Chest Pain: Causes and When to Seek Help

Chest pain. Pain with breathing?

I occasionally experience heart pain...
I'm not sure how to describe it clearly, but it feels like something is gripping me, as if I'm tied up with a rope that's being pulled tight, causing severe pain that makes it difficult to breathe.
Every breath I take is very painful, which sometimes forces me to hold my breath.
If I hold it until I can't anymore and take a slight breath, it still hurts, so I can only take short breaths.
This situation usually lasts for a few minutes.
What could be going on? Thank you for your response, doctor.

Miao Miao, 20~29 year old female. Ask Date: 2006/05/29

Dr. He Dongjin reply Cardiology

Dear Meow, your symptoms are most likely caused by mitral valve prolapse.
It is advisable to visit a cardiology clinic for further examination.

Mitral valve prolapse (MVP) is a condition that requires an understanding of the heart's structure.
The heart consists of four chambers: the left and right atria and the left and right ventricles, separated by valves that function like doors between rooms, allowing blood to flow in one direction and preventing backflow.
The mitral valve is located between the left atrium and left ventricle and is named for its resemblance to a bishop's miter.
During diastole, blood flows from the left atrium through the open mitral valve into the left ventricle.
When the left ventricle is filled with blood from the left atrium and enters systole, the mitral valve closes automatically, allowing blood to be pumped from the left ventricle into the aorta and throughout the body, preventing backflow into the left atrium.
Mitral valve prolapse occurs when congenital or acquired factors cause the annulus of the mitral valve (analogous to a door frame) to enlarge, making the valve itself relatively smaller (the frame is larger than the door), preventing a proper seal and causing part of the valve to prolapse into the left atrium.
Alternatively, the mitral valve may undergo degenerative myxomatous changes or become elongated (the door is larger than the frame), leading to part of the valve being forced into the left atrium during closure, resulting in mitral valve prolapse.
It is estimated that about 5-10% of the population has MVP, with the exact cause often unknown, but it is mostly related to genetic factors.
It is more common in females than males, with a ratio of approximately 3:1.
Most patients are asymptomatic and discover MVP incidentally during routine examinations or evaluations for other conditions.

Those who do experience symptoms typically present with at least two of the following: chest pain, palpitations, fatigue, shortness of breath, dizziness, insomnia, anxiety, panic attacks, or even syncope.
These symptoms are not directly caused by heart issues but are due to excessive sympathetic nervous system activation, leading to a syndrome often referred to as autonomic dysregulation syndrome.
Mitral valve prolapse is merely another manifestation of this syndrome and does not have a causal relationship with other symptoms.

In some patients, the inability of the mitral valve to close tightly results in some blood flowing backward into the left atrium during left ventricular contraction, clinically referred to as mitral regurgitation.
Mitral valve prolapse, in addition to causing regurgitation and left atrial enlargement, may also lead to young-onset stroke, infective endocarditis, or even sudden death, which should not be taken lightly.
Diagnosis of mitral valve prolapse involves clinical auscultation, where a characteristic click or murmur may be heard.
However, electrocardiograms and chest X-rays have limited diagnostic value.
The most important examination is echocardiography, which can visualize mitral valve prolapse and assess for mitral regurgitation or other related conditions such as rheumatic heart disease or ischemic heart disease.
The frequency, timing, triggers, and severity of symptoms in patients with mitral valve prolapse vary widely.
Some may experience episodes weekly, while others may have them monthly or even yearly.
Symptoms can last from a day or two to several weeks.
Triggers can include: colds, menstruation, emotional stress, lack of sleep, delayed meals, excessive fatigue, engaging in unfamiliar physical activities, prolonged exposure to dry and hot enclosed spaces, dehydration from excessive sweating, or the use of stimulants such as tobacco, alcohol, coffee, or drugs.
Most patients can tolerate these symptoms, but a small number may find them severely debilitating, leading to frequent emergency room visits and disrupting their daily lives, resulting in what is termed a life crisis.
There are instances where patients, due to severe chest pain, are diagnosed with angina and undergo cardiac catheterization.
However, fatalities due to life-threatening crises are extremely rare.
Medications can only provide symptomatic relief and do not cure mitral valve prolapse.
Surgery is only indicated in cases of significant mitral regurgitation affecting heart function or in cases of infective endocarditis, and it does not alleviate the aforementioned symptoms.
Fortunately, the number of cases requiring surgery is quite rare, and most patients can achieve some degree of symptom relief through medication.
Patients should also come to terms with living with this condition, accepting it as an invisible defect of the body.
If individuals experience the aforementioned symptoms and suspect they may have mitral valve prolapse, they should consult a cardiologist for evaluation.
If echocardiography confirms mitral valve prolapse, patients should be aware of situations that may trigger their symptoms and strive to avoid them.
With appropriate medication prescribed by their physician, most symptoms can be well-controlled.
If moderate to severe regurgitation is present, patients should inform their physician about the need for prophylactic antibiotics during invasive procedures or dental extractions to reduce the risk of infective endocarditis.
Unless there is significant regurgitation affecting heart function, the vast majority of patients can have children.
As for the safety of exercise, opinions vary.
If symptoms occur during exercise, it is advisable to consult your cardiologist to assess what types of exercise are appropriate.

