thyroid tests, gastroscopies, abdominal ultrasounds, and both standard and 24-hour ECGs, is a good step toward ruling out significant cardiac or structural issues. However, the persistence of your symptoms suggests that further evaluation may still be warranted.

When to Seek Medical Help
1. Severity and Duration: If your chest pain becomes severe, lasts longer than a few minutes, or is accompanied by other symptoms such as sweating, nausea, or radiating pain to the arm or jaw, you should seek immediate medical attention. These could be signs of a heart attack.

2. New or Worsening Symptoms: Since you mentioned that your symptoms have recently returned and are causing discomfort, it would be prudent to consult a healthcare provider. Even if previous tests were normal, new or worsening symptoms warrant further investigation.

3. Associated Symptoms: The presence of palpitations and breathlessness, especially if they are new or have changed in character, should not be ignored. These symptoms can indicate various conditions, including anxiety, arrhythmias, or even respiratory issues.

Potential Next Steps
- Cardiology Referral: Given your history of palpitations and chest discomfort, a follow-up with a cardiologist may be beneficial. They can assess your heart health further, possibly recommending additional tests like a stress test or Holter monitor to evaluate your heart's function during physical activity.

- Pulmonary Evaluation: Since you also experience breathlessness, a pulmonary function test may help determine if there are any underlying respiratory issues contributing to your symptoms.

- Gastroenterology Consultation: If you have not already done so, consider consulting a gastroenterologist, especially if you have symptoms that could suggest gastroesophageal reflux disease (GERD), which can mimic cardiac pain.

Lifestyle Considerations
In the meantime, consider lifestyle modifications that may help alleviate some of your symptoms:
- Breathing Techniques: Practice deep breathing exercises to help with breathlessness. This can also help reduce anxiety, which may be contributing to your palpitations.

- Avoid Triggers: If you notice that certain activities or foods exacerbate your symptoms, try to avoid them.

- Regular Monitoring: Keep track of your symptoms, noting when they occur, their duration, and any associated activities or foods. This information can be valuable for your healthcare provider.

Conclusion
In summary, while your previous tests have not indicated a serious condition, the recurrence of your symptoms suggests that further evaluation is necessary. It is advisable to consult with a healthcare provider who can guide you on the appropriate next steps, whether that involves further cardiac evaluation, pulmonary assessment, or another specialty. Your health is paramount, and addressing these symptoms proactively is essential for your well-being.

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