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Heart Disease (Expert Forum)
Anxiety???
Answered by
Cleveland - OH
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Anxiety???
by SuperSnell, Dec 08, 2006 12:00AM
Ok I have constant chest pains. I went to the ER and they said I had anxiety. Thats was two years ago. I have been put on Lexapro and Ativan and still have constant pains. I have been treated with previcid also no help. I had an echo and my left vent was slightly enlarged but doctor said it was due to patient habitus? They also gave me a stress test on the treadmill that i finsihed with no problem and reach 100% of max heart rate. I wore a holter moniter and it said no problems. I am 32 years old with no real medical history my appendix ruptured when i was 16 or so. I am fat, about 30 pounds over weight. non smoker and rarely drink. My job is like constant exercise so i get plenty. my cholesteral levels are kind of wack though.
Total = 113
ldl = 40
hdl = 38
tri = 85
bp is 125ish / 60 ish
ef = 75%
Hr is always 56- 62 when at rest.
Ok so my questions--
1 when i work out or get winded my nose seems to "clog" up like i cant get enough air through it. Is this what shortness of breath is?
I have had chest pains for nearly two years EVERY day so given my test i am sure it isnt my heart but just wanted your opinion.
I know I sound like a total anxiety freak but i am lost.
2 could it be heart failure. I mean i feel fine when i lay down and have no real other symptoms of HF but its like my problems are brought on by hard work. Working out, running, etc but given the Stress Test i assume that would have caught HF.
Well I appreciate your time and thanks for any info you can give.
SuperSnell
also with my cholesterol numbers no way for plaque?
Total = 113
ldl = 40
hdl = 38
tri = 85
bp is 125ish / 60 ish
ef = 75%
Hr is always 56- 62 when at rest.
Ok so my questions--
1 when i work out or get winded my nose seems to "clog" up like i cant get enough air through it. Is this what shortness of breath is?
I have had chest pains for nearly two years EVERY day so given my test i am sure it isnt my heart but just wanted your opinion.
I know I sound like a total anxiety freak but i am lost.
2 could it be heart failure. I mean i feel fine when i lay down and have no real other symptoms of HF but its like my problems are brought on by hard work. Working out, running, etc but given the Stress Test i assume that would have caught HF.
Well I appreciate your time and thanks for any info you can give.
SuperSnell
also with my cholesterol numbers no way for plaque?
Doctor's Answer
by Cleveland Clinic, Dec 08, 2006 12:00AM
, Dec 08, 2006 12:00AM
supersnell,
thanks for the post.
Unless you are a professional athlete, you can't substitute your work activity for exercise. The fact that you are overweight indicates an imbalance between activity and your metabolism.
Shortness of breath is the sensation of lack of air. It has many causes from deconditioning and sinus problems to primary cardiac and pulmonary issues.
The chronic nature of your chest pain would argue that it is not related to coronary disease or heart failure.
Sometimes asthma or reactive airway disease can cause both symptoms you describe, I would look into that.
There is always a way for 'plaque'. Besides your cholesterol I would look into addressing your activity and obesity.
thanks for the post.
Unless you are a professional athlete, you can't substitute your work activity for exercise. The fact that you are overweight indicates an imbalance between activity and your metabolism.
Shortness of breath is the sensation of lack of air. It has many causes from deconditioning and sinus problems to primary cardiac and pulmonary issues.
The chronic nature of your chest pain would argue that it is not related to coronary disease or heart failure.
Sometimes asthma or reactive airway disease can cause both symptoms you describe, I would look into that.
There is always a way for 'plaque'. Besides your cholesterol I would look into addressing your activity and obesity.
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it turne out to be my lungs. i have bad allergies, but it never crossed my mind that it could be my lungs(chest)
have you had that checked out?
or your bones? sometimes if i sleep funny my chest bones hurt?
