Seeking Help for Persistent Chest Pain and Uncontrolled Hypertension

Could you please assist me, as I am unsure of what to do? (Forwarded from the Director's mailbox)

Hello.
I need assistance because I don't know how to seek medical care! I discovered I had slightly high blood pressure six years ago, so I have been regularly taking antihypertensive medication at a clinic in Tainan City.
There were no issues from the time I found out about my hypertension until a few years ago.
For some reason, three years ago, I started experiencing chest pain and angina.
I was taken to the emergency room and hospitalized for examinations, including an electrocardiogram, exercise stress test, and MRI, all of which showed no problems.
However, the chest pain persisted.
The doctor suggested I see a psychiatrist, but the psychiatrist, after just one interview, asked if I was worried about financial stress (who isn't, unless they are extremely wealthy) and diagnosed me with "generalized anxiety disorder," prescribing antidepressants.
I felt increasingly depressed while taking them, and my symptoms did not improve, leading to frequent angina episodes requiring emergency care.
Therefore, I stopped taking the psychiatric medication and did not return to the psychiatrist.
Two years ago, I went to Taipei Veterans General Hospital for an examination, where a 24-hour Holter monitor detected abnormalities in my ECG.
The doctor said it was due to cardiovascular spasms and prescribed medication, which I have been taking for two years without any issues, and my angina symptoms have improved.
However, this year, I started experiencing headaches, and my blood pressure has not been manageable.
The antihypertensive medication I have been taking for six years, which previously controlled my blood pressure, is no longer effective.
Whenever my blood pressure spikes to 140/105, all my previous symptoms reappear simultaneously: angina, accompanied by headaches, neck tightness, and numbness in my limbs.
It is extremely painful, but after going to the hospital, tests indicated everything was normal.
ECG, MRI, and neck ultrasound results all came back normal.
I don't know what to do now.
I hope you can assist me; I am willing to cooperate and pray for your help in investigating the exact cause of my condition, much like a prosecutor investigates a crime.
A divine inquiry indicated that the pain is due to vascular blockage, but the doctors say there is no blockage, and at my age, in my thirties, it is unlikely to have cardiovascular diseases or angina.
What should I do now? Below, I provide my daily blood pressure readings, but these are only the results from scheduled measurements; whenever I feel dizzy, the readings are even higher.
I hope you can assist me, at least to help lower my blood pressure.

Date: Systolic/Diastolic
5/1: 107/79
5/25: 125/93
5/31: 131/99
6/5: 122/92
6/12: 123/93
6/15: 136/101
75

Chen, 30~39 year old female. Ask Date: 2010/05/11

Dr. Bu Shiyun reply Cardiology

(1) You have been feeling unwell for the past two to three years, which is indeed troubling for you.
However, based on your blood pressure records, there doesn't seem to be any significant hypertension or elevated readings after medication, indicating that your blood pressure is relatively well controlled.
Therefore, hypertension may not be your primary issue.
Of course, occasional increases in blood pressure under special circumstances, such as dizziness, headaches, or feeling unwell due to a cold, should not be considered as true hypertension.
It is best to rely on measurements taken during quiet times.
If there are other factors affecting your emotional stability, blood pressure may also rise.

(2) At the age of 30, the likelihood of having cardiovascular disease is indeed low unless there are special circumstances.
If you experience multiple symptoms such as dizziness, headaches, neck tightness, chest pain, insomnia, numbness in the hands, or shortness of breath, these are usually due to stress or anxiety, which can cause discomfort.
It is important to relax and manage psychological stress.
You may also consider visiting a psychosomatic medicine clinic.
(3) I recommend that you seek assistance from a physician.
If you experience discomfort after taking medication, you should discuss it with your doctor, who will likely make adjustments based on your situation.

Reply Date: 2010/05/11

More Info

It sounds like you are experiencing a complex set of symptoms that are significantly impacting your quality of life. Persistent chest pain, uncontrolled hypertension, and the accompanying symptoms you describe, such as headaches, neck tightness, and numbness in your limbs, can be quite distressing. Given the history of your symptoms and the various medical evaluations you've undergone, it’s important to approach this situation methodically.

Firstly, it’s essential to understand that chest pain can arise from various causes, including cardiac, gastrointestinal, musculoskeletal, and psychological factors. Since you have undergone extensive testing, including ECGs, stress tests, and MRIs, which have all returned normal results, it may be worthwhile to consider non-cardiac causes of your chest pain. Conditions such as anxiety disorders, which can manifest as chest pain and palpitations, may be relevant, especially given your previous diagnosis of panic disorder.

