Anxiety chest pains

dear Doctor,
I'm 32 years of age and have been having chest pains almost
every day for two years.I've had all the usual tests.
The echo showed trivial mitral regurgitation  and slight
tricuspidal regurgitation.The cardiologist told me that at
my age there was nothing to worry about considering my
father had a bypass at 76 and my mother is currently healthy
at 66.
My cholesterol is low 112mg.
Despite all this I'm not able to get a clear answer about
chest pain.They are short sharp pains.Not more than a second
or two.Left sided(lower  to mid rib level) and sometimes  seem to be triggered in
stressful conditions.Rarely during physical activity.
Can you please tell me if anxiety can cause these types
of pains and if so are there any methods of reducing
or alleviating them?
Thank you
Martin Lynch

[Cleveland Clinic, MD]

Dear Martin,

There are many causes of chest pain.  Anxiety can certainly cause chest pain. However, the one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out the work-up can proceed at a more leisurely pace.

Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.

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