Persistent Chest Discomfort: Which Specialist to Consult?

A problem that has been troubling me for a long time?

Dear Doctor: A year ago, while I was at work, I suddenly experienced dizziness, difficulty breathing, and numbness in my hands and feet, feeling as if I was about to die.
Since then, I have continued to experience difficulty breathing and a sensation of tightness in my chest (feeling as if something is pressing down).
Sometimes, I feel cold accompanied by a rapid heartbeat (as if my heart is about to burst).
I have trouble sleeping at night and often feel like I can't eat.
I have undergone an electrocardiogram, chest X-ray, EEG, and 24-hour Holter monitoring, but everything came back normal.
After resting for a while, I felt that the episodes were not as frequent as before, but I still experience chest tightness and occasional rapid heartbeats (even while lying still).
Recently, I have been having frequent headaches, sometimes feeling like my head is about to explode, which is very uncomfortable and makes me feel faint.
I later consulted a traditional Chinese medicine practitioner who said my body is too weak and fatigued.
However, after a few months of treatment, I still feel no significant improvement and continue to experience chest tightness and difficulty breathing.
Additionally, a friend mentioned a report stating that scoliosis might be compressing my thoracic cavity and suggested seeing a rehabilitation specialist.
I have had chiropractic treatment, and they confirmed my scoliosis.
I have seen many doctors, from small clinics to large hospitals, and consulted both traditional and Western medicine, but there has been no significant improvement.
Could you please advise me on which specialty I should consult for these symptoms? Thank you for your help with my year-long health concerns.
Sincerely, Hui.

Hui, 20~29 year old female. Ask Date: 2004/08/18

Dr. Chen Guifeng reply Cardiology

Based on a comprehensive observation of various symptoms, it may be a case of autonomic nervous system dysregulation syndrome, primarily caused by stress, tension, fatigue, or emotional instability.
This condition can lead to dysfunction in multiple organs and a variety of symptoms.
Psychological adjustment or therapy can be provided by a psychiatrist or a psychosomatic specialist.

Reply Date: 2004/08/18

More Info

Hello Hui,
Thank you for sharing your experience and symptoms. It sounds like you have been through a challenging journey over the past year, and I commend you for your persistence in seeking help. Your symptoms, including chest discomfort, difficulty breathing, rapid heartbeat, and headaches, can be distressing and may have multiple underlying causes. Given the complexity of your situation, it’s essential to approach this systematically.

Firstly, it’s important to recognize that your symptoms could stem from various sources, including physical, psychological, or a combination of both. Since you have already undergone several tests, including an electrocardiogram (ECG), chest X-ray, and EEG, which have returned normal results, it may be beneficial to consider other potential causes.

1. Cardiology: While your initial cardiac tests were normal, it might be worth revisiting a cardiologist, especially if you continue to experience rapid heartbeats and chest discomfort. Sometimes, conditions like arrhythmias or other heart-related issues may not be evident in standard tests but can be diagnosed with more specialized monitoring, such as a Holter monitor or an echocardiogram.

2. Pulmonology: Since you experience breathing difficulties, consulting a pulmonologist could be beneficial. They can evaluate for conditions such as asthma, chronic obstructive pulmonary disease (COPD), or other respiratory issues that might not have been apparent in initial assessments.

3. Neurology: Given your symptoms of dizziness, headaches, and the sensation of your head "about to explode," a neurologist could help rule out any neurological conditions. They may conduct further imaging studies, such as an MRI, to assess for any underlying issues.

4. Psychiatry/Psychology: Your symptoms could also be related to anxiety or panic disorders, especially considering the acute onset of your symptoms during a stressful situation at work. A mental health professional can help assess whether anxiety is contributing to your physical symptoms and provide appropriate treatment options, including therapy or medication.

5. Physical Therapy/Rehabilitation: If there is a concern about your spine, such as scoliosis or other musculoskeletal issues, a physical therapist or a rehabilitation specialist could help. They can provide exercises and treatments to alleviate any physical strain that might be contributing to your discomfort.

6. Integrative Medicine: Since you have tried traditional Chinese medicine without significant improvement, you might consider exploring integrative approaches that combine both Western and Eastern practices. This could include acupuncture, yoga, or mindfulness practices, which can help manage stress and improve overall well-being.

In summary, I recommend that you consider a multidisciplinary approach to your symptoms. Start by revisiting a cardiologist and a pulmonologist, and then explore the possibility of consulting a neurologist and a mental health professional. Keeping a detailed diary of your symptoms, including when they occur and any potential triggers, can also be helpful for your healthcare providers in diagnosing and treating your condition.

Remember, it’s essential to advocate for yourself in the healthcare system. If you feel that your concerns are not being addressed, don’t hesitate to seek a second opinion or ask for referrals to specialists who can provide the care you need. Your health and comfort are paramount, and finding the right support is crucial in your journey towards feeling better.

Take care, and I hope you find the answers and relief you seek soon.

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