Heart Problems or Anxiety attacks

This is my last question, as I now have met my 2 ?'s in the time frame.  Weds. evening I was having left arm discomfort and fingers fluctuated between aching feeling then numbess. Yesterday, it radiated to the sternum area (more burning sensation) and slight tightness in throat.  I went to the Dr. and she did an EKG and stated there was a 'worrisome change' from the last ekg she did on me (back in June).  In her office, I started to get lightheaded bad (not spinning), just felt very faint and my heart rate went up.  She sent me right over to the ER for test.  They did ekgs and all the bloodwork, cardiac, etc.  The only thing the Dr. said was something about a wave on the ekg that some people have it when they have a heartattack.  But the blood work was fine, then he came back in.  He said since I had a clear angiogram this past January, he felt this wave was just me and how I am.  Anyway....I had 3 bad spells in the ER last night - I got the lightheaded feeling like I was ready to pass out.....a weird, cool flushed feeling throughout my body and my heartrate jumped up the 170's.  Heartrate slowly came back down within a few minutes.  A little later, same thing again.  They did give me a GI cocktail, which didn't help the discomfort.  When I first got there, the chest was burning a bit. But after the fast heart rate episodes..my center of chest sternum area just ached.  I could've sworn with my symptoms from Weds. night...it all seemed similar to a heart problem like CAD.  But they said no way since I just had an angiogram in January. What could it be?  I'm scared! Thank You

[CCF-M.D.-MJM]

Hi Lynn,

Trust me when I say you are not alone with this problem and it is very scary.  It puts you in a difficult situation because you aren't sure what to do.  It is very difficult to tell you for sure what is going on.  you should feel comforted that you had a normal coronary angiogram last January.  Angiograms tell you that there is not obstructive coronary artery disease.  Angiograms do not lend insight into your endothelial cell function, the cellular lining on the inside of your coronary artery.  There is a subset of people with angina like pain that have normal stress tests and normal angiogram that have angina like pain.  Many of these people will have "endothelial dysfunction" -- meaning that there endothelials cells cause the vascular smooth muscle to constrict when it is supposed to relax.  This can cause chest pain and EKG changes despite other normal tests.  The diagnosis of this requires invasive testing and usually only at specialized centers.  In general, we usually do not do this testing unless the diagnosis is really unclear.  The treatment is nitrates and calcium channel blockers.   We usually treat empirically and watch for benefit rather than doing invasive testing.  The prognosis from chest pain from this cause is very good and should overly concern you.

We also know that people with anxiety can have angina like chest pain with other normal cardiac testing.  It is possible to have one or both of these problems going on.  The "vagal" or passing out symptoms you describe is often associated with anxiety.  The word anxiety is often taken to mean that you are "crazy" or that you don't handle stress well, but this is often not the case.  There is a wide variation to how we all respond to stress and our physiologic response is guided by our central nervous system, with only part of this being over our control.  If your symptoms are from panic attacks or anxiety, often counselling or biofeedback will help control these events. It comes with recognizing the problem and being able to talk yourself down when your nervous system starts to get fired up.  This can be diffucult and take time to learn, but I have seen it pay dividends if you are willing to try and this is the underlying cause.

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

[Lynn8889]

I made and error - My arm discomfort started on Weds. evening, by Thursday (Not Friday)....it radiated to the chest area.  I felt bad on Thursday and went to my Dr. yesterday.  I greatly appreciate your taking the time to answer my question.  I'm petrififed that something is wrong and it's not being caught.

[Lynn8889]

My apologies, I failed to add some general info.  I am a 36 old female, on the thin side. One important question I wanted to ask and I ran out of room.   I, for some reason, tend to get dehydrated easier than others (not the case in the ER per Dr).  I faithfully drink Powerade......constantly.  I have one with me at all times.  I do not drink anything else......no water, no pop, no mild.......just powerade.  Is this a bad thing to be doing.  Could this be having some impact on my issues?

