Chest Pain: When to Seek Further Heart Evaluation

Suspected angina pectoris?

I have already had an ultrasound, and the doctor said there were no issues, but I often wake up at night sweating cold, my feet feel cold, and I experience chest tightness and pressure.
Sometimes I can't sleep all night, and I have severe palpitations that last the entire night; previously, my palpitations would only last a few minutes.
Ever since the doctor improperly administered antihistamines for heat exhaustion, my condition has worsened to the point where I experience palpitations all night.
My palms turn pale and bloodless when I open them.
However, the cardiologist keeps saying there are no problems.
I am afraid to go out.
A few times, I forgot to have breakfast, and while walking, it feels like I'm stepping into nothingness, making me feel lightheaded and on the verge of fainting.
I never knew what a headache was before, but now I have headaches every day.
There have been instances where my blood pressure spiked to 170, causing excruciating pain that made me want to hit the wall.
Is it possible that there are no issues? Should I undergo a cardiac catheterization to potentially find something? Will undergoing a cardiac catheterization help?

nv vivian, 40~49 year old female. Ask Date: 2024/01/05

Dr. Wu Xueming reply Cardiology

Typical angina occurs during physical activity or heavy lifting, presenting symptoms such as chest tightness or shortness of breath.
Patients often have risk factors for heart disease, such as hypertension, diabetes, and smoking.
It is recommended that you visit an outpatient clinic for further evaluation.

Reply Date: 2024/01/05

More Info

When it comes to understanding chest pain and determining when to seek further heart evaluation, it is crucial to recognize the complexity of symptoms and the potential underlying causes. Based on your description, it seems you are experiencing a range of distressing symptoms, including night sweats, cold feet, chest tightness, and severe palpitations, which have significantly impacted your quality of life.
Firstly, it’s important to acknowledge that while an echocardiogram (ultrasound of the heart) may have shown no immediate issues, this does not rule out all potential heart problems. Symptoms like those you describe can be indicative of various conditions, including anxiety disorders, panic attacks, or even more serious cardiovascular issues. The fact that you experience severe palpitations and chest tightness, especially at night, warrants further investigation.

The symptoms of cold sweats and cold extremities can sometimes be associated with anxiety or panic attacks, but they can also indicate issues with blood circulation or even heart function. The sensation of feeling faint or lightheaded, particularly when walking, could suggest that your heart is not pumping effectively or that there is a problem with blood flow. Additionally, the episodes of high blood pressure you mentioned (170 mmHg) are concerning, as they can lead to further complications if not managed properly.

Given your history of persistent symptoms, including daily headaches and severe palpitations, it is advisable to seek a comprehensive evaluation from a cardiologist. While your previous evaluations may not have indicated any immediate issues, the persistence and severity of your symptoms suggest that further testing may be necessary. Tests such as a Holter monitor (which records your heart's rhythm over 24-48 hours), a stress test, or even coronary angiography (heart catheterization) could provide more insight into your heart's function and any potential blockages or abnormalities.

Coronary angiography is a procedure that allows doctors to visualize the coronary arteries and assess for any blockages that may not have been detected through non-invasive tests. While it is an invasive procedure, it can be crucial in diagnosing coronary artery disease (CAD) or other significant heart conditions. The decision to proceed with this test should be made in consultation with your cardiologist, who can weigh the risks and benefits based on your specific symptoms and medical history.

In summary, while your echocardiogram may have shown no immediate issues, the combination of your symptoms—particularly the severe palpitations, chest tightness, and episodes of high blood pressure—suggests that further evaluation is warranted. It is essential to advocate for your health and communicate your concerns clearly with your healthcare provider. If you feel that your symptoms are not being taken seriously, seeking a second opinion or asking for more comprehensive testing may be necessary. Remember, your health and well-being are paramount, and it is crucial to address these symptoms proactively.

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