Chest Pain: Causes and When to Seek Help

Chest tightness or chest pain?

Hello doctor, I have been experiencing a feeling of tightness and pain in my chest for over two weeks now.
Initially, I thought it was due to exercise, but it hasn't improved over time.
When sitting, I often feel my heart beating strongly, and I can feel it throughout my body.
There is a persistent pain slightly above the center of my chest, and I experience severe pain in my heart about every two to three days that lasts for three to five seconds.
I also find myself getting short of breath more easily and feel very fatigued with even slight activity.
Could you please advise what might be the cause? I apologize for taking up your valuable time.

Johnny, 20~29 year old female. Ask Date: 2005/10/13

Dr. Zhao Chongliang reply Internal Medicine

On October 5th, another woman raised a similar question, and the response provided at that time is as follows for your reference.
(When considering general chest pain, one must take into account various sources of pain such as the chest wall, heart, respiratory organs, esophagus, and surrounding tissues.
Additionally, women may experience breast tenderness before menstruation, which can also lead to chest pain.
Regarding the chest wall, pain is often due to overuse of muscles during work or exercise, or from a strong impact that can cause muscle injury or even rib fractures, which seems similar to your situation.
In terms of the heart, conditions like angina or myocardial infarction are possible, but since the pain subsided after 20 minutes, these are unlikely.
If there are still concerns, an electrocardiogram (ECG) can be performed.
The respiratory organs may indicate pneumothorax, which mostly occurs in tall, thin individuals; a chest X-ray can help rule this out.
The esophagus may be involved in gastroesophageal reflux disease (GERD), which often presents with acid regurgitation, typically occurring when lying flat at night, unlike your symptoms while practicing piano.
Therefore, if chest X-rays and ECGs at the hospital show no abnormalities, general muscle relaxants or analgesics can be used, along with antacids.) However, you also mentioned experiencing palpitations and shortness of breath.
I wonder if you smoke; if so, it is advisable to quit smoking.
The chest X-ray should be carefully examined for any smoking-related damage, including chronic bronchitis, emphysema, and lung cancer.
If the ECG shows a heart rate exceeding 90 beats per minute, further investigation into thyroid function is warranted.
If this symptom persists, it is important to monitor your pulse to see if it exceeds 90 or 100 beats per minute.
If so, consider mitral valve prolapse or paroxysmal tachycardia, and additional tests such as echocardiography and a 24-hour Holter monitor may be necessary.
Severe cases can be life-threatening, so it is crucial to seek emergency care promptly.

Reply Date: 2005/10/13

More Info

Chest pain can be a concerning symptom and may arise from various causes, ranging from benign to serious conditions. Given your description of persistent chest discomfort, feelings of a racing heart, and episodes of sharp pain, it is essential to approach this situation with caution.

Firstly, the sensation of chest tightness and pain, especially if it has persisted for over two weeks, warrants a thorough evaluation. While it is possible that these symptoms could be related to musculoskeletal issues, such as muscle strain from physical activity, they could also indicate more serious cardiovascular problems. Conditions such as angina, which is chest pain due to reduced blood flow to the heart, or even a heart attack, could present with similar symptoms. Other potential causes include gastroesophageal reflux disease (GERD), anxiety, or even lung-related issues like pulmonary embolism or pneumonia.

The fact that you experience a racing heart and shortness of breath with minimal exertion is particularly concerning. These symptoms could indicate that your heart is under stress or that there is an underlying condition affecting your cardiovascular system. It is crucial to consider risk factors such as age, family history of heart disease, smoking, high blood pressure, high cholesterol, or diabetes, as these can significantly increase the likelihood of heart-related issues.

Given the duration and nature of your symptoms, I strongly recommend seeking medical attention as soon as possible. A healthcare provider will likely perform a physical examination and may order diagnostic tests such as an electrocardiogram (ECG), chest X-ray, blood tests, or even a stress test to assess your heart's function. These tests can help rule out serious conditions and guide appropriate treatment.

In the meantime, it may be beneficial to monitor your symptoms closely. Keep track of when the pain occurs, its intensity, and any associated symptoms such as sweating, nausea, or dizziness. This information can be invaluable for your healthcare provider in determining the cause of your symptoms.

If you experience any of the following symptoms, seek emergency medical care immediately:
- Severe chest pain or pressure, especially if it radiates to the arm, jaw, or back
- Shortness of breath or difficulty breathing
- Dizziness, lightheadedness, or fainting
- Sweating or a feeling of impending doom
In conclusion, while there are many potential causes for your chest pain, the combination of persistent discomfort, heart palpitations, and shortness of breath necessitates a thorough evaluation by a healthcare professional. Early intervention can be critical in addressing any underlying issues and ensuring your overall health and well-being. Please do not hesitate to reach out to a medical provider for further assistance. Your health is paramount, and addressing these symptoms promptly can lead to better outcomes.

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