Chest Pain/Fluttering

[tarek]

Hello,

I am a 23 year old. Good diet, regular cholesterol. I have been having chest pains for the last 4 months. At first they were sharp pain near the breast area but then they started coming in the middle while walking. I did an ECK,a stress echo, and then a regular echo and all normal the doctors said (i have been to two cardiologist). Lately however, i am feeling flutter in the left side of my stomach and in the middle. The flutter comes, and then an adrenaline feeling (like sinking heart) and then i can feel my heart racing (at around 120), i am also feeling extra beats...My questions:

1) Given all the tests i have done, should i be worried about the pains? (docs say anxiety and to ignore, but honeslty i dont know how anyone can ignore chest pains and i just cant seem to do it)

2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)

It seems that in the last four months, my life has been at a paused state.. I appreciate your input and help...
Thanks
Tarek

[CCF-M.D.-MJM]

Hi Tarek,

I can understand why you are so worried.  When people think of chest pains, they think of their hearts and all the problems that can come along with heart problems.  When we approach problems like this in clinic, after doing the history and physical exam we generate an estimate of the probability that you have something wroing with you heart and a differential diagnosis of what that may be.  For people you age, that is not a very long list and the overall incidence of cardiac disease in your age group is very low.  Once we substantiate our hypothesis with further cardiac testing like an echocardiogram, ekg, and stress test, we make our conclusions.

If you have normal cardiac tests and two cardiologists supporting that there is nothing wrong with your heart, you should start looking for other causes.  For someone in your age group with these symptoms, the overwhelmingly most common causes is panic anxiety.  For people that have been healthy there entire life, it is hard to believe that something as "subjective" as anxiety could cause symptoms like that.  Anxiety is a medical condition that can can take over people lives -- it is not a purely "psychological" disease.  There are physiologic reasons for these feelings -- it is likely a large adrenaline surge that causes chest pains and tachycarida (fast heart rates).

The good news about these conditions is that most people are able to take control of their symptoms with help, both medications and therapy.  Once you accept that there is nothing wrong with your heart, most people can talk themselves down from these sinking feelings.

For example:

chest pains --> fear that something is wrong --> believing something is wrong --> adrenaline goes up --> more chest pains and fast heart rates.

if you know there is nothing wrong with you heart

chest pains--> talk your self down from these fears by reassuring your self that nothing is wrong --> symptoms often lessen or even abate.


2) Given the new feeling of palpitations, should i go to the cardiologist again and ask for a holter monitor (can it detect something serious eventhough i had a normal stress test and an echo?)

I think you should feel pretty assured at this point that nothing is seriously wrong.  The only other option is a third opinion.


I hope this helps.  Try talking to your primary doctor about anxiety disorders and make an appointment with a counselor and possible an anxiety medication (not a benzodiazipine like xanax or ativan).

Thanks for posting.

[scag]

hi read your post i had all the same tests and things for same symptoms i had panic and anxiety disorder and hat was 6 years ago,i still have attacks occasionally,papls often etc,i would seek to talk to someone about it made me feel alot better,and a question for dr,mjm i was prescribed a 1mg dose for xanex,is there a reason you said not those drugs? curious thanks

[line]

I have been getting that fluttering in my stomach off and on for years, feels like a big flopping around. I was told it is abdominal spasms and when I get this every once in awhile I will get like a thud that sends a flutter up my chest to my throat. I have felt a few palps in pulse but was told that they are caused by the vegus nerve, I think the spelling is right. being aggrevated by the stomach spasms.

Hugs, Linda

[tarek]

Thank you doctor... and thank you all for your input ... Reading other people's posts about palps and how common they are is reassuring...

[mom4cem]

Hi,

I am older than you but can certainly feel for you. For the past two years I've been experiencing a feeling where I know my heartrate is starting to go faster. I feel a sinking feeling, or a drop in my stomach and I think uh oh. It starts to get quicker and quicker, usually peaks then slowly returns to normal. Other times it can stay high, like in the 120's for quite a while before it slowly goes down. I've captured these events on a monitor and been told it is sinus tachycardia. I've also had palpitations,pvc,pacs for years and have been under the care of a cardio.  

