Heart Issues: Why Tests May Not Reveal the Problem

Cannot be detected?

Recently, I went to the emergency department of a regional hospital at night due to chest tightness and arrhythmia (my blood pressure was measured at 153/85).
They arranged for an electrocardiogram (ECG), chest X-ray, and blood tests.
The emergency physician said there were no significant issues and prescribed me a sublingual nitroglycerin tablet.
After five minutes, when asked if my chest tightness had improved, I replied that there was no improvement, only that my heartbeat felt heavier.
A few days later, I visited another regional hospital for a follow-up, where my palpitations were quite noticeable, but the ECG results again indicated no significant problems.

My question is: Can issues related to cardiovascular health or recurrent palpitations and arrhythmias be initially assessed through ECG, X-ray, and blood tests? Additionally, I later underwent further examinations and found that my blood pressure consistently remained high, with systolic pressure above 140 and diastolic pressure above 90, and I have started taking antihypertensive medication.

A Guo, 40~49 year old female. Ask Date: 2016/03/07

Dr. He Dongjin reply Cardiology

Hello, if you have visited the emergency department and the ECG, chest X-ray, and blood tests do not reveal any acute issues, such as myocardial infarction or paroxysmal palpitations and arrhythmias, these cannot be diagnosed using the aforementioned methods.
It sounds more like a problem caused by autonomic nervous system dysfunction.
You may consider observation or arrange for a 24-hour Holter monitor test at a cardiology outpatient clinic.
Changhua Hospital cares about you.

Reply Date: 2016/03/07

More Info

Understanding heart issues can be complex, especially when initial tests do not reveal any significant problems. It is not uncommon for patients to experience symptoms such as chest tightness, palpitations, or irregular heartbeats, only to find that standard tests like electrocardiograms (ECGs), chest X-rays, and blood tests come back normal. This can lead to frustration and confusion, as patients may feel that their symptoms are not being taken seriously or that the underlying issue remains undiagnosed.

Firstly, it is important to understand the limitations of the tests commonly used to assess heart health. An ECG is a valuable tool for detecting electrical abnormalities in the heart, such as arrhythmias or signs of ischemia (reduced blood flow). However, it is a snapshot of the heart's electrical activity at a specific moment in time. If the symptoms are intermittent or occur sporadically, they may not be captured during the test. Similarly, chest X-rays can reveal structural issues or fluid around the heart but may not show functional problems or transient ischemic events.

Blood tests can provide insight into various factors affecting heart health, such as cholesterol levels, markers of inflammation, and kidney function. However, they may not directly indicate the presence of coronary artery disease or other specific heart conditions. For example, elevated blood pressure readings, as you mentioned (with systolic pressures above 140 mmHg and diastolic pressures above 90 mmHg), can indicate hypertension, which is a significant risk factor for heart disease. However, hypertension itself may not cause immediate symptoms, and its presence does not always correlate with acute heart issues.

In your case, the persistence of symptoms like chest tightness and palpitations, despite normal initial tests, suggests that further investigation may be warranted. It is essential to communicate openly with your healthcare provider about your ongoing symptoms and concerns. They may recommend additional testing, such as a Holter monitor (a portable ECG that records heart activity over 24 hours or longer) to capture any arrhythmias that occur outside of a clinical setting. Other options include stress testing, echocardiograms, or even advanced imaging techniques like cardiac MRI or CT angiography to assess blood flow and heart structure more comprehensively.

Moreover, lifestyle factors play a crucial role in heart health. Stress, anxiety, and lifestyle choices such as diet, exercise, and smoking can significantly impact heart function and contribute to symptoms like palpitations. It is advisable to adopt a heart-healthy lifestyle, which includes regular physical activity, a balanced diet low in saturated fats and high in fruits and vegetables, and stress management techniques.

In summary, while initial tests may not always reveal the underlying cause of heart symptoms, it is crucial to continue seeking answers and advocating for your health. Persistent symptoms warrant further evaluation, and lifestyle modifications can also play a significant role in managing heart health. Always consult with your healthcare provider to determine the best course of action tailored to your specific situation.

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