Rapid Heartbeat and Chest Pain: When to Seek Further Evaluation

Rapid heartbeat, chest tightness and pain, dizziness?

Hello, doctor: Previously, I felt my heart racing and experienced dizziness, so I quickly went to the emergency room.
I had an electrocardiogram (ECG) and X-rays done, and the doctor said there were no issues, just a faster heart rate, so I went home.
Later, I experienced the same symptoms again, so I scheduled an appointment with a cardiologist for further evaluation.
I underwent Holter monitoring, blood tests, and a urinalysis, and the doctor also said there were no problems.
However, I continue to experience rapid heart rate, chest tightness with stabbing pain, and dizziness, which have become more frequent.
During these episodes, I feel as if my heart might stop at any moment, leading to anxiety and fear of a myocardial infarction.
Therefore, I went to Chang Gung Memorial Hospital for more tests, including blood work, a 24-hour urine test, a resting ECG, a stress test, and an echocardiogram, and the doctor again said everything was normal.
Yet, I still have that feeling.
Whenever I feel unwell at home, I use an electronic blood pressure monitor, and both my blood pressure and heart rate are normal.
The doctor mentioned that it could be nerve pain near the heart, but that sensation is very frightening.
If I had a myocardial infarction, shouldn't it have been detected with all these tests? Should I consider seeing a neurologist?

STEVEN, 20~29 year old female. Ask Date: 2012/04/03

Dr. He Dongjin reply Cardiology

Hello, myocardial infarction can be detected through examinations.
Since you have undergone multiple tests that have all returned normal results, there should be no concerns in this regard.
The symptoms you are describing sound like they may be caused by anxiety or autonomic nervous system dysregulation.
It would be advisable to use some medication for adjustment.
Changhua Hospital cares about your well-being.

Reply Date: 2012/04/03

More Info

It sounds like you are experiencing a complex set of symptoms that can be quite distressing. Rapid heartbeat, chest pain, and dizziness can be alarming, especially when you have concerns about serious conditions like myocardial infarction (heart attack). Given that you've already undergone a variety of tests, including ECGs, echocardiograms, and blood tests, which have all returned normal results, it’s understandable to feel frustrated and anxious about your ongoing symptoms.

Understanding Your Symptoms
1. Sinus Tachycardia: This is a condition where your heart beats faster than normal, often due to stress, anxiety, or physical exertion. It can be a normal response to various stimuli, including caffeine, dehydration, or emotional stress.

2. Chest Pain and Discomfort: The sensation of chest pain can arise from various sources, not just the heart. Musculoskeletal issues, gastrointestinal problems (like acid reflux), or even anxiety can manifest as chest pain. The description of your pain as "sharp" or "stabbing" could suggest a non-cardiac origin, especially if it correlates with movement or certain positions.

3. Dizziness and Lightheadedness: These symptoms can occur due to a variety of reasons, including dehydration, low blood sugar, or even anxiety. If your blood pressure readings are normal, it may indicate that your dizziness is not related to a cardiovascular issue.

4. Anxiety and Panic Attacks: Given the recurrent nature of your symptoms and the fear of a heart attack, anxiety may play a significant role. Panic attacks can mimic heart-related symptoms, including rapid heartbeat, chest pain, and a feeling of impending doom.

When to Seek Further Evaluation
While your previous evaluations have not indicated any serious heart conditions, it is essential to continue monitoring your symptoms. Here are some guidelines on when to seek further evaluation:
- Persistent Symptoms: If your symptoms continue to worsen or become more frequent, it is advisable to consult a healthcare provider. Even if previous tests were normal, changes in your symptoms warrant further investigation.

- New Symptoms: If you experience new symptoms such as shortness of breath, severe chest pain, or fainting, seek immediate medical attention.

- Impact on Daily Life: If your symptoms are significantly impacting your quality of life or causing you distress, it’s important to discuss this with your doctor. They may consider referring you to a specialist, such as a cardiologist or a neurologist, depending on the nature of your symptoms.

Possible Next Steps
1. Cardiology Follow-Up: Since you have already seen a cardiologist, it may be beneficial to return for a follow-up. Discuss your ongoing symptoms in detail, and ask if further testing, such as a stress test or advanced imaging, might be warranted.

2. Neurology Consultation: If your symptoms suggest a neurological component, such as dizziness or visual disturbances, a neurologist can help evaluate for conditions like migraines or other neurological disorders.

3. Mental Health Evaluation: Given the anxiety surrounding your symptoms, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) or other therapeutic approaches can be effective in managing anxiety and panic symptoms.

Conclusion
While it is reassuring that your tests have returned normal results, your ongoing symptoms deserve attention. It is crucial to communicate openly with your healthcare providers about your concerns and the impact these symptoms have on your life. They can help guide you through the next steps, whether that involves further cardiac evaluation, neurological assessment, or addressing potential anxiety issues. Remember, your health and peace of mind are paramount, and seeking help is a proactive step towards understanding and managing your symptoms effectively.

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