He has told me he felt it was physiological. I have always described it as adrenaline surges.  I recently started to take a little lexapro. A very small dose. I think it has been helping. I have been taking a small dose of beta blocker for years but just added the lexapro over a month ago as well as seeing a therapist. I have had these surges but they have not produced and terribly high rates. So far in the 90's. Even though it still feels high it's not.  I don't know why it is occuring. I thought it was cycle related but just don't know.

Once you do get the clear that you are o.k., try to take that reassurance to heart. It's tough to feel these things and believe you are o.k.  

Hang in there.

[BillK3]

I am new to the world of coronary issues (read my post below) and thankfully my recent experience was just a vasospasm.

I am not new to anxiety disorder.  IMO (non-professional of course!) your symptoms could easily be anxiety.  In my experience, I realized I had an anxiety disorder in my teens, and then proceeded to have a very successful life and career by learning Rational Emotive Therapy techniques.  I would never accept the idea of a med to help.

However, after being successful for nearly 30 years managing anxiety, I came to a point a few years ago where merely using my techniques wasn't "doing-it".  My therapist and my GP said, you need a med, so I agree.

I was put on Paxil, progressing through 10mg 25mg to "wean-on".  Mistake.  Anxious people often don't need "theraputic" levels of 25mg and just using Paxil can increase anxiety.  I suggested that I don't like the affect of Paxil, and as I weaned-off, I paused at 5mg and Voila!  At that dose I am still get anxious about stuff, but that awful "fight/flight" adrenaline does not tend to happen.  I've been on Paxil at that very low dose for 3 years and "it works".

So, consider treating your anxiety, and don't be afraid of using a low dose med to help.  I wish someone had told me this years ago!!

[STUARTCBRANDT]

I have also been having palpatations, the other day my doc did a lepid profile, and my total Cholesterol was 196, then a week later he did it again and it was 147 total, I asked him if his machine was busted or what, he said he never has seen the numbers go down that fast, I have Changed my diet less fat more dark green veggies brussell sprouts and the like.
He wants me to get a stress test because of my age 42 but being uninsured that may be a problem.
I have been living in a circle of fear for the last three weeks.
Wondering if the BIG one is around the Corner Heart Attack that is. I was even afraid of having intimate time with my wife, well all I can say is my wife said abandon your fear and start living again. My doc said take an baby asperin daily and eat right and you should be ok. I have lost around 33 pounds and have started walking again, I was so consumed with fear checking my Blood pressure a few times a day, if the BP is high I would start freaking out and get scared then my pulse would go up to 160, then I would really start bugging out.
I got stuck in my truck with my Six kids and wife one day after a powerline fell on the road, I said oh no here we go my stress level went to 10 and thought here I go I am going to die here on this road with six Screaming kids, well I calmed down again and am still here, and the kids are still screaming lol.
I have been having more fun daily, trying to lower my stress level and more intimate time with my wife. Asperin is like low cost Viagra just kidding.

Stuart Brandt

[dplp]

I can understand frustration.

I've got PVC's, and some chest pain, arm pain, jaw pain.

I've had a stress echo, 64 slice ct, and numerous blood tests over the past 6 months.

I've tried various meds.  Two weeks ago I was THRILLED as I thought a calcium channel blocker had all but eliminated my PVC's.  I went 5 days without much of any.  This was after a HUGE aerobic effort though on my bicycle also.  Maybe that got things out of my system.

Then, sure enough they slowly came back and are driving me nuts again along with various chest pains etc.  It's not stress, I've tried anxiety meds.

Never had this a year ago.  It's the most frustrating thing I've ever dealt with.  Even more so now, in that I thought they were pretty much gone a week ago and I was in such a good mood.  Now, they are back and worry me.  I'm a tad better on the worry, but it sucks.

Only thing I have left to explore is some sort of disease like Lyme etc since I have some of this other stuff (jaw, muscle etc) and that it comes and goes.  

I would give an easy 5k to just get back to feeling normal, and being able to eat and drink what I want.  I've cut out caffene and everything else they suggest with no help.

34 years old, and I now assume I have to deal with this **** forever.  It sucks.

