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Family Medicine (Expert Forum)
chest pain or panic attack?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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chest pain or panic attack?
by jakey2, Jan 20, 2005 12:00AM
I'm needing some help so I'm hoping you can address some of my concerns. 34yr old female, 40 pounds overweight. Non smoker, non drinker, general good health. No family history of heart disease or cancers. Brother and Dad have type 2 border line diabeties, controled and now untraceable.
Last month started to feel as if i had a rapid heart beat, alittle fluttering. I started to feel anxious about it, possibly made it worse Went to PCP she said heart sounded normal, she order a 24 hr heart holter, test result were Normal. Xmas eve went to ER because experienceing chest spasms, discomfort, these are the test that were done with results basic metabolic panel done, results all in Normal range; TSH normal; Cholestrerol 123; WBC was normal; EKG, Normal; Rhythm strip, normal sinus rhythm; Chest X ray, Normal cardiac silhouette, Normal mediastinum. No evidence of infiltrates or heart failure. Bones and soft tissue within noraml limits. Pulse oximetry, no oxygenation feficits. After ER visit on Xmas eve went home felt fine until 4 days ago. Symptoms chest pain/discomfort started all over again. Sometimes I have a muscle spasm or twitching across chest area. I also intermittently feel like a squeezing in the center of my chest lasting 2 sec or so. Then I feel anxious and panic all over again too
Based on the above testing, should I continue with more heart testing, or is this basic anixety or panic disorder. I am starting pyschological therepy next week for panic attacks and anxiety, just to see if that is the issue. Should I rule out the heart being the culprit? Please give me some advice and suggestions. I don't think my PCP feels anything is wrong and might think its all in my head, but my body is reacting to something, heart or pyschological attacks. I've heard and read that heart disease is prevelant in women.
Last month started to feel as if i had a rapid heart beat, alittle fluttering. I started to feel anxious about it, possibly made it worse Went to PCP she said heart sounded normal, she order a 24 hr heart holter, test result were Normal. Xmas eve went to ER because experienceing chest spasms, discomfort, these are the test that were done with results basic metabolic panel done, results all in Normal range; TSH normal; Cholestrerol 123; WBC was normal; EKG, Normal; Rhythm strip, normal sinus rhythm; Chest X ray, Normal cardiac silhouette, Normal mediastinum. No evidence of infiltrates or heart failure. Bones and soft tissue within noraml limits. Pulse oximetry, no oxygenation feficits. After ER visit on Xmas eve went home felt fine until 4 days ago. Symptoms chest pain/discomfort started all over again. Sometimes I have a muscle spasm or twitching across chest area. I also intermittently feel like a squeezing in the center of my chest lasting 2 sec or so. Then I feel anxious and panic all over again too
Based on the above testing, should I continue with more heart testing, or is this basic anixety or panic disorder. I am starting pyschological therepy next week for panic attacks and anxiety, just to see if that is the issue. Should I rule out the heart being the culprit? Please give me some advice and suggestions. I don't think my PCP feels anything is wrong and might think its all in my head, but my body is reacting to something, heart or pyschological attacks. I've heard and read that heart disease is prevelant in women.
Doctor's Answer
by Kevin Pho, MD, Jan 20, 2005 12:00AM
, Jan 20, 2005 12:00AM
You want to rule out heart causes first before settling on panic attacks or anxiety as the cause of your symptoms. A simple test to consider would be a stress test, which can evaluate for cardiac causes of chest pain - this can be done with an echocardiogram for better clarity.
If this test is negative, then you can be better assured that the heart is not the culprit, and proceed towards optimizing anxiety treatment.
This can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
If this test is negative, then you can be better assured that the heart is not the culprit, and proceed towards optimizing anxiety treatment.
This can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Have you thought about GERD ? Some people complain of irregular heartbeats and twitches with that, in addition to chest pain etc.
Or perhaps esophageal spasms? An esophageal manometry can evaluate for that.
However, I'm so afraid of test that require tubes going down your throat. I know I should be brave, but i'm so afraid.
Thank you again for your input
I just happened upon your post as I usually only read the Heart Forum. I have benign premature ventricular beats that are made tons worse by GERD. As for being afraid of a endoscopy, I've had two and they are an absolute breese. The nurse talks to you and the next thing you remember is waking up with it all over with.
Hope you feel better.
YOU MAY HAVE SEEN SOME OF MY SRECENT POSTS. I TOO GET CHEST PAINS AND HAVE HAD A COMPLETE CARDIAC WORK UP. I WAS TOLD THAT EVERYTHING WAS FINE AND THAT IT WAS PROBABLY STRESS. YET, I STILL HAVE A HARD TIME WITH STRESS ACTUALLY BECOMING A PHYSICAL SYMPTOM. I AM ACTUALLY GOING TO FOLLOW SOME OF THE ADVICE GIVEN TO YOU AND SEE A GASTRO SPECIALIST. HOPEFULLY, EVERYTHING GOES WELL FOR YOU AND YOU CAN WHIP THIS ANXIETY THING. JUST KNOW THAT YOUR NOT ALONE.
If you find out that it is anxiety attacks or depression, let me suggest that you go to a health food store and ask for the herb,
feverfew. It is good for anxiety, panic attacks and depression. Just be sure to ask your doctor if it is ok if you are on other medication.
My daughter was in a bad car accident in October of last year and she started getting anxiety attacks after the accident. She was in ICU for 3 days. The doctor gave her medicine for depression but she could not take it because of the side effects. She started taking feverfew and it is the only thing that has helped her. Just thought I would pass this along in case it helps someone. She is much better now.
Thanks again.