Heart Pain: When to Seek Medical Attention

Chest pain

Hello Doctor, sometimes I experience sudden chest pain and a bit of shortness of breath.
During the pain, I force myself to take deep breaths.
This used to happen occasionally, but it has recently lasted for at least ten minutes.
It occurred after I helped a friend move.
My chest started to feel tight and painful, and I had some difficulty breathing.
I previously underwent a health check because of unexplained dizziness, but the results indicated that everything was fine.
I would like to ask if I should get checked again given my current symptoms.

CC, 20~29 year old female. Ask Date: 2012/09/04

Dr. He Dongjin reply Cardiology

Hello, based on your description, it is likely that you have mitral valve prolapse, which generally cannot be detected through a routine physical examination.
It is advisable to consult a cardiologist for further evaluation.
Attached is an introduction to mitral valve prolapse for your reference.

"Mitral valve prolapse" is a common condition in cardiology, frequently seen in young women.
Although this condition is generally not serious, the symptoms can sometimes be quite bothersome.
The human heart is roughly the size of a fist and has four chambers.
The right side consists of the right atrium and right ventricle, while the left side comprises the left atrium and left ventricle.
Between the atria and ventricles are two sets of structures functioning like pistons, preventing blood from flowing backward, known as atrioventricular valves.
The left side has two leaflets, called the mitral valve (named for its pointed shape), while the right side has three leaflets, known as the tricuspid valve.
The left structure resembles the hat worn by a bishop, hence it is also called the bicuspid valve.
"Mitral valve prolapse" refers to a condition where, when the mitral valve closes, it extends slightly beyond the baseline boundary into the left atrium.
Tricuspid valve prolapse can also occur, but it is less common.
In studies focusing on young, taller, and thinner females, it is found that about one in ten may have this condition, which is not insignificant.
The severity of the disease can range from very mild to severe; fortunately, most patients experience mild symptoms, so those with this condition need not worry excessively.
Diagnosis is best made through a combination of medical history, physical examination, auscultation, and echocardiography, with particular emphasis on listening to heart sounds.
Echocardiography is a widely used and accurate diagnostic tool primarily used to assess the severity of valve prolapse.
Patients often report symptoms such as palpitations, chest pain, discomfort, fatigue, shortness of breath, dizziness or fainting, arrhythmias, reduced exercise capacity, lightheadedness when sitting up, a sensation of something stuck in the chest or neck, and even neuropsychological symptoms.
As seen, the symptoms can be quite diverse, with most cases occurring in individuals aged twenty to thirty.
If symptoms are pronounced, it may indicate that the patient's autonomic nervous system is in a heightened state.

Women are generally more sensitive to fluid changes, so symptoms may worsen during menstruation, and hydration should be monitored.
Substances that can stimulate the heart, such as caffeine, cigarettes, alcohol, or medications containing adrenal hormones, are not advisable.
Short-term, low-dose beta-blockers like Inderal (propranolol) can help control the autonomic nervous system, and mild, gentle sedatives can alleviate symptoms in over ninety percent of patients.
The vast majority of patients fall into a low-risk category, so those with mild symptoms may not require medication.
For those with more pronounced valve changes, regular echocardiographic follow-up may be necessary based on clinical needs.

Reply Date: 2012/09/04

More Info

Experiencing heart pain can be a concerning symptom, and understanding when to seek medical attention is crucial for your health. Based on your description, it seems you have been experiencing episodes of heart pain that last around ten minutes, accompanied by a feeling of breathlessness. This situation, especially if it has become more frequent or prolonged, warrants careful consideration.

Understanding Heart Pain
Heart pain, or angina, can manifest in various ways, including a feeling of pressure, tightness, or pain in the chest. It can also radiate to other areas such as the arms, neck, jaw, or back. The sensation can be triggered by physical exertion, stress, or even occur at rest. Given your history of occasional dizziness and the recent increase in the duration and intensity of your heart pain, it is essential to evaluate the underlying causes.

When to Seek Medical Attention
1. Duration and Frequency: If your heart pain lasts longer than a few minutes or occurs more frequently, it is advisable to seek medical attention. Episodes lasting ten minutes or more, especially if they are new or changing in nature, should not be ignored.

2. Associated Symptoms: Pay attention to any accompanying symptoms such as shortness of breath, sweating, nausea, or lightheadedness. These could indicate a more serious condition, such as a heart attack, especially if they occur alongside chest pain.

3. Previous Health Issues: Given your history of dizziness and previous health checks that indicated no significant issues, it is still important to consider that symptoms can evolve. If you have risk factors for heart disease (such as family history, smoking, high blood pressure, or diabetes), this increases the urgency to get checked.

4. Physical Activity: You mentioned that the pain occurred after helping a friend move. Physical exertion can sometimes trigger heart-related symptoms, especially if you are not accustomed to such activity. If this is a recurring theme, it may indicate that your heart is under stress during exertion.

Recommendations for Further Evaluation
Given your symptoms and their recent changes, it would be prudent to schedule a follow-up appointment with a healthcare provider. Here are some steps you can take:
- Consult a Cardiologist: A specialist can perform a thorough evaluation, including a physical examination, an electrocardiogram (ECG), and possibly a stress test to assess how your heart responds to exertion.

- Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated activities or stressors. This information can be invaluable for your healthcare provider.

- Lifestyle Modifications: While awaiting your appointment, consider lifestyle changes that can improve your heart health. This includes regular exercise, a balanced diet, stress management techniques, and avoiding tobacco and excessive alcohol.

- Emergency Situations: If you experience severe chest pain, especially if it feels like pressure or squeezing, or if you have symptoms like difficulty breathing, call emergency services immediately.

Conclusion
In summary, while occasional heart pain can be benign, the changes in your symptoms suggest that it is time to seek further evaluation. Your health is paramount, and understanding the signs that warrant medical attention can help you manage your condition effectively. Don’t hesitate to reach out to a healthcare provider to discuss your symptoms and get the appropriate tests done. Early intervention can make a significant difference in outcomes, especially concerning heart health.

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