Is It a Heart Issue? Chest Pain and Symptoms

Is it a heart problem?

Hello Doctor: Sometimes I feel a tightness in my chest, as if I can't get fresh air.
When I take deep breaths, I occasionally experience a sudden sharp pain and also have inexplicable shooting pains.
Additionally, I often feel dizzy and nauseous, and sometimes my vision goes black, which doesn't seem to be due to anemia (as my lab results are normal).
Because of this, I previously visited the cardiology department at Chang Gung Memorial Hospital, where I only had an electrocardiogram done.
The doctor said my condition was fine and attributed my symptoms to anxiety and stress, which could cause an increased heart rate and lead to the sensation of shooting pain.
However, I later realized that the shooting pains occur irregularly; sometimes, I might be speaking and suddenly feel a sharp pain, or I might feel it while sitting or standing.
The pain lasts for a few seconds; it's not unbearable, but it is uncomfortable, and the frequency of discomfort is increasing, which is quite distressing for me.
Once, I went to a clinic for a check-up and requested an echocardiogram.
The doctor mentioned that my mitral valve is longer and thicker than average, which might be the reason for my discomfort.
However, I am still confused about what exactly is causing my frequent discomfort.
P.S.
My blood pressure readings are approximately 70-80 systolic and 50-60 diastolic, and they can even be lower.
I would appreciate any advice you could provide, thank you!

Qi Qi, 10~19 year old female. Ask Date: 2007/04/15

Dr. He Dongjin reply Cardiology

Based on your symptoms, it is highly likely that you have what is known as mitral valve prolapse (MVP).
This condition can often be managed with medication to alleviate symptoms.
The tall and slender physique associated with mitral valve prolapse is often considered the ideal model figure, especially among young women.
However, from a medical perspective, this body type, along with a sensitive personality, is typical of patients with mitral valve prolapse, also referred to as "mitral valve prolapse syndrome." Approximately 5% of the population is affected by this condition, which is notably more prevalent in females, who are twice as likely to be affected as males.
The primary characteristics of these patients are being thin and tall.
During embryonic development, if the connective tissue of the valve undergoes myxomatous degeneration, it can lead to elongated and lax valve leaflets, which may subsequently prolapse.
When the heart contracts, these elongated leaflets may not close properly, resulting in the backflow of blood from the left ventricle into the left atrium.
In addition to the characteristic "click" of the prolapsing valve, a heart murmur may also be audible.
Patients with this abnormality often report a wide range of symptoms, including dizziness, insomnia, palpitations, chest pain, anxiety, fatigue, tightness in the chest, generalized numbness, shortness of breath, and gastrointestinal discomfort.
These symptoms may be related to autonomic nervous system dysregulation, which involves either excessive or insufficient responses from the sympathetic or parasympathetic nervous systems.
Clinically, patients may present with various types of arrhythmias, including sinus tachycardia (the most common), bradycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, or even cardiac arrest.
The chest pain associated with mitral valve prolapse can sometimes be difficult to distinguish from angina or myocardial infarction.
The underlying cause may be due to the excessive movement of the elongated valve leaflets, which can lead to localized ischemia, arrhythmias, and autonomic dysregulation.
Mitral valve prolapse is also commonly found in patients with congenital heart diseases (such as atrial septal defects), hypertrophic cardiomyopathy, and certain connective tissue disorders (such as Marfan syndrome).
Although patients with mitral valve prolapse may seem to have multiple health issues, over 90% of cases are benign.
Aside from being somewhat anxious, these patients generally do not face significant health risks.
Regular exercise, adequate rest, and occasional use of low doses of beta-blockers or sedatives can be beneficial.
Only a small percentage of patients (about 1%) may experience complications such as heart failure, endocarditis, arrhythmias, stroke, or sudden cardiac death.
Therefore, patients with mitral valve prolapse, especially those with significant heart murmurs, should have follow-up evaluations at least once a year.

Reply Date: 2007/04/15

More Info

Chest pain and discomfort can be alarming, and it's understandable that you're seeking clarity on your symptoms. Based on your description, it seems that you are experiencing a range of sensations, including chest tightness, sharp pains, dizziness, and feelings of nausea. These symptoms can be distressing, especially when they occur unpredictably and interfere with your daily life.

Firstly, it's important to note that while chest pain can be associated with heart issues, it is not always the case, particularly in younger individuals without a history of cardiovascular disease. The heart is a complex organ, and various factors can contribute to chest discomfort, including anxiety, stress, and musculoskeletal issues. In your case, the medical evaluation you've undergone, including an electrocardiogram (ECG) and an echocardiogram, did not reveal any significant heart problems, which is reassuring.

Your symptoms of feeling tightness in the chest and experiencing sharp pains could be related to anxiety or panic attacks. Anxiety can manifest physically in many ways, including increased heart rate, muscle tension, and changes in breathing patterns. When you feel anxious, your body may react by tightening the muscles around your chest, leading to discomfort. This can also cause you to feel as if you are not getting enough air, which can further exacerbate feelings of panic.

The fact that you mentioned experiencing these symptoms during moments of stress or when you are feeling particularly anxious suggests that there may be a psychological component to your physical sensations. It's not uncommon for individuals dealing with anxiety to experience chest pain or discomfort, and this can sometimes lead to a cycle of worry that intensifies the symptoms.

Regarding your mention of the mitral valve being longer and thicker than average, this could be a benign anatomical variation known as mitral valve prolapse. In many cases, this condition does not cause significant problems and is often asymptomatic. However, if it is associated with palpitations or discomfort, it may be worth discussing further with a cardiologist to ensure that it is not contributing to your symptoms.

Your blood pressure readings, particularly the low diastolic pressure (50-60), could also be a factor in your symptoms. Low blood pressure can lead to feelings of dizziness and faintness, especially if you stand up quickly or are dehydrated. It's essential to maintain good hydration and discuss any concerns about blood pressure with your healthcare provider.

Here are some recommendations to help manage your symptoms:
1. Stress Management: Consider incorporating relaxation techniques into your daily routine, such as deep breathing exercises, meditation, or yoga. These practices can help reduce anxiety and improve your overall sense of well-being.

2. Regular Exercise: Engaging in regular physical activity can help alleviate anxiety and improve cardiovascular health. Aim for at least 150 minutes of moderate exercise each week, but consult with your doctor before starting any new exercise program.

3. Healthy Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support your overall health and may help regulate blood pressure.

4. Sleep Hygiene: Ensure you are getting adequate sleep each night, as poor sleep can exacerbate anxiety and physical symptoms.

5. Follow-Up Care: If your symptoms persist or worsen, it is crucial to follow up with your healthcare provider. They may recommend further testing or a referral to a specialist, such as a cardiologist or a mental health professional.

In summary, while your symptoms are concerning, they may not necessarily indicate a serious heart condition, especially given the normal results from your cardiac evaluations. However, addressing the psychological aspects of your symptoms and making lifestyle adjustments can significantly improve your quality of life. Always consult with your healthcare provider for personalized advice and to ensure that any underlying conditions are appropriately managed.

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