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Chest pain, heart palpitations. No dizziness, shortness of breath or pain in arms, neck, or jaw. Normal tests. Reason?

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General & Family Physician
Practicing since : 2001
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I am a 27 year old healthy female (also a Registered Nurse). 5'9" and 125 lbs. I eat a healthy diet (most of the time) and work out 4-5 times per week (running, bike riding, power walking). For the past month I have been experiencing a nagging pain/discomfort in my chest, and intermittent heart palpitations. There was one day about three weeks ago where I had dozens of palpitations in one day and ever since that day I get one or two palpitations a day, usually in the evening, at rest. They feel like a skipped beat. The pain in my chest is mild (1/10) and feels tight with little twinges of pain every now and then. The pain is usually worst in the morning, and then gets better throughout the day. I don't have any shortness of breath, pains in my arms/neck/jaw, dizziness. I actually don't feel affected at all aside from this nagging pain and occasional palpitation, but I never used to experience these symptoms. I have cut back on caffeine, 1-2 small cups of home brewed coffee in the morning, nothing later in the day. I am still able to work out without getting any pain in my chest or any palpitations. I saw a doctor two weeks ago and had an ECG which was normal, electrolytes, thyroid, CBC and BMP normal. She said my heart sounded normal with a regular rhythm. She didn't think much of the palpitations and said I likely aggravated a nerve or muscle in my chest and to come back in a month if it hasn't improved. I'm getting a little worried that there is something wrong with my heart because I didn't used to have palpitations and now I do. I don't normally have much anxiety, but these palpitations and chest pain have caused my anxiety to rise. I am planning my wedding and do have some stress with that, but I have definitely been more stressed in my life without experiencing any of these symptoms. I just wanted a second option on the description of my symptoms, because I'm not convinced about this muscle/nerve diagnosis.
Posted Sun, 25 Aug 2013 in General Health
Answered by Dr. Michelle Gibson James 35 minutes later
Hi, thanks for using healthcare magic

Palpitations can occur for a number of reasons. In the normal heart beat, the beat starts at the sinus node to the atrioventricular node to the bundles of his into the ventricles.

Palpitations occur due: (1)to increased stimulation at the sinus node (2) abnormal place of stimulation of impulse (3) abnormal passage or any blockages along the pathways (4) abnormal structure of the heart

Since you are having persistent palpitations and the ECG was normal, you may want to consider a holter test. The ECG may only show an abnormality if you experience palpitations at the time of the test unless there are other heart issues that would show constant changes on ECG.
Since the holter is a 24 hour examination and you experience the symptoms daily then it should pick up any abnormality.

The fact that they do not occur with activity or exercise implies that there is adequate blood supply to the heart which is good.

The holter would give definitive answers as to whether there are any cardiac arrhythmias.

If the holter is normal then it is unlikely that there is any cardiac disease. In that case,it may be possible that the palpitations are related to increased stress especially since the blood tests were normal.

I hope this helps, feel free to ask any other questions
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