[28M] With high heart rate, chest pain, and shortness of breath
Patient Description
A 28-year-old male has been experiencing a high heart rate for the past 2 years, which occurs frequently during activities such as walking, standing, and running. These episodes last until he sits down, taking about 2 to 10 minutes for his heart rate to return to normal. Running is a specific trigger. He also reports chest pain for the past 2 years, described as tightness when running (severity 6-9) and sharp pain when walking or climbing stairs (severity 3). Slowing down when running helps to manage the pain. Additionally, he experiences moderate shortness of breath, particularly when climbing stairs or hills, and has noted fatigue and weight gain. Since moving to Colorado, he has experienced increased anxiety, trouble staying asleep, and waking up out of breath, starting a few months after the move. He reports pounding palpitations when running and fluttering palpitations when lying down, as well as swelling in his legs and occasional dizziness or lightheadedness. He has no history of fainting, nausea, or vomiting. He does not use tobacco, alcohol, or recreational drugs. He runs 3-5 times a week and maintains a decent diet, avoiding fast food and energy drinks. His family history includes a mother who had a stroke and a great-grandmother who had cancer and heart disease. He is not currently taking any medications.
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Arora's Assessment
What might be happening
It is likely that your symptoms are related to multiple issues. Here are some possible explanations:
High Heart Rate, Chest Pain, and Shortness of Breath
- Cardiac Issues: Given your family history of heart disease and stroke, it's important to consider cardiac issues such as arrhythmias (irregular heartbeats) or other heart conditions. The tightness and sharp pain in your chest, along with a high heart rate and shortness of breath, could be indicative of conditions like angina or even early signs of heart disease. Diagnostic tests like ECG, Holter monitor, and possibly an echocardiogram are typically used to evaluate these symptoms.
- Anxiety: Increased anxiety can also contribute to a high heart rate, palpitations, and shortness of breath. Anxiety can exacerbate physical symptoms, making it difficult to distinguish between anxiety-related and cardiac-related issues.
Fatigue and Weight Gain
- Thyroid Issues: Hypothyroidism (underactive thyroid) can cause fatigue, weight gain, and other symptoms. Blood tests to check thyroid function (TSH, T3, T4) are usually performed to diagnose this condition.
- Sleep Apnea: Waking up out of breath and having trouble staying asleep could be signs of sleep apnea, a condition where breathing repeatedly stops and starts during sleep. A sleep study can help diagnose this condition.
Swelling in Legs
- Fluid Retention: Swelling in your legs could be due to fluid retention, which can be related to heart issues, kidney problems, or even prolonged standing. Compression stockings and elevating your legs can help manage this symptom.
Unifying Diagnoses
- Heart Failure: Given the combination of high heart rate, chest pain, shortness of breath, fatigue, and leg swelling, heart failure could be a unifying diagnosis. This condition occurs when the heart is unable to pump blood effectively, leading to fluid buildup and other symptoms.
- Anxiety Disorder: Anxiety can manifest in various physical symptoms, including high heart rate, palpitations, shortness of breath, and sleep disturbances. Managing anxiety through therapy, medication, or lifestyle changes can help alleviate these symptoms.
What you can do
High Heart Rate, Chest Pain, and Shortness of Breath
- See a Doctor: Given the severity and duration of your symptoms, it's crucial to consult a healthcare provider as soon as possible. They may recommend further diagnostic tests like an ECG, Holter monitor, or echocardiogram.
- Lifestyle Changes: Avoid strenuous activities that trigger your symptoms. Practice deep breathing exercises and relaxation techniques to manage anxiety.
Fatigue and Weight Gain
- Consult a Doctor: A healthcare provider can order blood tests to check for thyroid issues or other underlying conditions.
- Healthy Lifestyle: Maintain a balanced diet and regular exercise routine. Ensure you get adequate sleep and manage stress.
Swelling in Legs
- Compression Stockings: Wear compression stockings to help reduce swelling.
- Elevate Legs: Elevate your legs when sitting or lying down to help reduce fluid buildup.
Anxiety and Sleep Issues
- Therapy: Consider talking to a mental health professional to manage anxiety.
- Sleep Hygiene: Maintain a regular sleep schedule, avoid caffeine and electronics before bed, and create a relaxing bedtime routine.
What you should look out for
Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:
- Severe Chest Pain: If you experience severe chest pain, especially if it radiates to your arm, neck, or jaw, seek emergency medical attention.
- Fainting or Severe Dizziness: If you experience fainting or severe dizziness, seek immediate medical care.
- Worsening Symptoms: If your symptoms worsen or new symptoms develop, consult a healthcare provider promptly.
Remember, while I can provide information and suggestions, it's essential to consult a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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3 mo ago