Persistent Chest Pain for a Month: Which Specialist Should You See?

Q: Persistent Chest Pain for a Month: Which Specialist Should You See?

Hello： After undergoing a chest X-ray and pulmonary function tests in the pulmonology department, the cardiology department can perform an echocardiogram and electrocardiogram.

If you have been experiencing chest pain for about a month, you should see a cardiologist?

Hello, in the past month, I have experienced three episodes of significant chest pain, primarily located on the left side near the heart, occasionally radiating from the center.
The first episode was sudden and accompanied by a feeling of breathlessness, lasting about 10 minutes.
The second and third episodes were similar, with sudden chest pain, but both times the pain became more pronounced after swallowing.
During these episodes, I also experienced some shortness of breath.
The symptoms of the third episode were intermittent and lasted over half an hour, with a period of increased pain and breathlessness lasting about two minutes before it improved.
Initially, the pain was localized to the left side of the chest and later spread slightly to the lower left area of the heart.
I felt that the third episode was the most painful, and it felt somewhat like heart pain (with significant pain and breathlessness at that time).

I have researched the causes of chest pain and am unsure if it could be a heart issue or gastroesophageal reflux, as I have not experienced symptoms of acid reflux or food regurgitation.
In addition to these three severe episodes, I have had a few sudden pains that lasted about three minutes before resolving.
Prior to this, I had influenza A and COVID-19; during the influenza A episode, I experienced sudden shortness of breath and increased heart rate.
I consulted a clinic physician who suggested it was likely not a heart issue.
With COVID-19, I developed a fever the night before my positive test, feeling very cold and breathless.

Given that I have experienced these episodes of chest pain multiple times in a month, should I see a pulmonologist, a cardiologist, or a general internist? Thank you, doctor.

Yun, 20~29 year old female. Ask Date: 2023/10/18

Dr. Wu Yingxun reply Pulmonology

Hello: After undergoing a chest X-ray and pulmonary function tests in the pulmonology department, the cardiology department can perform an echocardiogram and electrocardiogram.

Reply Date: 2023/10/18

More Info

Persistent chest pain can be a concerning symptom, especially when it occurs multiple times over a month and is associated with shortness of breath. Given the nature of your symptoms, it is crucial to approach this situation with caution and seek appropriate medical evaluation.

Based on your description, the chest pain you are experiencing is located primarily on the left side, near the heart, and is accompanied by episodes of shortness of breath. The fact that the pain intensifies with swallowing suggests that it could potentially be related to gastrointestinal issues, such as gastroesophageal reflux disease (GERD), but it is also essential to rule out any cardiac conditions.

When considering which specialist to consult, both cardiology and gastroenterology could be relevant. However, given the acute nature of your symptoms, especially the episodes of severe pain and difficulty breathing, it would be prudent to start with a cardiologist. A cardiologist specializes in heart-related issues and can perform necessary tests, such as an electrocardiogram (ECG), echocardiogram, or stress tests, to evaluate your heart's health and rule out any serious conditions such as angina or myocardial infarction (heart attack).

If the cardiologist determines that your heart is functioning well and that your symptoms are not cardiac-related, they may refer you to a gastroenterologist for further evaluation of potential gastrointestinal causes. GERD, for instance, can cause chest pain that mimics heart pain, especially if there is acid reflux affecting the esophagus.

In addition to consulting a specialist, it is essential to monitor your symptoms closely. Keep a diary of when the pain occurs, its intensity, duration, and any associated symptoms (like shortness of breath, nausea, or changes in heart rate). This information can be invaluable for your healthcare provider in making an accurate diagnosis.

Furthermore, given your history of influenza and COVID-19, it is worth mentioning that respiratory infections can sometimes lead to complications such as myocarditis (inflammation of the heart muscle) or other post-viral syndromes that could contribute to chest pain and breathing difficulties. Therefore, sharing this information with your doctor will provide a more comprehensive view of your health history.

In summary, I recommend that you see a cardiologist first to evaluate your chest pain and shortness of breath. If cardiac issues are ruled out, a referral to a gastroenterologist may be necessary to explore potential gastrointestinal causes. Do not hesitate to seek immediate medical attention if your symptoms worsen or if you experience severe chest pain, as this could indicate a medical emergency. Your health and safety should always be the priority.

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