First step...?

  I experienced a major panic attack 2 years ago that seemed to last for an hour.  All the symptoms were there...hyperventalating, rapid heart beat, light-headedness, etc.   You name it, I felt it.  I went to the doctors about 3 months later because the attacks didn't go away.  The doctor proceded to ask me if my heart started racing first, or if I panicked first.  I had told him that I panicked first.  Now, my attacks are less frequent, but I've notices that I don't panick unless I feel my heart speed up or flutter really hard.  It made me think that I have some kind of heart condition.  
  I have poor blood circulation (my hands and feet are ALWAYS freezing- even in the summer) and sometimes i can feel my arms going slightly numb, like the circulation is being cut off.  Heart problems run in my family, too.  I'm not sure what my aunt has, but she can't go on any rides at the fair for example.  Her daughter has heart trouble too.  And I know that my grandmother has mitral valve prolapse.  This is all on my mothers side of the family.  I haven't seen my father since I was 2 so I don't even know his history.  I'm not over weight (5'6", 117-121 lbs [but I'm not one for exercize either]).  I also eat like ****.  My diet mainly consists of chocolate, and I love salt.  I get heartburn alot too. I don't think that I have high blood pressure - it used to be normal, then it was too low, then a little high than normal again.  I've never had my cholesterol tested.  And unfortunately I smoke, but a pack can last me almost 3 days.
  I'm starting to fear that these little "panick" attacks are a sign of a heart attack soon to come, though I am only 21 yrs old.  It sounds crazy to you I'm sure, but Ive read up on heart disease, and I think that there is something wrong with my heart.  Sometimes I'll be cooking and I'll go sit down for a minute and my left side of my chest will ache, but it is bearable pain.   There will be days that I check the "strength"  of my heart so to speak by placing  my hand accrossed my chest, just below my breast when I feel my heart flutter or have an "attqack",  and the beat will be really strong;  Other times I can't feel it at all ( it seems like that, anyway).
  I need to know If this seems like it is all in my head, or if I should go to the doctors.  I don't have insurance, so that is why I've held off for so long on going.  Do you think that an EKG would help?  Or any other suggestions?  Is there anyway you gould give me an estimate on prices so I could save money?
  Thanks so much

[CCF CARDIO MD APS]

Dear Ang,
Try to follow me here as I attempt to answer all of your questions.  Firstly it sounds like a history and physical exam will be all that you need, preferably by an internal medicine doctor who is young(just finished residency) and probably preferably a female physician, although young male general internists are excellent too.  Usually you can call the doctor's secretary and ask how much this general exam would be, go ahead shop around.
I agree with whomever told you that if the panic attacks come before the palpitations, it is probably all anxiety.  But I will have you know that many people without panic attacks get ectopic heart beats, a fluttering sensation in their chest, and many other sensations like you experience-rapid heart rate.  These can be associated with Mitral Valve Prolapse or they can just occur on their own and are benign(nor harm will come of them.)
You are not at increased risk for MVP just because your aunt has it, however if you do have the MVP syndrome this is something that can be diagnosed in the office.  Often when a patient has abnormal heart beat sensations unrelated to anxiety the doctor will order a holter monitor study to record on a tape recorder the actual heart beat for 24 hours, and in that time correlate your symptoms.  This price I do not know as it varies from place to place.
I truly believe that the best prices in town are often at the big inner city hospitals that care for those who have very little if any insurance.  I will not speak any further on the subject of money as I doubt you will need much more than one visit to the physician  Let me now tell you the risk factors for coronary heart disease: cigarrette smoking,diabetes,hypertension, hypercholesterolemia, sedentary lifestyle(no exercise), and a family history of
premature coronary artery disease(heart attack in a man<50yo or woman<60yo).  It is very unlikely that you have any of these risk factors let alone this type of heart disease.  The electrical portion of your heart determines the rhythm (how fast or slow your heart will beat) and this is what needs to be checked out in your case, at least that is my best guess given the current information.  One visit with a doctor could also address the cold hands and feet issue
as often this is due to low normal blood pressure or cold intolerance, and not 'poor circulation' which implies that you have blockages(disease or atherosclerosis)in the blood vessels that go to your arms and legs; this is even more unlikely than anything else in your case.  This does not mean you should just suffer with it, rather it should be one of your complaints or questions when you see the physician.  After a full history and physical in most 20ish year olds there
is no need to follow up except as needed until about 35 years of age.  Panic attacks are ' all in the head' but that does not mean you do not need treatment and counselling as such, and as it happened for you panic attacks usually get better in time following the diagnosis.  As for the chest pain you describe it sounds atypical in that true heart pain can be any pain that is related to exertion(worse with exertion and better with rest).  Your stomach upset could be an ulcer or
gastritis and is most likely related to your anxiety level.  For the stomach try tums or maalox and if there is no improvement see a doctor for further evaluation.  Other lifestyle modifications for someone with stomach problems are avoid things like chocolate(that hurts to hear),coffee,tea,mints, alcohol, and eating just before bedtime.  Heed the warning signs on any over the counter medications and never take more than the recommended dose
for longer than the recommended time.  It always helps a lot to keep a journal of symptoms, things that aggravate your symptoms or make them go away or get better.  More advice is as follows: stop using your normal weight as a free ride , take care of yourself by exercising regularly(30-60minutes for 7days a week), eating right(all the salt you want if your blood pressure is normal), and remember that exercise is one of the best remedies for anxiety and panic attacks.  As before call around and ask prices, it is your right-
the prices you are most likely to be charged( and should therefore ask about) are the cost of a history and physical exam(one test) and a holter monitor(only a possibility).  Get an evaluation before you start an exercise program and once you do start,do it slowly with increases in intensity of exercise every 5-7 days.  Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).