[STUARTCBRANDT]

Dude I know how you feel, I went up to my fatherinlaws place today and all I did was worry about getting home to where it is safe, hospital three blocks away that type of thing. I could not even enjoy riding the boat with my wife and Six kids.
All I was thinking is am I going to get chest pains or whatever else I could come up with. This really does suck, I better start praying. I still need to see a Cardiologist and get a stress test. I will call duke Tuesday and find out if they can help a person who is uninsured, or maybe the can find me a grant because I am low income, strange my kids get medicaid but my wife and I get the Shaft. I know I need to get insurance, I will not make fun of people who pay 500.00 a month for health insurance anymore that was a big mistake.

Stuart Brandt

[wmac]

I am also wondering why the doc said no xanax or ativan. I take ativan and it certianly has helped me with my anxiety. wonder why the doc said that also very curious. The doc should have explained that one.
wmac

[wmac]

I also thing that ativan has helped me with the adreline surges and kinda keeps me at a lower level and not so hyper. Although I think it has caused me some depression.
wmac

[STUARTCBRANDT]

I also take Ativan it seems to help get me to sleep and relax, when I was at the ER they gave it to me and it calmed me down a bit.
Maybe it slows down the heart a bit too much for some folks.
When I take it at night it slows my heart to around 60 Bpm.

Stuart Brandt

[tickertock]

I can't speak for the doctor but I think he was referring to the addictive nature of benzodiazepines, such as xanax, ativan, valium not to mention a few more. I can take valium on daily basis for weeks to months and stop without problem of with drawal, I take it mainly as to control muscle spasms and pain related to connective tissue disease I have, its helps a great deal with the problem.

[woodruff]

I think mom4's and BillK's posts are very useful for anyone who recognizes anxiety as part of the problem.   An anxious state tends to be a long-lasting affair, and docs usually don't like to give benzos like ativan over the long haul, because of the addictive possibility.  And, in any case, ativan and such wear off after a few hours, and then you have to take another dose.   There are better drugs for helping with a long-term (weeks or months) anxious state.  Mostly, as mom4 and BillK noted, these are antidepressants.  If you get the right one--and several trials may be needed--it will knock out the fear.  A side benefit is that the acute awareness of what your heart is doing usually fades away, and you can concentrate on stuff that's more useful--and more fun.

[wmac]

I take ativan for my anxiety. My doc also want me to try the antidepressents he gave me zoloft but I read that one of the serious side effects is heart palps, or tachycarida. So I myself have been afraid to take it. What if my heart starts in and I dont know if its a serious side effect or just me being me. Has anyone had that side effect? I would love to take it and be happy again and not worry about the nsvt. The doc did however say exactly what you said that you wouldnt worry about it and have your life back. So someone please let me know it it truely works.
wmac

[woodruff]

I take 25 to 50mg of zoloft when I have these little attacks, and I have experienced only a lessening either of the number of odd beats--or of my awareness of them.  My shrink is a specialist in pharmacological treatment of these things, and he knows which drugs are more likely to have cardiac effects.  For me, zoloft is the magic item.  I have experienced no cardiac effects.  The literature says that Zoloft, like Prozac, generally has little to no direct effect on the heart.  However, it may take a week or two to give any drug a fair trial.  Since these are meds that act on the psyche, you can expect to feel other minor weirdnesses during the time you're getting used to the stuff.  Minor weirdness; not major things.  If they're bearable, you just wait it out for a bit, but stay in close contact with the prescribing doc.  Do NOT be shy about phoning for advice.

Over the years, I have found that not only do different people have different responses to these drugs, but the same person can have a somewhat different response from a previous one.  This sounds a little strange, but our physiology varies with all kinds of circumstances, so perhaps it is not so odd.

The point is that a person may have to try different drugs, or maybe even different doses of the same anti-anxiety drug or antidepressant, to get the best effect for him/her--but one of the worst things can be to do nothing at all, out of fear.

Talk to your doc, and discuss, discuss, discuss how likely the proposed drug is to have any cardiac effect.  And then, take his/her advice, and give it a fair trial.

