Is It a Heart Problem? Symptoms and Seeking Further Testing

Is this a heart problem?

Hello Doctor: I previously had an electrocardiogram (ECG) at the hospital, which lasted only one to two minutes.
The doctor diagnosed me with a slight arrhythmia and said it was nothing to worry about.
However, I felt that my condition during the ECG was not severe, so I doubt the accuracy of the results.
For the past two years, I have often experienced a sensation of tightness in my heart, and I instinctively check my pulse, which sometimes feels slow and other times fast.
Occasionally, I find myself massaging the area near my heart under my armpit to feel more comfortable.
When I lie down, I notice that my breathing becomes rapid; for instance, just a few minutes ago while typing, I felt fine, but suddenly I felt a load on my heart.
Additionally, if I hold my phone with my left hand for about twenty minutes, I experience a sensation of tightness in both my left hand and heart.

Previously, I had a period where my heart rate frequently exceeded 90 beats per minute, but in recent months, I have started to appreciate the importance of health and have been taking appropriate rest, which has somewhat improved my shortness of breath.
I have also wondered if I might be experiencing hyperthyroidism due to fatigue.
However, the tightness in my heart has not gone away, and I sometimes experience nasal congestion in my left nostril, which lasts for several hours, while the right side is less affected, but it has not reached a point where I can't breathe.
I also feel somewhat lightheaded, as if my brain is lacking oxygen.

Could you please tell me what type of heart problem this situation is most likely related to? Is it hypertrophy or heart failure? Additionally, if I suspect I have had hyperthyroidism, can it improve naturally with lifestyle adjustments? I ask this because a year ago, I was very fatigued, and my symptoms were almost identical to those of hyperthyroidism.
A month ago, I wanted to check for hyperthyroidism and went for a blood test.
However, the doctor insisted on his approach, stating that my heart rate was not above 100 beats per minute and that my condition was stable, so a blood test was unnecessary.
I insisted on paying out of pocket, but he still said it was not necessary, so I left.

I feel that my condition has improved recently because I have been resting well over the past few months.
However, I still have doubts about my heart condition, which is a daily concern.
Regarding follow-up examinations, the doctor I previously consulted said I was fine.
If I want to undergo further tests, such as an echocardiogram, will the doctor refuse? If he does refuse, can I insist on having the test done at my own expense, or would I only be able to do a 24-hour ECG? Thank you for your response.

won, 20~29 year old female. Ask Date: 2001/05/27

Dr. Ke Zhengchang reply Internal Medicine

Young males can occasionally experience arrhythmias, but most are benign and transient.
Avoiding smoking, alcohol, coffee, and tea, as well as maintaining a regular routine, is crucial.
If symptoms persist and cause discomfort, a 24-hour Holter monitor can be arranged.
Thyroid function tests are meaningful only if there are clinical symptoms suggestive of hyperthyroidism, such as weight loss, rapid heartbeat, insomnia, goiter, or exophthalmos.
Echocardiography is not particularly helpful in diagnosing arrhythmias unless there are heart murmurs or signs of cardiac enlargement.

Reply Date: 2001/05/27

More Info

It's understandable to feel concerned about your heart health, especially given the symptoms you've described. Let's break down your situation and address your questions regarding potential heart problems and the steps you can take for further evaluation.

First, the symptoms you've mentioned—such as the sensation of pressure or discomfort in your chest, irregular heartbeats, and feelings of breathlessness—can indeed be concerning. However, it's important to note that many factors can contribute to these sensations, including anxiety, stress, and even physical fatigue. Your previous evaluations, including the electrocardiogram (ECG) and the doctor's reassurance about your heart's condition, suggest that there may not be an immediate, serious heart problem.
The feeling of "acid" or discomfort in the heart area could be related to several non-cardiac issues, such as musculoskeletal pain, gastroesophageal reflux disease (GERD), or anxiety-related symptoms. The fact that you have experienced some improvement with lifestyle changes, such as getting adequate rest, is a positive sign. It indicates that your body is responding to healthier habits, which can significantly impact overall well-being.

Regarding your concerns about potential thyroid issues, hyperthyroidism can indeed cause symptoms such as increased heart rate, anxiety, and fatigue. If you suspect that you might have thyroid problems, it is reasonable to pursue further testing, such as blood tests to check thyroid hormone levels (TSH, T3, and T4). If your doctor is hesitant to order these tests, you can express your concerns clearly and insist on the importance of ruling out thyroid dysfunction, especially since you have a history of fatigue and other related symptoms.

As for your question about further cardiac evaluation, such as an echocardiogram (heart ultrasound), you have the right to seek additional testing if you feel it is necessary. If your current physician refuses to order these tests based on their clinical judgment, you can consider seeking a second opinion from another cardiologist. Many patients find it helpful to consult with a specialist who may be more open to conducting further evaluations based on your symptoms and concerns.

In the United States, patients often have the option to self-refer for certain tests, especially if they are willing to pay out of pocket. However, it's essential to communicate openly with your healthcare provider about your symptoms and concerns. If you feel that your symptoms warrant further investigation, don't hesitate to advocate for yourself.
In summary, while your previous tests have not indicated serious heart issues, your ongoing symptoms warrant further discussion with your healthcare provider. Consider the following steps:
1. Document Your Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any potential triggers. This information can help your doctor understand your situation better.

2. Seek a Second Opinion: If you feel your concerns are not being addressed, consider consulting another healthcare provider or a cardiologist for a fresh perspective.

3. Request Specific Tests: If you believe thyroid issues could be contributing to your symptoms, ask for blood tests to evaluate your thyroid function. Similarly, express your desire for an echocardiogram if you feel it is necessary.

4. Lifestyle Modifications: Continue to focus on healthy lifestyle choices, such as regular exercise, a balanced diet, and stress management techniques, as these can significantly improve your overall health and potentially alleviate some of your symptoms.

5. Mental Health Support: Given the anxiety and stress you are experiencing, consider speaking with a mental health professional. They can provide strategies to manage anxiety, which may help reduce the physical symptoms you are experiencing.

Remember, your health is paramount, and it's essential to feel confident in the care you receive. Don't hesitate to advocate for yourself and seek the answers you need for peace of mind.

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