Unusual Heart Sensations: When to Seek Further Evaluation

Cardiac dysphoria

Hello, Doctor.
I am 55 years old, with normal height and weight.
I have a family history of hyperlipidemia and am currently on medication, with my levels now normal.
I usually maintain a light diet, do not smoke or drink, and exercise regularly.
However, a few days ago, I woke up feeling an unusual sensation in my chest that gradually became more pronounced, expanding from the size of a fist to about the size of a bowl.
After about five minutes of applying a warm compress, the sensation disappeared.
Later, while walking, I felt a tingling in my right back, which eased as I rubbed it.
When I returned home and did some exercise, I experienced nausea and the urge to vomit, which also gradually subsided.
After visiting the municipal hospital, the unusual sensation was gone.
Blood tests and an electrocardiogram were normal, and the doctor said it was just nerve pain.
Is that really the case? The sensation this time feels different from my previous heart discomfort.
I also have a long-standing issue with gastroesophageal reflux and have been undergoing rehabilitation for shoulder pain due to frozen shoulder and various inflammations.
Could these be contributing factors? Although my hyperlipidemia has been managed with medication and my levels are now normal, I am concerned that this could be a precursor to a myocardial infarction.
Should I undergo further testing? Thank you for your response, Doctor.

Jess Chen, 50~59 year old female. Ask Date: 2023/06/01

Dr. He Dongjin reply Cardiology

Hello, it is very likely that what you mentioned is related to frozen shoulder, gastroesophageal reflux, or possibly a precursor to myocardial infarction.
It's hard to say for certain, so if you're feeling uneasy, it would be advisable to visit a cardiologist for further evaluation.
Changhua Hospital cares about your well-being.

Reply Date: 2023/06/01

More Info

When it comes to unusual heart sensations, especially in the context of a 55-year-old individual with a family history of hyperlipidemia, it is crucial to approach the situation with caution. Your symptoms, which include a sensation of tightness in the chest that expands and is accompanied by right-sided back numbness and nausea, warrant a thorough evaluation to rule out any serious cardiac conditions, despite the initial tests showing normal results.

Firstly, it is important to understand that chest discomfort can arise from a variety of causes, not just cardiac issues. Given your history of gastroesophageal reflux disease (GERD), it is possible that some of your symptoms could be related to acid reflux, which can mimic cardiac pain. The sensation of tightness and discomfort can often be confused with heart-related issues, especially if it is located in the chest area. Additionally, your history of shoulder pain and inflammation could also contribute to referred pain, which is when pain is perceived in an area different from its source.

However, the fact that you experienced a significant sensation that expanded in size and was accompanied by nausea is concerning. While the initial evaluation at the hospital, including blood tests and an ECG, returned normal results, it is essential to consider that these tests do not always capture transient ischemic events or other underlying conditions. The absence of immediate symptoms during the examination does not rule out the possibility of cardiac issues, particularly if you have a family history of heart disease and hyperlipidemia.

The right-sided back numbness you experienced could also be indicative of nerve-related issues, such as thoracic outlet syndrome or even referred pain from a cervical spine issue. However, it is essential to differentiate between musculoskeletal pain and potential cardiac ischemia. The presence of nausea and the nature of your discomfort could suggest that further evaluation is warranted.

Given your concerns about myocardial infarction (heart attack) and the unusual nature of your symptoms, it would be prudent to seek further evaluation. This could include more advanced cardiac testing, such as a stress test or a cardiac imaging study like a myocardial perfusion scan, which can provide more insight into the blood flow to your heart muscle during stress and at rest. These tests can help identify any ischemic changes that may not have been evident during your initial evaluation.

In summary, while your initial tests were normal, your symptoms and medical history suggest that further investigation is warranted. It is always better to err on the side of caution, especially with potential cardiac symptoms. I recommend discussing your concerns with your healthcare provider, who may refer you for additional testing to ensure that any underlying issues are identified and managed appropriately. Your health and peace of mind are paramount, and taking proactive steps in evaluating your symptoms is essential.

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