Your mention of hypertension is also critical. Blood pressure readings of 140/105 mmHg indicate stage 2 hypertension, which can lead to various complications if not managed appropriately. It’s concerning that your blood pressure has become difficult to control despite being on medication for several years. This could suggest that your current treatment regimen may need to be reassessed. Factors such as medication adherence, lifestyle changes (diet, exercise, stress management), and potential secondary causes of hypertension (like hormonal imbalances or kidney issues) should be explored.

Regarding your experience with psychiatric medications, it’s not uncommon for individuals to feel worse before they feel better when starting antidepressants or anti-anxiety medications. However, if you feel that these medications are exacerbating your symptoms, it’s crucial to communicate this with your healthcare provider. They may consider adjusting your treatment plan or exploring alternative therapies.

Given the complexity of your symptoms and the interplay between physical and psychological factors, a multidisciplinary approach may be beneficial. Here are some steps you could consider:
1. Follow-Up with a Cardiologist: Since you have a history of chest pain and hypertension, a follow-up appointment with a cardiologist may be warranted. They can reassess your cardiovascular health and possibly recommend additional tests or a different medication regimen.

2. Consult a Neurologist: Given your headaches and neck pain, a neurologist can help determine if there are any underlying neurological issues contributing to your symptoms. They may suggest imaging studies or other diagnostic tests to rule out conditions like migraines or tension-type headaches.

3. Psychiatric Evaluation: If you haven’t already, consider a comprehensive evaluation by a psychiatrist who specializes in somatic symptom disorders. They can provide a more nuanced understanding of how anxiety and stress may be contributing to your physical symptoms.

4. Lifestyle Modifications: Implementing lifestyle changes can significantly impact blood pressure and overall health. This includes a heart-healthy diet (low in sodium and rich in fruits, vegetables, and whole grains), regular physical activity, stress management techniques (such as mindfulness or yoga), and avoiding tobacco and excessive alcohol.

5. Regular Monitoring: Keep a detailed log of your blood pressure readings, symptoms, and any potential triggers. This information can be invaluable for your healthcare providers in tailoring your treatment plan.

6. Consider a Pain Management Specialist: If your pain is persistent and debilitating, a pain management specialist may offer additional strategies for managing your symptoms.

In conclusion, while your symptoms are undoubtedly challenging, a comprehensive and collaborative approach involving various specialists can help identify the underlying causes and develop an effective treatment plan. Don’t hesitate to advocate for yourself and seek further evaluations until you find a satisfactory resolution to your health concerns.

Similar Q&A

Managing Heart Pain: Tips for High Blood Pressure and Arrhythmia

Doctor, my mother is 50 years old and has high blood pressure and arrhythmia. Recently, she has been experiencing chest pain that radiates to her left shoulder. The nearby hospital only has outpatient services available on Tuesday. What should I do to alleviate her symptoms or wh...

Dr. Zheng Shumeng reply Cardiology
There are many causes of chest pain, including heart disease, gastrointestinal disorders, neuromuscular inflammation, and lung diseases, among others. If a 50-year-old mother with hypertension experiences persistent chest pain, the primary concern should be heart disease, which i...

Understanding Persistent Chest Pain: Causes and Treatment Options

I often experience chest pain, sometimes feeling it almost all day long. The pain is located around the area level with my left chest and shoulder. I have previously undergone static and dynamic electrocardiograms and echocardiograms at the hospital, and the doctor indicated that...

Dr. Chen Guifeng reply Cardiology
The sensation of chest pain is highly subjective. If it is not caused by cardiac-related angina, it is generally associated with psychological stress. It is advisable to manage it through lifestyle changes or moderate exercise to alleviate the symptoms.

Managing Long-Term Heart, Cough, and Headache Issues: A Patient's Journey

Dear Dr. Chen, I have been suffering from persistent cough and headaches for over twenty years, and I have been on antihypertensive medication for the past ten years. For the last two months, I have frequently felt tightness in my chest. One day, I felt extremely unwell, experie...

Dr. Chen Guifeng reply Cardiology
The only medication that must be taken daily in the long term is for hypertension; most other medications are for short-term use and are not of major concern. The adjustment of mindset is the most important factor!

Seeking Help for Persistent Chest Pain: A Patient's Journey

Hello, I would like to inquire about my symptoms. I have been experiencing chest pain since the year before last. I have visited Kaohsiung Ruann General Hospital, Chang Gung Memorial Hospital, and the 802 Military Hospital, consulting specialists in cardiology, neurology, pulmono...

Dr. Huang Jianling reply Family Medicine
Dear Mr. Hsieh, Mr. Hsieh has been experiencing chest pain for over a year and has consulted various specialists who have all indicated that there are no issues. Due to the insufficient description of symptoms and examination data, I am hesitant to speculate on the underlying co...