Chest Pain, Dizziness, and Low Blood Pressure: A Cardiac Perspective

Chest pain, fainting, low blood pressure, external impact?

Doctor, I occasionally experience sharp pain in my chest, which has been severe enough to require a visit to the emergency room.
However, the doctors could not determine the cause.
A chest CT scan showed normal results.
My blood pressure fluctuates between 140/80 with a heart rate of 66 and 105/55 with a heart rate of 88.
I consulted a cardiologist, and I had an electrocardiogram (ECG) performed four times—two were normal and two were abnormal.
An echocardiogram confirmed mitral valve prolapse.
An exercise stress test showed abnormal results, but the doctor could not explain the reason for the abnormalities.
A 24-hour Holter monitor indicated occasional palpitations.
What could be the cause of the severe chest pain? Additionally, I faint when standing or squatting for long periods, and I experience temporary blackouts when rising from a seated position.
There is a family history of low blood pressure.
A tilt table test showed normal results, and a cranial ultrasound was normal.
Could my fainting episodes be due to low blood pressure? (When standing for a long time, I sweat, my face turns pale, and I experience brief loss of consciousness, with my vision first becoming white and blurry before turning black and fainting.)

kevin, 20~29 year old female. Ask Date: 2016/01/30

Dr. He Dongjin reply Cardiology

Hello, based on your description, it seems to be postural hypotension causing your movements to slow down.
Please take care, and Changhua Hospital is concerned about you.

Reply Date: 2016/01/30

More Info

Understanding chest pain, dizziness, and low blood pressure from a cardiac perspective can be complex, especially when symptoms are intermittent and diagnostic tests yield mixed results. In your case, the combination of chest pain, episodes of dizziness, and fluctuating blood pressure readings suggests a multifactorial issue that may involve both cardiac and non-cardiac factors.

Chest Pain and Cardiac Concerns
Your history of chest pain, particularly the episodes severe enough to warrant an emergency room visit, is concerning. While the CT scan of the chest was normal, indicating no structural abnormalities, the presence of mitral valve prolapse (MVP) identified through echocardiography could be a contributing factor. MVP can sometimes lead to palpitations and atypical chest pain due to the abnormal motion of the valve leaflets. Although MVP is often benign, it can be associated with arrhythmias, which might explain the abnormal findings on your exercise electrocardiogram (ECG).

Dizziness and Blood Pressure Fluctuations
The episodes of dizziness, especially when standing up or after prolonged sitting, could be indicative of orthostatic hypotension, a condition where blood pressure drops significantly upon standing. This can lead to symptoms such as lightheadedness, fainting, or feeling "black out" as you described. Your family history of low blood pressure may suggest a genetic predisposition to this condition.

The variability in your blood pressure readings—140/80 mmHg at one moment and then dropping to 105/55 mmHg—could reflect autonomic dysfunction, where the body struggles to regulate blood pressure effectively. This can happen in conditions like postural orthostatic tachycardia syndrome (POTS) or other forms of dysautonomia. The fact that you experience sweating and pallor during these episodes further supports the possibility of an autonomic response.

Heart Rate and Arrhythmias
The heart rate fluctuations you mentioned, with a resting heart rate of 66 bpm and spikes to 88 bpm or higher, could indicate an underlying arrhythmia, especially given the episodes of palpitations. The 24-hour Holter monitor showing occasional palpitations suggests that you may be experiencing paroxysmal atrial fibrillation or other types of supraventricular tachycardia. These arrhythmias can sometimes be triggered by stress, caffeine, or other stimulants, and they may not always be captured during a standard ECG.

Recommendations
1. Follow-Up with a Cardiologist: Given the complexity of your symptoms, it is crucial to have a thorough evaluation by a cardiologist who can interpret your ECG results in the context of your symptoms. They may consider additional testing, such as an electrophysiological study, to assess for arrhythmias more definitively.

2. Monitor Blood Pressure: Keep a log of your blood pressure readings at different times of the day and during various activities (sitting, standing, after exercise). This information can help your doctor understand the patterns and triggers of your symptoms.

3. Lifestyle Modifications: Consider lifestyle changes that may help manage your symptoms. Staying well-hydrated, increasing salt intake (if not contraindicated), and avoiding prolonged standing or sudden position changes can help mitigate orthostatic symptoms. Regular, moderate exercise may also improve cardiovascular health and autonomic regulation.

4. Manage Stress and Anxiety: Since stress can exacerbate both cardiac symptoms and blood pressure fluctuations, incorporating stress management techniques such as mindfulness, yoga, or counseling may be beneficial.

5. Consider a Tilt Table Test: If orthostatic hypotension is suspected, a tilt table test can help confirm the diagnosis and guide treatment options.

In conclusion, while your symptoms are concerning, they may be manageable with appropriate medical guidance and lifestyle adjustments. It is essential to maintain open communication with your healthcare providers and advocate for further evaluation if your symptoms persist or worsen.

Similar Q&A

Understanding Chest Tightness and Numbness: Heart Health Concerns

The patient's mother, aged 54, recently visited a clinic due to a cold, where her blood pressure readings were consistently high, despite her previous history of anemia and low blood pressure. After monitoring her blood pressure at home for about two weeks, it showed only a ...

Dr. He Dongjin reply Cardiology
Hello, currently it is known that discomfort and unstable blood pressure can be caused by either high blood pressure leading to discomfort or discomfort causing high blood pressure. It is recommended to first address these uncomfortable symptoms such as numbness in the hands, diz...

Understanding Low Blood Pressure and Chest Pain: What You Need to Know

In recent days, I have been experiencing headaches and sharp chest pain. On February 24th, a blood pressure monitor at a small clinic recorded a reading of 52/77, with a heart rate of 86. At night, just before sleeping, my heartbeat sounds very loud. I would like to know what I s...

Dr. He Dongjin reply Cardiology
Hello, don't be nervous. The sensations of headache, chest pain, and sharp pain are mostly related to muscular or neurological issues. A blood pressure reading of 52/77 is unlikely; there may be an issue with the machine. If you still feel unwell, please visit the cardiology...

Understanding Chest Discomfort and Sleep Issues: A Cardiovascular Perspective

Hello, doctor. I apologize for the previous message being incomplete due to formatting issues on my phone. I would like to ask for your guidance again. Thank you. I would like to inquire about what type of heart disease my condition may fall under or what direction I should take ...

Dr. He Dongjin reply Cardiology
Hello, the coronary catheterization shows 10% blockage, which does not affect functional capacity. Overall, there seems to be no cardiac issues; it is likely related to anxiety and autonomic nervous system dysregulation. It is recommended to visit a psychosomatic medicine special...

Understanding Dizziness and Heart Issues: A Guide to Symptoms and Concerns

Hello, doctor. I have a history of dizziness for 15 years, with symptoms including spinning sensations, tinnitus, nausea, blurred vision, shortness of breath, palpitations, and a rapid heartbeat (these symptoms occur during episodes and have become more frequent in recent years)....

Dr. He Dongjin reply Cardiology
Hello, if I were you, I would have many questions as well. However, I apologize that the information provided is limited and cannot answer your inquiries. It is advisable to visit the cardiology outpatient department of the hospital for a physician to explain the examination resu...