Chest Pain and Discomfort: Causes and Concerns

Q: Chest Pain and Discomfort: Causes and Concerns

Hello： Myocardial infarction is an emergency condition, and patients typically experience more pronounced and even severe chest pain, often accompanied by related symptoms. <br>The electrocardiogram usually shows abnormal changes, and cardiac markers will be elevated during blood

Chest tightness and chest pain?

Dear Dr.
Lin,
I am currently studying abroad and returned to Taiwan for a health check-up in early June.
I underwent a comprehensive health examination, including a cardiac ultrasound, and everything was normal.
However, my LDL cholesterol level was 155 mg/dL, and I have symptoms of gastroesophageal reflux disease (GERD) for which I take medication regularly.

At the end of September this year, I experienced chest pain and tightness, prompting me to visit the emergency room.
I had a chest X-ray, blood tests, and a resting electrocardiogram, all of which were normal.
The doctor advised me to increase my HDL levels, so I have been taking Omega-3 fish oil regularly.
Although the emergency physician mentioned that myocardial infarction is rare at my age, I am still quite concerned because since the emergency visit on September 25, I frequently experience chest tightness, usually while sitting and studying.

From December 20 until today, I often feel my heart beating, sometimes accompanied by chest tightness and occasional pain.
Since December 28, I have felt slightly nauseous after lunch, and my back has been quite sore.
On January 1, while playing table tennis, I experienced unusual shortness of breath and a bit of dizziness, which is not typical for me.

I would like to ask you about the following symptoms:
1.
Could these symptoms be caused by gastroesophageal reflux? I have read that GERD can also lead to chest tightness and pain, but I take my medication daily, eat moderately, and intentionally elevate my head while sleeping.

2.
If further examinations are needed, what tests should I undergo? I have had tests done at my school's health center, but they only performed a resting electrocardiogram, blood tests, and X-rays.

3.
Is there a possibility that this could be a myocardial infarction?
Thank you very much for your assistance, and I truly appreciate your help.

P.S.
Recently, I have occasionally felt a bit of pain in the diaphragm area, similar to the discomfort after running for a long time, occurring every two to three days and lasting about five minutes.
Warm regards,
Eric

Eric, 20~29 year old female. Ask Date: 2016/01/02

Dr. Lin Jixiong reply Cardiology

Hello: Myocardial infarction is an emergency condition, and patients typically experience more pronounced and even severe chest pain, often accompanied by related symptoms.
The electrocardiogram usually shows abnormal changes, and cardiac markers will be elevated during blood tests.
Based on your description, it does not appear to be a myocardial infarction.
As for chest pain, there are many potential causes, and gastroesophageal reflux disease (GERD) could also lead to discomfort in the chest area.
Dr.
Lin Chi-Hsiung, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/02

More Info

Dear Eric,
Thank you for reaching out with your concerns regarding your chest pain and discomfort. It’s understandable to feel anxious about these symptoms, especially given your recent health checks and the ongoing issues you’re experiencing. Let’s break down your concerns and provide some clarity.

1. Gastroesophageal Reflux Disease (GERD) and Chest Pain: Yes, it is indeed possible that your symptoms of chest pain and discomfort could be related to gastroesophageal reflux disease (GERD). GERD can cause a sensation of chest pain or tightness, often mistaken for heart-related issues. This occurs when stomach acid flows back into the esophagus, leading to irritation and discomfort. Since you mentioned that you are already on medication for GERD and are taking precautions such as eating smaller meals and elevating your head while sleeping, it’s crucial to ensure that your treatment is effective. If your symptoms persist, you may want to discuss with your healthcare provider the possibility of adjusting your medication or exploring additional treatments, such as dietary changes or lifestyle modifications.

2. Further Investigations: Given your ongoing symptoms, it may be beneficial to pursue additional testing to rule out any cardiac issues, especially since you are experiencing chest pain and discomfort. While your previous tests (chest X-ray, blood tests, and resting ECG) came back normal, you might consider discussing the following with your doctor:
- Stress Test: This test evaluates how your heart performs under physical stress and can help identify any underlying heart conditions.

- Echocardiogram: Although you mentioned having a heart ultrasound, if there were any concerns or if your symptoms have changed, a follow-up echocardiogram might be warranted.

- Holter Monitor: This portable device records your heart's activity for 24-48 hours, which can help identify any irregular heart rhythms that might not be captured during a standard ECG.

- Upper Endoscopy: If GERD is suspected to be a significant contributor to your symptoms, an endoscopy may help visualize the esophagus and stomach lining to assess for any damage or complications.

3. Concern for Myocardial Infarction (Heart Attack): While it is true that myocardial infarction is less common in younger individuals, it is not impossible, especially if there are risk factors present. Your elevated LDL cholesterol level is a concern, as high levels can contribute to the development of coronary artery disease. However, given your recent evaluations and the fact that you are relatively young, the likelihood of a heart attack is lower, but not to be completely dismissed. It’s essential to continue monitoring your symptoms and communicate any changes to your healthcare provider.

Regarding the pain you feel in the diaphragm area, this could be related to several factors, including muscular strain, anxiety, or even referred pain from your gastrointestinal issues. It’s important to keep track of these symptoms and discuss them with your doctor.

In conclusion, while your symptoms may be related to GERD, it’s crucial to rule out any cardiac issues, especially since you are experiencing persistent discomfort. I recommend scheduling a follow-up appointment with your healthcare provider to discuss your ongoing symptoms and the possibility of further testing. Additionally, managing stress and anxiety can also play a significant role in alleviating physical symptoms, so consider incorporating relaxation techniques or speaking with a mental health professional if you feel overwhelmed.

Take care, and I wish you the best in your health journey.

Warm regards,
Doctor Q&A Teams

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