Persistent Left Chest Pain: Causes and Next Steps

Left chest tightness and pain?

Hello Doctor: Six months ago, I experienced a sensation as if my heart was being tightly squeezed, accompanied by shortness of breath, dizziness, and weakness in my limbs.
I went to the hospital for X-rays and both static and dynamic electrocardiograms, and the doctor said everything was normal and that my heart was fine.
He suggested it might be due to autonomic nervous system dysfunction and prescribed muscle relaxants and medication for angina.
However, over the past six months, I still experience occasional dull pain in my left chest, a tight feeling, and persistent symptoms that sometimes worsen, leading to a sensation of not being able to catch my breath.
Occasionally, I also feel sharp pain.
These symptoms are present regularly and are not only triggered by intense exercise.
My blood pressure was previously around 140/100, but after taking medication, it is currently about 125/85.
My height is 180 cm and my weight is 65 kg.
What additional tests should I consider?

A-Zhi, 30~39 year old female. Ask Date: 2009/07/17

Dr. He Dongjin reply Cardiology

Hello, it feels like my heart is being tightly squeezed, making it hard to breathe, followed by dizziness, weakness in my limbs, and a persistent dull pain in my left chest.
Sometimes the symptoms worsen, and I feel like I can't catch my breath, while at other times I experience sharp pains.
This is likely caused by autonomic nervous system dysfunction related to mitral valve prolapse.
Patients with mitral valve prolapse often experience a range of symptoms "from head to toe," including dizziness, insomnia, palpitations, chest pain, panic, fatigue, chest tightness, numbness throughout the body, difficulty breathing, and gastrointestinal discomfort.
The underlying cause may be related to autonomic nervous system dysfunction, which involves either excessive or insufficient responses from the sympathetic or parasympathetic nervous systems.
Clinically, patients may present with various arrhythmias, including sinus tachycardia (the most common), bradycardia, ventricular tachycardia, atrial flutter, atrial fibrillation, or even cardiac arrest.
The chest pain symptoms associated with mitral valve prolapse can sometimes be difficult to distinguish from angina and myocardial infarction.
The underlying mechanism may involve the elongated valve opening and closing, excessively pulling on the heart muscle, leading to localized hypoxia, arrhythmias, and autonomic nervous system dysfunction.
Patients with mitral valve prolapse may seem to have widespread symptoms, but over 90% of cases are benign.
Aside from being somewhat anxious, they do not pose significant health risks.
Regular exercise, adequate rest, and occasional use of small doses of beta-blockers or sedatives can be beneficial.
Only a small percentage of patients (about 1%) may develop complications such as heart failure, endocarditis, arrhythmias, stroke, or sudden death.
Therefore, patients with mitral valve prolapse, especially those with significant heart murmurs, should have follow-up examinations at least once a year.
Echocardiograms or autonomic nervous system assessments can be performed at Changhua Hospital, which cares about your health.

Reply Date: 2009/07/17

More Info

Persistent left chest pain can be a concerning symptom, especially given your history of experiencing tightness, shortness of breath, and dizziness. While your previous tests, including X-rays and both static and dynamic electrocardiograms (ECGs), returned normal results, it is crucial to consider a comprehensive approach to understanding your symptoms further.

Possible Causes of Left Chest Pain
1. Musculoskeletal Issues: Given that you have been prescribed muscle relaxants, it is possible that your chest pain could be related to musculoskeletal problems. Conditions such as costochondritis (inflammation of the cartilage connecting the ribs to the sternum) or muscle strain can cause persistent chest pain that may feel tight or sharp. This type of pain often worsens with certain movements or palpation of the affected area.

2. Anxiety and Stress: Your symptoms, including the sensation of tightness and difficulty breathing, could also be linked to anxiety or panic attacks. These conditions can manifest physically, leading to chest pain and feelings of breathlessness. It’s essential to consider whether stress or anxiety might be contributing to your symptoms.

3. Gastroesophageal Reflux Disease (GERD): Sometimes, chest pain can be caused by acid reflux, where stomach acid flows back into the esophagus, leading to discomfort that can mimic heart-related pain. This is often accompanied by symptoms like heartburn or a sour taste in the mouth.

4. Cardiac Considerations: Although your heart tests have come back normal, it is important to rule out any cardiac issues thoroughly. Conditions like angina, which can occur due to reduced blood flow to the heart, may present with chest pain that can radiate to the left side. Given your elevated blood pressure history, it is wise to keep cardiac health in mind.

5. Autonomic Nervous System Dysfunction: Your doctor mentioned autonomic nervous system dysregulation as a potential cause. This can lead to symptoms such as palpitations, dizziness, and chest discomfort. It may be beneficial to explore this further with a specialist in autonomic disorders.

Recommended Next Steps
1. Follow-Up with a Cardiologist: Since you have a history of chest pain and elevated blood pressure, a follow-up with a cardiologist may be warranted. They might recommend further testing, such as a stress test, echocardiogram, or even advanced imaging like a cardiac MRI, to ensure there are no underlying cardiac issues.

2. Consider a Gastroenterologist: If GERD is suspected, a consultation with a gastroenterologist may be beneficial. They might suggest an upper endoscopy or pH monitoring to assess for acid reflux.

3. Mental Health Evaluation: Given the potential for anxiety to contribute to your symptoms, a mental health evaluation could be helpful. Cognitive-behavioral therapy (CBT) or other therapeutic approaches may assist in managing anxiety and its physical manifestations.

4. Musculoskeletal Assessment: If musculoskeletal issues are suspected, a physical therapist or a specialist in musculoskeletal medicine could provide an evaluation and recommend appropriate exercises or treatments.

5. Lifestyle Modifications: Continue monitoring your blood pressure and consider lifestyle changes that can improve overall cardiovascular health, such as a balanced diet, regular exercise, and stress management techniques like yoga or meditation.

Conclusion
Persistent left chest pain can arise from various causes, and it is essential to approach it holistically. While your previous tests have ruled out some serious conditions, ongoing symptoms warrant further investigation. Collaborating with healthcare professionals across different specialties can help pinpoint the underlying cause and develop an effective treatment plan. Always prioritize your health and seek immediate medical attention if your symptoms worsen or if you experience new symptoms such as severe shortness of breath, dizziness, or fainting.

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