Chronic Cough and Chest Discomfort: When to See a Neurologist?

Chronic cough with occasional chest tightness and chest (back) pain?

Hello, doctor.
I have been experiencing related symptoms for about two years.
The frequency of my cough is relatively high but not severe.
My main concerns are "chest tightness and chest (back) pain," which mostly occur in the area near my left upper back.
The chest tightness feels like varying degrees of pressure, and when it hurts, it feels more like a net-like sensation rather than a sharp pain.
Additionally, I suspect I have palpitations, but I'm unsure if they are related to the aforementioned symptoms or if they are a consequence of post-COVID complications.
I have two possible causes in mind.
The first and most concerning is that I had a motorcycle accident five years ago.
After falling, I rolled over on the road, and my body acted as a cushion for the motorcycle, sliding for a distance before stopping, which resulted in severe bruising and fractures in my chest area.
When I bend my upper body, I feel a tearing pain in my chest.
After a brief period of rest, I noticed that my ribs seemed to protrude outward.
I went to the emergency department at National Cheng Kung University Hospital for an MRI, but no issues were found.
I then visited a traditional Chinese medicine clinic, where the practitioner suggested that my ribs and spine might be misaligned, mentioning that this could lead to "pseudo-heart disease." I wonder if this indicates that the nerves above or below my spine might also be injured or misaligned, which could be causing my chest tightness and chest (back) pain symptoms due to lack of treatment.
The second possibility is that I do not smoke, drink, or chew betel nut (aside from being frequently exposed to secondhand smoke from neighbors or passersby).
However, I lack exercise habits and am overweight.
I have a history of consuming cold drinks, staying up late, and maintaining poor posture (hunching), and my chest tightness and chest (back) pain mostly occur when I stay up late and sit at the computer.
The intervals between occurrences usually range from a few days to a few weeks, and resting for a few minutes lying down can alleviate the symptoms.
I do not experience dizziness or difficulty breathing, and I do not feel pain in my chest (or lungs) while breathing, nor do I have significant insomnia.
Recently, due to my new work environment, I have been exposed to cold winds for extended periods, leading to prolonged chest tightness.
Even while wearing multiple layers, I still feel cold in my chest and back.
During my afternoon rest lying down, I have also experienced palpitations, with a noticeable increase in heart rate.
Therefore, last week, I visited a thoracic hospital and informed them that I had undergone a health check at National Cheng Kung University Hospital in October, where the report mentioned "infiltration behind the heart." Subsequent chest X-rays and an electrocardiogram showed no abnormalities.
The hospital doctor only prescribed pain relief medication and suggested a visit to a cardiologist.
However, after taking the medication as instructed the next day, my symptoms did not improve.
I then sought treatment at a traditional Chinese medicine clinic, where the doctor, after taking my pulse, suspected heart issues and also recommended a cardiology consultation.
Today, I visited the cardiology department, and the diagnosis was consistent with that of the thoracic hospital, ruling out the possibility of heart disease.
They only arranged for blood tests and prescribed medication to alleviate palpitations, with a follow-up appointment scheduled in a month to review the test results.
I would like to ask the doctor, if no source of pain is found in the cardiology department, should I consider consulting a neurologist? I truly do not know what to do next...

HMG, 20~29 year old female. Ask Date: 2023/11/28

Dr. Wu Mukhan reply Neurology

Hello, palpitations may be related to autonomic nervous system dysfunction causing an increased heart rate, or they may be associated with psychological factors such as anxiety and stress.
If no cause is found in cardiology, further evaluation can be sought in neurology or psychiatry clinics.

Reply Date: 2023/11/28

More Info

Chronic cough and chest discomfort can be quite distressing, especially when they persist over an extended period. Your symptoms, including chest tightness, back pain, and palpitations, warrant a thorough evaluation to determine their underlying causes. Given your history of a significant chest injury from a motorcycle accident, it is essential to consider both physical and neurological factors that could contribute to your current symptoms.

Firstly, the chest pain and discomfort you describe, particularly the sensation of pressure and the "net-like" feeling, could be related to musculoskeletal issues stemming from your past injury. Rib fractures or dislocations can lead to chronic pain and discomfort, especially if they have not healed properly or if there is ongoing irritation of the nerves in that area. The fact that your pain intensifies with certain positions or activities, such as sitting for long periods or bending, supports this possibility. It may be beneficial to consult with a specialist in physical medicine and rehabilitation or a chiropractor who can assess your spine and ribcage alignment.

Additionally, your symptoms could also be influenced by anxiety or stress, particularly given your mention of palpitations and the impact of your work environment. Anxiety can manifest physically, leading to symptoms such as chest tightness, increased heart rate, and even chronic cough. The connection between psychological stress and physical symptoms is well-documented, and addressing anxiety through therapy or stress management techniques may provide relief.

Regarding your question about seeing a neurologist, it could be a reasonable step if your symptoms persist despite evaluations from other specialists. Neurological issues, such as nerve compression or irritation, can lead to referred pain in the chest and back. A neurologist can perform specific tests to assess nerve function and determine if there are any underlying neurological conditions contributing to your symptoms.

It is also important to consider the possibility of post-COVID syndrome, given your history of a COVID-19 infection. Some individuals experience lingering symptoms, including respiratory issues, chest pain, and palpitations, long after the initial infection has resolved. If your symptoms align with this, a multidisciplinary approach involving pulmonologists, cardiologists, and neurologists may be necessary to address the various aspects of your health.

In summary, if your heart and lung evaluations have returned normal results, and you continue to experience symptoms, it would be prudent to explore the possibility of musculoskeletal issues, anxiety-related symptoms, or neurological factors. A comprehensive approach that includes physical therapy, psychological support, and possibly a consultation with a neurologist could help you find the relief you seek. Always ensure that you communicate openly with your healthcare providers about your symptoms and concerns, as this will aid them in providing the best possible care tailored to your needs.

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