I hope you feel better.
with that being said, I have been chasing this "anxiety" for a little over two years now. its started when I took psuedoephedrine..sp.. and thought i was going to DIE... went to the er had a bp of 180/110 hr around 120 and elevated ST waves on an EKG. They freaked me out telling me it was heart related and then the cardio guy said no and ran another ekg and it was fine. they tested for the tropin things or something... long story short no heart attack. So i just stayed away from sinus medicine and things were great. Well then i would fatigue easy and i told the doc so I had a battery of cardio test and the only thing bad was that enlarged left vent but he said it was just because i was a big guy. 6'2" 230lbs. Not really fat by looking at me just by BMI definition. so my gp tested me over and over for everything under the sun and said they only thing left was anxiety. I accepted that dx and took the lexapro drug and it made me manic but they said it would pass. well that was 8 months ago and i still have pain, still fatigue easy, and still "feel" like i cant breath sometimes.
So the moral is that i am in no better shape today than i was two years ago and it is driving me nuts. If this is what anxiety is i would never wish it on anyone.
Thanks for listening to my rant...
Snell
1. do you think its cardiac?
2. should i get a 2nd opinion?
3. is it possible for me to have a heart attack even with no fam history?
4. do you think anxiety?
5. is the gastro right about GERD and gastritis?
6. how long will it take for nexium to work?
I would appreciate ANY responses. Thanks and good luck to all of you!
Gastritis can cause chest pain, but your gut has been inspected pretty thoroughly, and nothing horrible has been found. I've known people who have serious gastritis, and they are SICK. You wouldn't confuse them with someone who looked well, and had problems just with gut discomfort and some belching.
"My regular MD, my psychiatrist, my gastro and my cardiologist are all saying not heart related...why can't I believe this? "
You have posted the same symptoms and questions numerous times for several months now, and since you have been checked out quite thoroughly, it is reasonable to say that your problems are not cardiac. Being young, female, and without family history, you are NOT going to have a heart attack anytime within the next twenty years.
You do have what's called a "cardiac neurosis," a neurotic obsession with your heart. This is a psychiatric problem. Since you continue to fear dying, and ativan, prozac, and your current therapist are not helping, you need to find a psychiatrist--not a counselor--and discuss both a proper therapy and a change of medications.
If you really wish to feel better, you will be talking to another shrink. Please post again in a month or two and let us know that you have taken these steps.
Mike
Thanks
Mels, in terms of physical indications of heart disease, you're in the clear. Time and time again, you post concerns over the same symptoms, or test values that are, statistically speaking, mostly irrelevant. Always, always, you come back with no significant risk . But you resolutely dodge the issue of emotional problems. What's going on here?
You're too young to have heart disease, and you have no family history, anyhow. You've had a lot of heart tests, which you pass with flying colors; you can do your ordinary activities (which heart patients cannot; ask Al Dente); but I haven't heard that you have been aggressively pursuing the only logical alternative, which is psychiatric care. Yeah, you say you've had a little counseling and some psych drugs that haven't worked, but as to the next step? Is it possible that you NEED a heart condition for some reason?
If you don't want to live like this, destroying your marriage and the emotional health of your child, I'd like to hear that you have made an appointment with a different shrink and discussed other meds and another strategy. You need to let go of this neurosis and get on with your life.
Thanks for trying to help me. I realize I have a problem with this but I continue to have chest pains and that fact that my HDL #s are lower than my 52 year old mother scares me more. I am going to see a new psychiatrist next week and possibly go on different meds.I will let you know how that goes but can I ask you some questions? You said you have fibro too, what do you do for it? I've been on a new diet for it for 3 weeks and for some reason my overall cholesterol went down with my LDL but unfortunately so did my HDL. Isn't it true that women should have one higher than 50? Mine is 46. How do you get HDL up? My mom's is 70. I don't know if its the new diet or not. Anyway, I've had less pain recently with it so if this new doctor helps hopefully all symptoms will subside. I can't remember but do you have heart problems? I'm sorry if you do. We watched my husband's grandfather die of CHF and it was so scary. Well anyway, I appreciate your time and any suggestions and answers you have for me...THANKS!
You have no symptoms of real heart disease, and your chest pains wander about too much to be heart related. It’s possible they may be related to your fibro; certainly, that’s a more reasonable source of pain than your young, healthy heart.
