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Heart Disease (Expert Forum)
Chest Pain/Fluttering
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Chest Pain/Fluttering
by tarek, Sep 02, 2006 12:00AM
Hello,
I am a 23 year old. Good diet, regular cholesterol. I have been having chest pains for the last 4 months. At first they were sharp pain near the breast area but then they started coming in the middle while walking. I did an ECK,a stress echo, and then a regular echo and all normal the doctors said (i have been to two cardiologist). Lately however, i am feeling flutter in the left side of my stomach and in the middle. The flutter comes, and then an adrenaline feeling (like sinking heart) and then i can feel my heart racing (at around 120), i am also feeling extra beats...My questions:
1) Given all the tests i have done, should i be worried about the pains? (docs say anxiety and to ignore, but honeslty i dont know how anyone can ignore chest pains and i just cant seem to do it)
2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)
It seems that in the last four months, my life has been at a paused state.. I appreciate your input and help...
Thanks
Tarek
I am a 23 year old. Good diet, regular cholesterol. I have been having chest pains for the last 4 months. At first they were sharp pain near the breast area but then they started coming in the middle while walking. I did an ECK,a stress echo, and then a regular echo and all normal the doctors said (i have been to two cardiologist). Lately however, i am feeling flutter in the left side of my stomach and in the middle. The flutter comes, and then an adrenaline feeling (like sinking heart) and then i can feel my heart racing (at around 120), i am also feeling extra beats...My questions:
1) Given all the tests i have done, should i be worried about the pains? (docs say anxiety and to ignore, but honeslty i dont know how anyone can ignore chest pains and i just cant seem to do it)
2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)
It seems that in the last four months, my life has been at a paused state.. I appreciate your input and help...
Thanks
Tarek
Doctor's Answer
by CCF-M.D.-MJM, Sep 02, 2006 12:00AM
Hi Tarek,
I can understand why you are so worried. When people think of chest pains, they think of their hearts and all the problems that can come along with heart problems. When we approach problems like this in clinic, after doing the history and physical exam we generate an estimate of the probability that you have something wroing with you heart and a differential diagnosis of what that may be. For people you age, that is not a very long list and the overall incidence of cardiac disease in your age group is very low. Once we substantiate our hypothesis with further cardiac testing like an echocardiogram, ekg, and stress test, we make our conclusions.
If you have normal cardiac tests and two cardiologists supporting that there is nothing wrong with your heart, you should start looking for other causes. For someone in your age group with these symptoms, the overwhelmingly most common causes is panic anxiety. For people that have been healthy there entire life, it is hard to believe that something as "subjective" as anxiety could cause symptoms like that. Anxiety is a medical condition that can can take over people lives -- it is not a purely "psychological" disease. There are physiologic reasons for these feelings -- it is likely a large adrenaline surge that causes chest pains and tachycarida (fast heart rates).
The good news about these conditions is that most people are able to take control of their symptoms with help, both medications and therapy. Once you accept that there is nothing wrong with your heart, most people can talk themselves down from these sinking feelings.
For example:
chest pains --> fear that something is wrong --> believing something is wrong --> adrenaline goes up --> more chest pains and fast heart rates.
if you know there is nothing wrong with you heart
chest pains--> talk your self down from these fears by reassuring your self that nothing is wrong --> symptoms often lessen or even abate.
2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)
I think you should feel pretty assured at this point that nothing is seriously wrong. The only other option is a third opinion.
I hope this helps. Try talking to your primary doctor about anxiety disorders and make an appointment with a counselor and possible an anxiety medication (not a benzodiazipine like xanax or ativan).
Thanks for posting.
I can understand why you are so worried. When people think of chest pains, they think of their hearts and all the problems that can come along with heart problems. When we approach problems like this in clinic, after doing the history and physical exam we generate an estimate of the probability that you have something wroing with you heart and a differential diagnosis of what that may be. For people you age, that is not a very long list and the overall incidence of cardiac disease in your age group is very low. Once we substantiate our hypothesis with further cardiac testing like an echocardiogram, ekg, and stress test, we make our conclusions.
If you have normal cardiac tests and two cardiologists supporting that there is nothing wrong with your heart, you should start looking for other causes. For someone in your age group with these symptoms, the overwhelmingly most common causes is panic anxiety. For people that have been healthy there entire life, it is hard to believe that something as "subjective" as anxiety could cause symptoms like that. Anxiety is a medical condition that can can take over people lives -- it is not a purely "psychological" disease. There are physiologic reasons for these feelings -- it is likely a large adrenaline surge that causes chest pains and tachycarida (fast heart rates).
The good news about these conditions is that most people are able to take control of their symptoms with help, both medications and therapy. Once you accept that there is nothing wrong with your heart, most people can talk themselves down from these sinking feelings.
For example:
chest pains --> fear that something is wrong --> believing something is wrong --> adrenaline goes up --> more chest pains and fast heart rates.
if you know there is nothing wrong with you heart
chest pains--> talk your self down from these fears by reassuring your self that nothing is wrong --> symptoms often lessen or even abate.
2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)
I think you should feel pretty assured at this point that nothing is seriously wrong. The only other option is a third opinion.
I hope this helps. Try talking to your primary doctor about anxiety disorders and make an appointment with a counselor and possible an anxiety medication (not a benzodiazipine like xanax or ativan).
Thanks for posting.
Hugs, Linda
I am older than you but can certainly feel for you. For the past two years I've been experiencing a feeling where I know my heartrate is starting to go faster. I feel a sinking feeling, or a drop in my stomach and I think uh oh. It starts to get quicker and quicker, usually peaks then slowly returns to normal. Other times it can stay high, like in the 120's for quite a while before it slowly goes down. I've captured these events on a monitor and been told it is sinus tachycardia. I've also had palpitations,pvc,pacs for years and have been under the care of a cardio.
He has told me he felt it was physiological. I have always described it as adrenaline surges. I recently started to take a little lexapro. A very small dose. I think it has been helping. I have been taking a small dose of beta blocker for years but just added the lexapro over a month ago as well as seeing a therapist. I have had these surges but they have not produced and terribly high rates. So far in the 90's. Even though it still feels high it's not. I don't know why it is occuring. I thought it was cycle related but just don't know.
Once you do get the clear that you are o.k., try to take that reassurance to heart. It's tough to feel these things and believe you are o.k.
Hang in there.
I am not new to anxiety disorder. IMO (non-professional of course!) your symptoms could easily be anxiety. In my experience, I realized I had an anxiety disorder in my teens, and then proceeded to have a very successful life and career by learning Rational Emotive Therapy techniques. I would never accept the idea of a med to help.
However, after being successful for nearly 30 years managing anxiety, I came to a point a few years ago where merely using my techniques wasn't "doing-it". My therapist and my GP said, you need a med, so I agree.
I was put on Paxil, progressing through 10mg 25mg to "wean-on". Mistake. Anxious people often don't need "theraputic" levels of 25mg and just using Paxil can increase anxiety. I suggested that I don't like the affect of Paxil, and as I weaned-off, I paused at 5mg and Voila! At that dose I am still get anxious about stuff, but that awful "fight/flight" adrenaline does not tend to happen. I've been on Paxil at that very low dose for 3 years and "it works".
So, consider treating your anxiety, and don't be afraid of using a low dose med to help. I wish someone had told me this years ago!!