Persistent Dizziness and Chest Pain Despite Normal Heart Tests: What to Do?

Despite having normal test results, there are still frequent episodes of fainting?

I would like to ask the doctor about my condition.
Previously, I experienced sudden chest pain that made it impossible for me to stand, almost leading to fainting (this occurred while I was at rest).
After taking nitroglycerin, I felt some improvement.
However, a few days later, while resting at home, I suddenly started to feel chest tightness and discomfort again.
I underwent a stress echocardiogram, 24-hour monitoring, and a cardiac ultrasound, all of which reported normal results, even indicating that my heart was in good condition.

Despite this, I fainted for three to four hours after a massage.
No matter what I did, it didn't help, and even after returning home, I continued to experience chest tightness, shortness of breath, and discomfort.
Today, while riding my bike, I had another sudden episode of acute dizziness and cold sweats.
My vision darkened, but I did not faint.
Upon returning home, I drank a lot of sugary water (although I had been eating normally throughout the day, without any significant changes in my diet), and the dizziness improved, but the chest tightness persists.

I am unsure which specialty I should follow up with regarding this situation.
I am very afraid that next time I might faint and not wake up.

Qing, 20~29 year old female. Ask Date: 2015/07/06

Dr. He Dongjin reply Cardiology

Hello, it is possible that you are experiencing autonomic nervous system dysfunction, with excessive vagus nerve stimulation.
It is recommended to arrange a tilt table test with the cardiology department at a medical center.
Changhua Hospital is concerned about your well-being.

Reply Date: 2015/07/06

More Info

Persistent dizziness and chest pain, especially when accompanied by episodes of near-fainting or significant discomfort, can be concerning symptoms that warrant thorough evaluation. Given your history of sudden chest pain, dizziness, and the fact that you have undergone several heart tests that returned normal results, it is essential to consider a multifaceted approach to your situation.

Firstly, it is important to recognize that while normal results from tests such as exercise electrocardiograms, echocardiograms, and continuous heart monitoring are reassuring, they do not entirely rule out the possibility of underlying issues. Your symptoms could be related to several factors, including but not limited to anxiety, gastrointestinal issues, musculoskeletal pain, or even atypical presentations of cardiac conditions.

Steps to Take:
1. Follow-Up with a Cardiologist: Since you have experienced significant symptoms like chest pain and dizziness, it is crucial to continue working with a cardiologist. You may want to discuss the possibility of further testing, such as a coronary angiogram, especially if your symptoms persist despite normal non-invasive tests. This invasive test can provide a clearer picture of your coronary arteries and help rule out any significant blockages.

2. Consider Other Specialists: If your cardiologist continues to find no cardiac issues, it may be beneficial to consult other specialists. A neurologist can evaluate for potential neurological causes of your dizziness and fainting spells. Additionally, a gastroenterologist could assess for any gastrointestinal issues that might be contributing to your symptoms, such as acid reflux or esophageal spasms, which can mimic cardiac pain.

3. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any associated activities (like exercise, stress, or meals). This information can be invaluable for your healthcare providers in identifying patterns or triggers.

4. Lifestyle Modifications: While waiting for further evaluations, consider lifestyle changes that may help alleviate your symptoms. This includes staying hydrated, managing stress through relaxation techniques, and avoiding known triggers (like certain foods or activities that exacerbate your symptoms).

5. Emergency Plan: Given your fear of potentially fainting or having a more severe episode, it is wise to have an emergency plan in place. This could include having someone accompany you when you go out, carrying a phone for emergencies, and knowing when to seek immediate medical attention (for instance, if you experience prolonged chest pain, severe dizziness, or fainting).

6. Psychological Evaluation: Sometimes, persistent physical symptoms can be exacerbated by anxiety or stress. A mental health professional can help you explore any psychological factors that may be contributing to your symptoms and provide coping strategies.

Conclusion:
Persistent dizziness and chest pain can be distressing and may require a comprehensive approach to diagnosis and management. While it is reassuring that your heart tests have returned normal results, it is essential to continue seeking answers. Collaborate closely with your healthcare providers, consider consulting additional specialists, and keep track of your symptoms to facilitate a thorough evaluation. Your health and well-being are paramount, and addressing these symptoms proactively is crucial.

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