[CCF-M.D.-MJM]

The fact that you are 36 years old makes coronary disease very unlikely.  Statistically, more people will present with anxeity related chest pain then endothelial dysfunction.  From our understanding now, people with endothelial function tend to be overweight, hypertensive, and diabetic or glucose intolerant.  There may also be an increased risk for people with polycystic ovary disease or syndrome.

[Lynn8889]

Thanks so much for your detailed and informative feedback.  It is greatly appreciated!

[STUARTCBRANDT]

Hi Stop Drinking the Powerade and see what happens, I went to the er a while back with a pulse of 174 and bp of 160 over 109 and had all kinds drinks that day with all kinds of sugar.
Do yourself a favor just drink water and Oj for a while.
Some people if they are just a bit dehydrated they can get angina.

Water water water. Not Powerade.

Also check out www.watercure.com

Stuart Brandt

[Lynn8889]

Thanks for your post.  I often wondered if drinking strictly Powerade was bad.  I mean I always, always drink this.....and nothing else.

[anacyde]

Hi there.  If you were having an esophageal spasm, the GI cocktail wouldn't do much to help your discomfort...which can feel frighteningly like cardiac pain complete with radiating pain and occasionally shortness of breath.  I'm not saying you have this, just that if everything else is normal and the GI cocktail didn't help, you may want to try an esophagus-friendly diet and see what happens.

I've just recently gotten my esophageal spasms under control after over a YEAR of these horrid things.  Gatorade and sports drinks were big no-nos for me, they would easily induce the spasms.  Chocolate, peppermint, very warm beverages and too much sugar or garlic were also culprits, though everyone seems different in what they can or can't handle.  If your workup is normal, I would try backing off the sports drinks and seeing if that helps.  I drank nothing but water for months, then slowly introduced a couple glasses of skim milk a day - no juices.  Recently I've added 4 oz of orange juice to my breakfast meal, but that's as brave as I'm getting for now!  

The cold waves, I get those when I'm having an anxiety attack or if I am in a great deal of pain.

Hope you feel better soon.

[Lynn8889]

Thanks for your post.  I know you are very knowledgeable when it comes to the heart, I've seen your posts before.  Maybe you can answer a few ?'s for me.  I am still having the left shoulder, arm discomfort...with occasional chest / sternum burning or aching.  I did have an angiogram in January. They did all the bloodwork and a few EKG's.....bloodwork fine, but one 'wave' on the EKG the Dr. said it could mean someone could have had a heart attack, but they believed this wasn't the case for me since I just had a normal angiogram.  Could I have a blocked artery now even though I just had an angio.  My blood pressure has always been 110's /70's......now its running in the 130's/140's over upper 90's.  With of course on and off lightheadedness. Would the bloodwork show if I had CAD?  Thanks in advance for answering.  As I said, I see that you know your stuff about the heart......and I value your opinions as well as I do the Drs.  I just ran out of room to ask the Dr. these ?'s. Thanks Anacyde!

[Lynn8889]

I forgot to say.....all the bloodwork and EKG's were done in the ER Friday night.

[anacyde]

Hi there :)  Honestly I really don't know all that much, I just have the unfortunate "benefit" of experiencing my own problems and having a family full of heart patients.

I would say go with your doctor's advice and assessment.  EKGs can have all sorts of ambiguous blips that can mean something or absolutely nothing.  Only an experienced doctor can truly say for sure when something is benign or of some significance.  Everything has to be interpreted not just alone, but in the context of all other factors involved.  If other testing had indicated a problem, then I would be concerned, but all of your other testing looked okay.  In light of a normal angiogram, I would trust your doctor's conclusion (if it were me in your shoes) that in all likelihood you are okay.  When in doubt though, a second opinion can't hurt, especially if you're still having symptoms.

If it makes you feel any better, my mom had a similar problem last year.  She had a non-nuclear stress test come back abnormal, indicating possible ischemia.  They did an angiogram and thallium stress test and both were normal, ruling out an ischemic problem.  She's doing fine.

Hang in there!