Reply Date: 2006/05/29

More Info

Chest pain can be a concerning symptom, and understanding its potential causes is crucial for determining when to seek medical attention. Based on your description, it sounds like you are experiencing a type of chest pain that is sharp and intense, often accompanied by difficulty breathing. This can be indicative of several underlying issues, some of which may require immediate medical evaluation.

Possible Causes of Chest Pain
1. Musculoskeletal Issues: One common cause of chest pain is musculoskeletal strain, which can occur from activities that involve heavy lifting, twisting, or prolonged poor posture. This type of pain is often sharp and can worsen with movement or deep breathing.

2. Gastroesophageal Reflux Disease (GERD): Acid reflux can cause a burning sensation in the chest, often mistaken for heart-related pain. It may be accompanied by a sour taste in the mouth or a feeling of food coming back up.

3. Anxiety and Panic Attacks: Anxiety can manifest physically, leading to chest tightness or pain. Panic attacks can produce intense feelings of fear, often accompanied by shortness of breath, heart palpitations, and a sense of impending doom.

4. Cardiac Issues: While less common, chest pain can be a sign of serious heart conditions, such as angina or myocardial infarction (heart attack). Symptoms may include pressure or squeezing in the chest, pain radiating to the arms, neck, or jaw, and associated symptoms like sweating, nausea, or dizziness.

5. Pulmonary Conditions: Conditions affecting the lungs, such as pneumonia or a pulmonary embolism, can also cause chest pain. This pain may be sharp and worsen with deep breaths or coughing.

When to Seek Help
Given the intensity and nature of your pain, it is essential to consider the following guidelines for when to seek medical help:
- Immediate Attention: If you experience chest pain that feels like pressure, squeezing, or fullness, especially if it radiates to your arms, neck, or jaw, seek emergency medical assistance immediately. This is particularly important if the pain is accompanied by shortness of breath, sweating, nausea, or lightheadedness.

- Persistent Symptoms: If your chest pain lasts for more than a few minutes or recurs frequently, it is advisable to consult a healthcare provider. They may perform diagnostic tests, such as an electrocardiogram (ECG), chest X-ray, or blood tests, to determine the cause.

- Associated Symptoms: Pay attention to any additional symptoms that accompany your chest pain. If you notice changes in your heart rate, difficulty breathing, or if the pain worsens with physical activity, these could be signs of a more serious condition.

Conclusion
While occasional chest pain can be benign, the nature of your symptoms suggests that it is essential to take them seriously. It is always better to err on the side of caution when it comes to chest pain. I recommend scheduling an appointment with a healthcare provider to discuss your symptoms in detail. They can help determine the underlying cause and develop an appropriate treatment plan. Remember, your health is paramount, and seeking help is a proactive step towards understanding and managing your symptoms effectively.

Similar Q&A

Understanding Chest Pain: When to Seek Medical Attention

Recently, I have experienced occasional chest pain, a condition that hasn't occurred for a long time. The most severe episode happened during my middle school years when I suddenly felt chest pain and difficulty breathing while asleep. I quickly drank some water, which allev...

Dr. Xiao Yongxun reply Internal Medicine
Dear Miss Anonymous: 1. There are many causes of chest pain, which can originate from superficial chest wall issues (such as shingles, costochondritis, shoulder arthritis, spinal nerve compression, breast lesions, etc.) or from deeper organ-related pain (such as angina, myocard...

Understanding Chest Pain: Symptoms, Causes, and When to Seek Help

Hello: Recently, I have been experiencing some chest pain and occasional dizziness. Could this be a precursor to any diseases? Thank you!

Dr. Zhou Ziguang reply Pulmonology
Hello: There are many possible causes of chest pain, such as muscle strain, neuralgia, pleuritis, etc. A physician needs to conduct an examination for differential diagnosis; it cannot be determined solely from the description provided. Please consult a pulmonologist. Dr. Chou Tz...

Recognizing Heart Issues: When to Seek Medical Help for Chest Pain

I have a history of hypertension, asthma, and peptic ulcers, and I occasionally experience sudden chest tightness and mild pain. Each time, the chest tightness is followed by significant soreness in my jaw and back, but after a few minutes, I feel completely fine, as if nothing h...

Dr. He Dongjin reply Cardiology
Hello, it is recommended that you undergo a thorough examination at the hospital when you are feeling well to rule out issues such as angina and to investigate the possibility of coronary artery vasospasm. Changhua Hospital cares about your health.

Understanding Chest Pain: When to Seek Cardiac Care

Hello Doctor: I have been experiencing chest pain in the area of my heart for the past six months. The pain is often dull and uncomfortable, and I find that applying slight pressure with my hand alleviates the discomfort. I am unsure of the cause and whether I need to seek medica...

Dr. Zhong Yuxun reply Cardiology
Hello Pomelo user, There are many causes of chest pain, including myocardial ischemia, muscle pain, intercostal neuralgia, esophagitis, gastric pain, and autonomic nervous system disorders. Please consult an internist or cardiologist for diagnosis and treatment. Sincerely, Dr...