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Q. My ECG and echocardiogram are normal, but I have chest pain and palpitations. Why?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 09, 2021 and last reviewed on: Aug 12, 2021

Hi doctor,

I have been to ER three times in the last five days with chest pain, shortness of breath and light-headedness, as well as palpitations. I am a 23-year-old male. Nothing has been found. I have had ECG, echocardiogram, and blood tests. Even having all normal, I am freaking out if I get a sudden cardiac arrest. Especially as I still have chest pain and discomfort and palpitations on and off. Do I have to worry, or am I safe after the tests? Notice the palpitations more at night, I would say. I am freaking out that I will drop dead. I just got back from ER again tonight. Kindly help me.

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Hello,

Welcome to icliniq.com.

Did you have chest pain during taking ECG (electrocardiogram) and echocardiogram? It is unlikely to be cardiac chest pain, and symptoms are probably related to anxiety. Do you have gastric symptoms like bloating, burping, epigastric heaviness, or constipation?

The probability of heart attack is low at this age. The nature and course of pain are altogether different in a heart attack. Also, pain due to coronary artery disease would typically increase on exertion and relieve with rest. Do you do any addiction? Kindly answer the questions so that I can guide you accordingly.

Hi doctor,

Thank you.

I get some gastric discomfort. I presented to emergency with weird feeling chest and perceived palpitations. I am terrified of sudden cardiac arrest. I also sometimes get weird sharp nerve pain in my little finger radiating to the chest in my mind. I do not know if I had pain at the exact moment of the tests as they come and go, but the echocardiogram was fine. I have some long-term breathlessness, too, which doctor believe is anxiety. I am kind of freaking out. I am more worried about sudden cardiac arrest than heart attacks. Does the echo rule out serious problems? Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Sudden cardiac arrest occurs as a result of a heart attack only. Considering normal test results, the possibility of any heart disease as a cause for these symptoms and sudden cardiac arrest is very low.

Such nonspecific off-and-on pain are rarely related to the heart. I think you need to calm down. Have some antacids for gastric discomfort. Stay busy with some or other work. I hope this was helpful.

Hi doctor,

Thank you.

Is there nothing to worry about palpitations and other symptoms? Does an echocardiogram rule out most things? If emergency doctors are not worried, then nothing is wrong? Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

An echocardiogram does not rule each and everything but rules out many diseases like structural heart disease. And when we combine it with normal ECG and nonspecific symptoms, then the probability of any significant disease is low.

The majority of the causes of palpitations are psychological only, rather than any disease. Also, abnormal palpitations are usually associated with dizziness or loss of consciousness with severe breathlessness, are sudden in onset and offset. So ER (emergency) people must have taken everything into the scenario.

Is there any particular factor that precipitated this? Still, you can request for repeat cardiology consultation for your added assurance. I hope this was helpful.

Hi doctor,

Thank you.

I get some chest pain like pinching, and I do get breathlessness and dizziness but not only with palpitations. Kindly help me.

#

Hi,

Welcome back to iclinniq.com.

Pinching pain is usually not cardiac pain. Cardiac pain is dull aching, diffuse, and classically occurs on exertion and relieves with rest. It persists for atleast a few minutes. Dizziness and shortness of breath with palpitations may indicate arrhythmia, but isolated is usually not arrhythmic. I hope this was helpful.

Hi doctor,

Thank you.

The dizziness comes on randomly and is often more like a wooziness and while it can occur with palpitations. It does not always, and often the palpitations will appear without the dizziness, etc. My doctor assures me that an echocardiogram and the individual ECGs I have had are good enough, but I am not convinced.

The breathing issues I have are long-term and have existed for a number of years. The doctors have not checked my heart for that specific issue, but they believe it is anxiety-related. Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

This does not appear to be significant. Considering the nonspecific nature of symptoms and low suspicion based on symptoms, ECG and echocardiogram are enough for you. I hope this was helpful.

Hi doctor,

Thank you.

So with ECG, echocardiogram, and blood tests, you would be pretty comfortable saying that I will be fine and that anxiety is the cause? Kindly give your opinion.

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Hi,

Welcome back to icliniq.com.

Considering the entire scenario, yes. I hope this was helpful.

Hi doctor,

Thank you.

So there is no need for any more meltdowns or sleepless nights worrying about sudden cardiac arrest. Kindly give your opinion.

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Hi,

Welcome back to icliniq.com.

Yes, no need to worry about it. Please get back if you have further doubts.

Hi doctor,

Thank you.

Will cardiac arrest not happen? Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

Nothing supports the possibility of it. So no point in worrying about it. I hope this was helpful.

Hi doctor,

Thank you.

Is not the risk incredibly low? Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

It is low. Please calm down and take care.


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