Chest Pressure

   I am a 37 M with some seemingly heart-related symptoms.  They began as sharp, burning pains underneath the breastbone which radiated to my left arm.  These came and went and were often preceeded by my left hand going numb. I went to my GP who did a history and ordered an ECG, an Echo, and a nuclear stress test. All were fine and that plus my age and no family history led to the conclusion that there was no issue and it was likely anxiety.
   I was still anxious about something being missed because of the severity of the symptoms. I went on a weeklong overseas trip where I had a lot of anxiety (HR would shoot over 100 bpm and stay there for an hour+) and got very little sleep.  Around that time, my symptoms changed a lot.  I began to get a lot of pressure in the center of my chest making it somewhat difficult to breathe and forcing me to cough (a few times an hour).  I also got nauseous (which I'm not prone to) and had extreme sweatiness.  The chest tightness produces a little pain but is somehow much more sinister than the burning pain I first experienced.  These symptoms worsen as the day goes on or if I exercise (e.g. treadmill walking).  I've noticed that these symptoms improve a little with sleep so are less severe in the morning though the past few mornings, I have had more chest tightness than usual.  I am taking an SSRI for anxiety now and feel that it has taken the edge off but my inability to exercise and the changing character of my symptoms has me concerned that perhaps something is actually wrong.
   I don't want to overreact but I also don't want to ignore potential warning signs until too late.  I have a cardiologist visit scheduled in a few weeks but would like opinions on whether I should be seeking earlier help such as an ER trip or a visit back to the GP.  Also, can extended periods of extreme stress 1) damage your heart, and/or 2) if not damage your heart then tire your heart out such that it needs a rest of many days to get back to normal?

[Forum-M.D.-MJM]

Hello,
Sorry to hear about your symptoms. To be honest the symptoms and clinical situation does sound much more like anxiety than cardiac chest pain.  The negative work up should be reassuring and are the same tests a cardiologist would ordered.  You are clearly not at ease with the diagnosis and I agree that a second opinion is necessary to confirm the opinion of the first and also help to put your mind at ease.  Dealing with anxiety is difficult enough, but always having it in the back of your mind that their could be something really wrong makes it impossible for you to move on.  I honestly believe that people have an anxiety induced chest pain syndrome, you MUST believe there is not a heart problem in order to combat the anxiety issue.


1) can prolonged anxiety damage your heart

Prolonged stress and anxiety is not good for your whole body.  There is data that shows that type A personalities develop more coronary disease.

2) if not damage your heart then tire your heart out such that it needs a rest of many days to get back to normal?

Not really.  A young heart can usually take a lot of stress.  Anxiety on the other hand is usually worse with stress, pressure, sleep deprivation, etc.

I hope this answers your questions.  Good luck and thanks for posting.

[netrox]

It sounds like severe anxiety with GERD - sharp.. burning.. that spread out. You said you had anxiety that caused your HR to go high. Too much anxiety can cause more stomach acid production.

If you did have a heart attack, abnormal results would show up on ECG, I believe.

So, if your doctors find no abnormal results, then I'd say it's anxiety or something non-cardiac.

It never hurts to ask for a second opinion (that is if you can afford!)

[CaptainL]

Thank you both for the quick responses and the reassurances.  I suppose this could be GI related as well but I have been taking Prilosec for a couple of months now and don't seem to have any GERD symptoms any more.  It's a pretty complicated anatomy area though so who knows?

I guess my main concern is that my symptoms have changed substantially since I had my first work-up.  The pains I experienced then seemed very serious but in hindsight were pretty clearly signs of anxiety.  All of the cardiac tests I have had were done at that time and before any of these new symptoms popped up.  The key one that concerns me is the exercise issue.  It's hard for me to rationalize why chest pressure/chest squeezing would worsen under very mild exercise conditions if there were no underlying problem.  I'm not in race shape or anything but I'm also not in bad shape and I'm within 5 lbs or so of ideal weight.  Yet, a 1.25 mile walk on a treadmill at a 2.5 mph pace had me hurting pretty good.

I'll talk to the cardiologist and see what he thinks and go from there.  If there are warning signs you think I should definitely not ignore such that I should drop into the ER if they occur before my cardio appt., please let me know.

Again, thanks for reading and replying.

[Carolina03]

CaptainL,

Anxiety meds like Xanax can worsen anxiety due to the dependence. SSRI's are great.

I have angina but haven't had GERD-like symptoms. The numbness in your hand does sound like its anxiety-related. In addittion to meds, why not try visualization sessions, massage or even yoga or pilates stretches. My father does the "sun series" every AM to help with work-related pressure. (He's a neurosurgeon). The yoga keeps his mind, body and spirit in sync.

Hope this helps. You may need a test like a thallium stress test to help you get over the thought that your symptoms are heart-related. They are but the root cause isn't disease but rather stress chemicals gone array. If you had heart disease and lots of unresolved stress, you would be at risk.

Hope this helps.

Kim

[Tylernick]

I had very similar symptoms, kept taking myself to the ER convinced I was going to die... Turned out to be anxiety and panic attacks.

My symptoms kept changing as I became comfortable with the fact that it was "just" anxiety.  My interpretation was that my body really needed to get my attention.  I was living with stresses in my life that very much needed to be addressed, and as long as I was writing off my symptoms as "just" anxiety I wasn't addressing them.

It's been 17 years and I still deal with these bouts - and consider them chemically induced, and I still take meds to control them... but I don't want to stop listening to my body, either!

Good luck!