Fibro and diet? People in pain search desperately for anything--anything--that might possibly help. Dietary changes probably won’t hurt anything. To deal with my own fibro, I exercise--hard--five or six days a week. Exercise is a tried and true therapy for this condition. Fibro is correlated (no one knows if it's cause or effect) with poor sleep, and better sleep seems to be associated with an improvement in symptoms. Exercise can improve sleep, as can certain antidepressants. You might want to look for a fibro support group online. At the very least, it will give you something more than your heart to think about:
http://fibromyalgia.ncf.ca/
Yes, high HDLs are a good thing, but for many people, these numbers are hard to change significantly. A lot of the time, it’s just a matter of genes. Vigorous exercise is said to be very helpful, and I know that you’re not doing that right now, because of your baby. It would be good to get a sitter at least twice a week to allow you to get out for a half hour of either jogging or walking really fast. A treadmill every day would be better. The exercise would be at least as good for your mind as your body.
Here’s a website with good info about drugs like niacin and so on:
http://heartdisease.about.com/cs/cholesterol/a/raiseHDL.htm
However, once again, it’s important to emphasize that at your age, your blood fats are really not an issue, particularly since you are a young woman with, as you say, no family history. I think that your emotional problems lead you to seize on anything heart related, and your fascination with HDLs and LDLs is just another way of tricking yourself into not looking at the real problem, which is between your ears.
Google “cardiac neurosis,” and I think you’ll see yourself in print. To have a good life again, you simply must get beyond your fixation with your ticker, and to do that, you are going to have to accept what you’ve been told by every medico you’ve spoken to, and actively seek help for your compulsive, unhealthy thoughts. If your shrink is any good, he/she should recognize the pattern you’re stuck in, and should offer you ways to break the cycle. If he doesn’t, then you need to look for another shrink.
As to my heart, I have PVCs, sometimes only a few, sometimes a ton of them. This year, I was found to have a floppy aortic valve. It leaks mildly, and someday, I may have to have it replaced, but right now, it’s stable. I take antibiotics before tooth-cleanings, and have to get a stress echo every year to monitor things. No biggie, just the breaks.
1. Could this be prinzmetal's angina? I read it was common in young women and the only way to dignose it is to cause the spasms during an angiogram
2. Why all the belching, gas, pain all of a sudden?
3. Could it be gastritis or GERD?
4. I've now been on 40 mg nexium and a strict non-acidic diet for 30 days now and it hasn't helped...if it were gastrointestinal, wouldn't this have stopped by now? Doesn't that sound cardiac?
5. Do you think I can ask for calcium channel blockers?
I understand I have no risk factors, but I have ALL the symptoms and I'm just afraid they are missing something. I mean look at Al, it took him a while before they finally diagnosed CAD for him. I don't know what else to do. I've started an aspirin regimen just so there is something I can do about my fears. Would a 24 hour holter show anything? Please help.
Any suggestions would be more than appreciated.
Happy Holidays!
If your instincts are telling you there is something wrong, you should push to have it checked into further. That's what a nurse at a large hospital told me while I was in the cardiac care unit having atypical angina investigated. Although most of the doctors were nice, I do not believe that they actually thought there was anything seriously wrong...when I was handed maalox and sent home, it confirmed my feelings that the doctors did not feel there was anything wrong with my heart. If it weren't for the nurse, and my family doctor, who reassured me that it was "not in my head", I'd probably be in bad shape right now.
In fairness to the doctors, I have been told that my case was a little unusual and did not fall into some of the typical patterns.
I will "try" to summarize my history as you really don't need to be reading a novel haha, although it may be difficult.
June 2003 (female, age 39), no risk factors (with the exception of being a smoker), had tingling and numbness in both arms, shortness of breath, a feeling of bad gas, and an "uneasy feeling" while I was washing my car. I dismissed the symptoms. They continued off and on all day and evening and the pressure in my chest felt like a balloon inflating from below my breasts to my neck, and from shoulder to shoulder...I still dismissed it as gas.
