Heart Constriction: Insights from a Cardiovascular Specialist

Q: Heart Constriction: Insights from a Cardiovascular Specialist

Hello： After the follow-up for patients who have undergone cardiac catheterization, in addition to symptom assessment, examinations such as electrocardiogram, echocardiogram, and myocardial perfusion scan are performed. <br>If the results are normal, the patient will continue to

The heart contracts?

Hello Dr.
Lin, I had a catheter placement done a year ago.
Aside from frequently experiencing mild chest tightness and pain (or sharp pain), my condition has been relatively stable.
However, I have a question that has not received a clear answer, and I would like to seek your opinion.
Six years ago, I experienced rapid heart contractions and went to the hospital for an examination, but they only identified high cholesterol (without medication), and I have not had any episodes since then.
Six years later, I was hospitalized for a myocardial infarction and underwent catheter placement, but since then, the issue of sudden heart contractions has been persistent.
Sometimes it occurs several times a day, while other times it may happen only a few times a week or even close to two weeks apart.
Follow-up examinations after the myocardial infarction, including two 24-hour Holter monitors, two echocardiograms, and one perfusion scan, all yielded normal results.
However, during the 24-hour Holter monitoring, there were indeed instances of heart contractions, yet the results showed no abnormalities.
When I experience these contractions (which feel like being suddenly squeezed and accompanied by difficulty breathing), I have to intentionally cough forcefully to relieve or stop them; otherwise, they can occur repeatedly.
Additionally, I notice that these contractions can also happen when I squat down for an extended period (the type of squat where my knees are close to my chest).
Since the examinations have shown no abnormalities, the doctor suggested that I need to manage my condition well, and perhaps I have had these contractions for a long time without realizing it.
I would like to consult you regarding this matter.
Thank you for your guidance, Dr.
Wang Lin.

Mr. Zhang, 50~59 year old female. Ask Date: 2015/01/27

Dr. Lin Jixiong reply Cardiology

Hello: After the follow-up for patients who have undergone cardiac catheterization, in addition to symptom assessment, examinations such as electrocardiogram, echocardiogram, and myocardial perfusion scan are performed.
If the results are normal, the patient will continue to be monitored with regular follow-ups.
Dr.
Lin Chi-Hsiung, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/01/27

More Info

Understanding heart constriction, particularly in the context of a history of coronary artery disease (CAD) and myocardial ischemia, requires a comprehensive approach that considers both the physiological and psychological aspects of heart health. Based on your description, it appears that you have experienced episodes of chest tightness and discomfort, which can be distressing, especially following a significant cardiac event such as a myocardial infarction (heart attack) and subsequent catheter placement.

Overview of Heart Constriction
Heart constriction, often described as a feeling of tightness or pressure in the chest, can arise from various causes. In patients with a history of CAD, it may be related to myocardial ischemia, where the heart muscle does not receive enough blood and oxygen, leading to discomfort. However, it can also be influenced by non-cardiac factors such as anxiety, stress, or even musculoskeletal issues.

Evaluation of Symptoms
Your history of chest tightness, particularly after a heart attack, warrants careful evaluation. The fact that you have undergone multiple tests—including 24-hour Holter monitoring, echocardiograms, and myocardial perfusion scans—without significant abnormalities is reassuring. However, the recurrent nature of your symptoms suggests that they may not solely be cardiac in origin.

1. Myocardial Ischemia: The episodes of constriction you describe could be indicative of transient ischemic events. However, the normal results from your recent tests suggest that significant coronary artery obstruction is unlikely. The presence of high cholesterol in the past is a risk factor, but it seems to have been managed effectively since you have not reported any ongoing issues.

2. Psychological Factors: Anxiety and stress can manifest as physical symptoms, including chest tightness. Given that you have experienced these symptoms intermittently, it might be beneficial to explore whether anxiety plays a role, especially in the context of your history of heart disease.

3. Musculoskeletal Issues: The description of your symptoms when squatting or bending could indicate a musculoskeletal component. Tightness in the chest can sometimes be related to muscle strain or tension, particularly if you are holding certain positions for extended periods.

Recommendations
1. Lifestyle Modifications: Engaging in regular physical activity, maintaining a heart-healthy diet, and managing stress through techniques such as mindfulness or yoga can be beneficial. These changes can improve overall cardiovascular health and may help alleviate symptoms.

2. Follow-Up with a Cardiologist: Since your symptoms persist, it would be prudent to discuss them further with your cardiologist. They may consider additional diagnostic tests or refer you to a specialist in cardiac rehabilitation or a psychologist who specializes in cardiac patients.

3. Monitoring Symptoms: Keeping a detailed diary of your symptoms, including when they occur, their duration, and any associated activities, can provide valuable information for your healthcare provider. This can help in identifying triggers and patterns that may not be immediately apparent.

4. Medication Review: If you are on any medications, including those for cholesterol management or blood pressure, ensure that your doctor reviews them regularly to optimize your treatment plan.

5. Emergency Plan: Given your history, it’s essential to have a plan in place for when you experience severe symptoms. Knowing when to seek immediate medical attention can be life-saving.

Conclusion
While your test results are normal, the experience of chest tightness should not be dismissed. It is essential to continue monitoring your symptoms and maintain open communication with your healthcare providers. By addressing both the physical and psychological aspects of your health, you can work towards a better understanding of your symptoms and improve your overall well-being. Remember, your health is a priority, and seeking clarity on your symptoms is a crucial step in managing your heart health effectively.

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