Chest discomfort, palpitations

[caldude]

I am a 21 year old male, college student. Only history of heart disease is stroke in my grandparents. For the past week I've been having more an more discomfort in my chest. First couple of days, I only had it when I woke up or went to bed. Then since Tuesday I've been having it much of the day. Along with that my heart seems to be beating faster than normal, making me break into sweats at times including at night. The discomfort is mainly in the left side and is hard to describe. Generally it feels raw, like some object is crawling around. Sometimes I feel it coming from my heart, going up or down my esophogus and I get a lumpy feeling at the notch of my throat and upper chest, exacerbated by swallowing. The sensation makes me belch somestimes. I don't have any pain except that it hurts when I press on my left armpit. The feelings come and go. Sometimes I also get needle feelings in my fingers.

Worried it could be a heart problem, I saw my doctor Wednesday who did an EKG, chest xray, and listened to my heart. My EKG had a slight ST elevation, but everything else was normal. Went back 2 days later where I did another EKG, same result as before. He told me the ST elevation could mean possible MI, but said it was common in young males and my symptoms due to anxiety. True I have been stressed about school and I was very worried about this, but even after his reassurance and tried to relax, I still feel those constricted feelings in my chest. My doctor says it might be GERD, but I don't have any heartburn and taking a Zantac didn't seem to help. Could my problem be something quite serious? Should I see another doctor or would anxiety really cause all these odd symptoms?

[Kevin Pho, MD]

The heart can certainly be further evaluation.  If there is any evidence of elevation or ischemic heart damage, a stress test can be considered.  At the very least, an echocardiogram should be obtained to evaluate the structure of the heart.

If the heart has been appropriately evaluated, you can consider further GI testing, including an upper GI series or upper endoscopy.  This can evaluate for GI causes of the discomfort - such as GERD, inflammation of the upper digestive tract or an ulcer.  

Anxiety can be considered if the tests remain non-revealing.  

These options 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.
http://www.straightfromthedoc.com