The next day, numbness in left arm only, a feeling of indigestion (which I had only ever experienced when pregnant), extreme fatigue, shortness of breath. It continued off and on most of the day , and after dinner, while cleaning up, I tried to ignore what my body was telling me, but ended up slumped over the counter and it felt like there was an elephant on my chest. I was rushed to e.r. I had had a heart attack with a blockage in mid- LAD cleared and stented (the funny thing is that no one could tell me how I got a blockage when I do not have high cholesterol).
I was sent home and told to go into the cardiac rehab program for 3 months and strongly advised to reduce stress in my life.
I continued to have symptoms off and on,passed all tests, including a thallium stress test, given maalox and sent home.
Jan. 2004-my family doctor pushed to have an angiogram done (I was quite willing to go on with my life and hoped the symptoms went away, luckily he was not comfortable with my symptoms).
Angio showed restenosis in stent, had 2 more stents (drug coated). Felt great afterwards.
April 2004-symptoms started again, choking feeling, pressure, feeling of food stuck in my chest, extreme fatigue. I passed ecg, echo, stress test.
Family doc added tiazac (cardizam?)to the rest of the meds I was taking. It helped, but not a lot. I gave up on going to specialists, despite the fact that symptoms were getting worse or more frequent. instead, I started seeing a psychologist because I wanted to be objective to the fact that these symptoms may be in my head (she did not feel they were).
May 2005 another heart attack. I had been tired of having to rest off and on during the day or take nitro to relieve symptoms. So, this day, I decided instead of resting, I would go grocery shopping. The chest discomfort got worse in the store, I still shopped, came home and tried nitro. The nitro helped, but did not get rid of it completely. My husband wanted to take me to the er, and although I knew it was my heart, I did not want to go until I knew it was bad enough that it would show up on an ecg. I just couldn't stand the thought of having another doctor look at me like it was in my head, but I knew if I pushed myself a little more physically that day, I could make it worse and then they'd believe me(I know, I know, that was really stupid). I guess I left it a little too long. The good thing was that it was captured on an ecg and the proof was also in my elevated cardiac enzymes. Angio showed that the stents were clear and there were no new blockages , which really surprised the cardiologist. He was very good and said to me "you women humble me every day. I learn more and more each time I deal with a woman as your symptoms can be so unusual".
It sounds strange, but finally I felt validated. I actually was beginning to think the symptoms were in my head.
They still do not know for sure what is causing the problems, but think it is Prinzmetal or Variant Angina. But, I agreed to be part of a research study. It made me feel good that I may be able to help prevent this from happening to other women.
I live on a lot of medications, but life is good now...except when my medications are wearing off in the morning and at night. Although sometimes I have a few moments of feeling sorry for myself (a pity party, I call it haha), because of the major changes this condition has caused in my life. Then I give myself a kick and try to be grateful for the fact I'm still on the planet and I have learned a great deal in these past few years. I live my life differently, and I'm enjoying it to the fullest.
Good luck with everything. My purpose of "telling my story" so to speak, is not to scare you, but to give you some moral support if you truly are feeling there is something wrong inside and no one seems to be listening. You know yourself best. Go with that.
Take care, Janne
p.s. sorry about the long post.
is your bp usually high while having a heart attack?
I have had a huge battery of tests including blood work, chest xrays, holter monitor, EKG, gall bladder and upper GI which have all come back clear! But after losing 20 pounds in the last month out of fear for my health, it is still hard to believe that nothing is wrong! My doctor is suspecting anxiety, but I am not aware of anything specific causing me stress(except the heart problems!). The only other evident problem is severe sleep onset insomnia.
I would appreciate hearing from anyone who has any experience with taking meds to control anxiety long term. My doc has suggested Paxil. Right now I am on Alprazolam(Zanax) for the attacks, but sometimes it doesn't actually reduce my pulse and it wipes me out so bad.
Has anyone tried any natural alternatives to the drugs? What can anyone tell me about adrenaline? When I get tachy, I feel exactly like I do when I have gotten in a car accident. Racing heart, dry mouth and I feel like I have to go to the restroom.
Thanks for considering these questions. SGJ