[Lynn8889]

Once again, thank you.  Between what the Dr. said on here and what you have said, I feel more at ease. I have a 'mandatory' follow up (per the ER) with my doctor tomorrow.  Hopefully we'll have some answers.  Again, thanks so much!

[anacyde]

Sending good thoughts your way for a good follow-up.  Keep us posted!  :)

[myowncrazybeat]

I pray you are feeling better.  Just wanted to comment on the "cold waves".  I have been told that is what happens when your body senses stress and has an adrenaline overload.  Think if you have ever had surgery... most people tend to get the shakes.  This is the body's natural response to the intense overload of the stress hormones.  Almost like the body is super sensitive to these hormones.  Has happened to me more times than I care to remember.  I heard one person even call them "stress seizures".  Not sure if this is true, but it did make sense to me.  After my recent c-section, I read up on it.  Hope this provides a little helpful info for you.

[anacyde]

Oooh yeah!  I got that during labor, both times.  I started just shaking uncontrollably, it was wild!  I couldn't stop laughing about it because it was so weird!

[Lynn8889]

I wondered if it was just stress that caused my bp to go up and to have that high of a heart rate (upper 160's or so).  Friday when I was at the Dr. and had these 'spells' (lightheadedness, felt like I was going to pass out and the high heart rate).  My Dr. did an EKG and stated there were worrisome changes......that's when the spells really started, and she sent me to the ER and had 3 or so spells while there.  Anyway, I went to see cardiologist yesterday.....and he had copies of EKG's from what my Dr. did and the one's the ER did.....he stated he didn't see anything concerning at all.   Kinda makes me wonder what is going on.

[woodruff]

"Anxiety/panic disorder and heart rhythm are "chicken and the egg" in regards to which came first or effected the other the most in my case."

This has been my experience, too; the pvcs arrive simultaneously with a jolt of adrenaline, so close together--and out of the blue--that I cannot tell which came first.   However, once they're on the scene, it's a matter of dealing with the symptom that can be treated effectively.

[PlayDoh]

I would suspect all your symptoms are anxiety related, not that I'm a doctor or have any idea about your Cardio related health. Rather, your post remind me of how I used to worry so much about my heart, that I would go in circles.

I dont think drinking only one drink religiously is a good idea, but its not going to kill you. Drinking only water is fine, but makes life a little bland I would think.

I've had 3 RF ablations, in 4 years and still get SVT episodes. I have severe anxiety, and if I don't take antidepressants (Effexor XR) I get constant PVC's (flutters) when I get stressed. Of course I recognize instantly when I get one, and a quick blast of adrenaline. I can get them every 10 seconds if I worry about them. If I take my mind off them, they go away.

I found after years of stressing, that being overly concerned with your heart is bad for your heart, and mind. I'm certain that anxiety plays a large role in my SVT/Arrhythmia, if not the sole cause.

You should have little worry about a heart attack with a clear angiogram, and the more you understand that, I'd bet the better your other symptoms would get. I found my local mental health therapists more helpful them my EP in regards to alleviating my heart conditions and overall health. Although my EP is my Hero.

Anxiety/panic disorder and heart rhythm are "chicken and the egg" in regards to which came first or effected the other the most in my case. It is quite common I've noticed, Anxiety and Arrhythmia, with I'm sure Adrenaline and the Amygdala   in common. But again I'm not a doctor.

Basically, a long post suggesting you may want to take time off investigating your health, and try to relax, de-stress like a normal person (joke) and enjoy life. At least its the medicine I found very helpful.

Take care

[Lynn8889]

Thank you for your post. I realize now that I need to work on my anxiety when it comes to my heart.  Your post definitely has made me realize that I need to work on these issue of worrying.  Thanks a bunch!!!!!!!