[Tilapia2006]

I've been reading through these forums and have seen so many posts similar to what I'm feeling. My health insurance has not kicked in yet so I don't have the advantage of test results. But I think I'm having PVCs or PACs. I have always (as long as I can remember) had what I called "skipped" heart beats.  They were always rare though. However, two months ago I had an "attack" of them that made me feel like I would die.  No warning, no gradual increase over several weeks.  Just all of a sudden one day I started having them at a rate of about 5 per minute for several hours and dozens an hour the rest of the time.  I had no pain.  And I don't know if I would really say I had shortness of breath - just an occasional need to yawn even though I wasn't tired.  Over the past 5 years, I have gained about 40lbs.  Also, one month before the big episodes began, I started a new (and high stress) job.  But after that first big palp episode (coincidentally 1 month into the new job), they continued to be very bad throughout the week.  I decided to check my blood pressure at the pharmacy (not sure of accuracy) and was startled to find it was 151/89.  I have never had an issue with high BP, so that worried me.  I took a look at a typical days worth of meals and found that I was getting huge amounts of sodium (between 8,000-10,000mg) each day.  Needless to say I began cutting sodium down.  The palps continued on, but after a couple weeks of low sodium, fresh foods and taking some children's aspirin each day, they started getting better and my BP dropped down to 137/81 (Also, 30mg of Potassium twice a day on bad days seemed to help a lot).  Now, about two months after this all began, my BP is hanging around 132/79 and the palps are better.  They are still quite noticeable, but are less in frequency and intensity.  However, I noticed they are definitely aggravated by stress from work.  Although, some days I don't notice a single palp - whether none occur or whether I just don't feel the light ones, I don't know.  But it almost seems as if my high BP aggravated a possible PVC (or PAC) condition that already existed (since I've had "skipped beats" most of my life).  These things really freak me out when they get going.  Sometimes they pound so hard I have trouble getting to sleep.  I'm hoping to get in and have some tests, like EKG, ECG, Stress test, etc., done so I can relax.  I have a new baby and I can't imagine leaving her and my wife without a husband and daddy.  I honestly feel a little better reading all these posts, but I've filled my head with so much info on every possible heart condition (curse of the internet) that I can't help but to worry about this constant nuisance.  My grandma has coronary artery disease, and I keep wondering if it all will come down to something that bad.  I'm hoping for the best, but even the best seems to be just living with these things.

[Tilapia2006]

Oh, I forgot to mention that throughout all of this, my pulse has always remained within 60 to 80 bpm. Even when I'm having a bad episode of palps, my pulse remains in the high 70s. I've worried about tracking my pulse because of a-fib, although I've read that a-fin can't always be felt through pulse and can just feel like a light buzzing in the chest. So much info to sort through ...
But all in all my pulse has remained normal.

[jason_k]

Hello Doctor,
I am a 32 year old male that have experienced chest pain while on a treadmill a few times over, pain that felt like blood was pumped out of my heart and could not fill up fast enough. heavy pain in the center of the sternum. this pain would come suddenly and only last a few seconds and would freeze my body, I would break out in a sweat. I weight train modorate to heay weights and do moderate cardio about 5 days a week. I have a resting heart rate of about 40 to 45 beats per minute. I have had bloodwork - normal. My cholesterol total is 132. I had 2 EKG's, normal. Stess Echo normal with slight heart enlargement(cardiologist said it was athletic heart). Cardiologist feels my heart is fine and the pain is not heart related, although it felt like the heart stopped for a sec. or could not handle the demand. Also, I am concerned with the low resting heart rate. If it is athletic heart, how long would one have to be lazy for the heart rate to return to a normal range of 60 beats per minute. I have stopped training for 2 weeks now to rest incase I pulled a chest muscle(I do not have muscle pain). Just very concerned about the low heart rate and the sudden angina like pain I felt. What are your thoughts and advice? Thanks!

[jason_k]

Forgot to add my blood pressure is 135 to 140 over 70 on average.

[cmiller]

Hi tilapia,

   I noticed you said that potassium helps.   What will help you "hold" potassium levels is Magnesium. You may have depetion of both of these in your cells, which does not always show up in plasma levels, which most doctors measure.   If you search this site for other postings by cmiller, you will find a lot of references to potassium and magnesium and it's effect on cardiac rhythm.

I find when I get the right amount of mg and k, my body relaxes and I start yawning. IMHO Yawning is about release of built up tension, as opposed to fatique.  Fatique just allows us to 'let go" of holding on to tension.  Holding on to tension makes us tired.  When we let go, it's a beautiful thing.

Good luck.

Cmiller