chest pain or panic attack?

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.  

[Kevin Pho, MD]

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

[TJV]

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.

[jakey2]

Thank you for the follow up.  I have thought of that, and I will bring that up to my PCP.

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

[SRELM]

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.

[jakey2]

Thanks for your input and assuring me.  I am feeling better right now, but its nice that you wrote to calm my nerves.  Thanks

[SINCLAIR]

HELLO,
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.

[jakey2]

Thank you for your post and comments, I hope you feel better soon too.  I do know that stree does have physical effects, so try and take it easy.  Give an update after you see the gastro doctor.

[bonbon6]

Hi,
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.

[jakey2]

Thank you all for your comments and input, it really is reassuring that I'm not alone.  The Cardio said, it is anxiety, and that everything is working and pumping fine with my heart.  So I appreciate the advice with herb and I will look into it.

Thanks again.