[Mels22]

I too am having left arm aches.  For about 2 months I have had shoulder pain, indigestion, anxiety and left-sided chest pains.  Now, a couple days ago, my shoulder pains started getting worse and radiating down my arm.  I have had nuclear stress test, ct scan, chest xray, 7 EKGs and nothing with my heart but I'm still scared!!!!  I am 25 with no history of heart disease, good BP and cholesterol and just had a baby 5 1/2 months ago.  This pain is going on as I type in my left arm.  My doctors keep saying its GERD or anxiety or postpardom but how do I know its not cardiac?  I went to the chiropractor today adn he said I have a lot of tension in my left side and pinched nerve and scoliosis.  I have an appt. on Friday for cardiologist..should I go?  How do I know what these pains are?  Am I too young to have a heart attack?  I have been to ER and called 911 several times and am at my wits end.  No one believes its my heart but why all the indigestion, pain and anxiety then?  I had a EKG this morning that was normal.  Please tell me what to do so I can take care of my baby!
THANKS!

[st tropez]

hi just thought i would ask some advice, i am 32yrs old and when i was 28yrs old i asked the doctor if i could get my heart checked out because i used to get feelings like my heart had stopped or missed a beat, i had a chest x ray, heart scan, ecg, 24hr tape, it came back saying i had ectopic heart beats, then when i was 29yrs old i suffered from anxiety caused by a horrible relationship, i was so scared of my heart going fast so it was like a vicious circle, i went private to see a cardiologist, he done tests, listened to my heart which he thought i had a heart murmer, he done my bp, ecg, heart scan, 24hr tape, it came back normal, i still have this heart phobia because i can always feel my heart beating all the time, if i have done any excersise its like my heart is to big for my body it feels  that loud, when i have drank alcohol when i get up in the morning my heart will race really fast which then gives me anxiety, i still feel like there is something wrong with my heart i think i just need some answers and reasurance.

[alsk]

It is both reassuring and unnerving how common this is.  I've been a "lurker" here for awhile, I have PVCs, tachycardia, anxiety which as stated many times before turns it all into a vicous cycle.  I am a nurse which seems to fuel the fire, because I know all about what "could" be wrong, and what rhythms I "could" slip into if the PVCs get out of hand.  Now, as for the anxiety, I am having difficulty returning to the mainstream after my latest scare last week.  I was at work, busy busy day, and when things slowed down, my heart when wacko......PVCs that made me dizzy, nausea, no pain but tingling in my hands, and I went downhill from there.  I went to the ER, PVCs about 10-12 per minute for about the first 30 minutes there, then slowed to about 4-6.  I could feel EVERY ONE!!  I felt like any minute I was going to die, anxiety took over, HR in the 150-160s, and it took Ativan to help me get a handle on things.  Now, if thats not a slap in the face.  I will say that for whatever reason my potassium was only 3.0, and the ER doc thinks thats why the PVCs got so out of hand, now taking supplements for that, follow up Wednesday.  But everytime I leave the house now, I get that tickly nervous feeling in my stomach, some SOB, and tachycardia........occas dizzyness.  Part of me is positive its anxiety, but that part of me can't talk the other part of me down.......I am 36 with an 8 yr old and 5 yr old, and can NOT let this consume me.  This happened about 3 yrs ago, ran the gammet of tests, EKG, stress test, echo, wore monitor, given the clear and told it is probably anxiety.......now what?  I am scared, both of the fact that something was missed, and that I am going crazy.

[Mels22]

Hi all...my echo came back normal.  Therefore I've had a normal myoview stress test, 8 EKGs, chest x-ray, CT scan, echo, MRI and physical check up...normal blood tests, BP and cholesterol.  The only thing that came back abnormal was my liver blood work.  Here is my question...could I still have a heart attack?  I just don't know what to do.  I still have left arm/shoulder/chest pain.  I've been to 2 regular MDs, cardiologist and neurologist and now they are saying maybe fibromyalgia.  If anyone has any suggestions, I would really appreciate it!  Do you think my pain is of cardiac origin?  I also have terrible ingiestion, burping and upper stomach pain - have had it for 2 months.  Is this normal?  Do you think I'll have a heart attack?  I'm scared everyday of this.
Help!!!!
Thanks!