chest aches, sharp pains & gastric distress

[frank-krogh]

  dear dr.: I have a history of anxiety and panic attacks, going back to 1989. I am a 46 year old male, supposedly in good health, although I never feel that way anymore. My current problem started a month ago while running. Usually I go about 30 minutes with no problem. this day, I hit the fifteen minute mark and noticed I was really laboring, and my pulse rate seemed to be too fast for the workload I was doing. Anyway, I had to stop when my legs were so weak I felt they were gving out. At that point, I felt weak, my heartrate was very fast, lightheaded and my stomach was queasy and gurgling a lot. I felt weak and out of sorts the rest of the evening. Let me say, that the air quality was bad, as we had extreme heat and wildfires in fla during that period. I have ben diagnosed with exercise induced asthma, although I rarely wheeze, but simply feel tight in the chest, a grainy feeling to m my breathing and achiness in the muscles of my back. I continued running during the next three weeks, but could not get up to my usual level of mileage, and always felt weak, muscles in the back ached, and stomach gurgled and felt achy. Finally, I took a business trip to Ohio, and after only one day there I had a severe panic attack while driving, ending up in Er by ambulance. EKG, enzymes, blood work was done, and all was ok and was released. By the way, I,d been under a lot of business stress before the trip. Anyhow, only two days later, while running, I'd only run four laps when I felt weak, my lungs and muscles tight, stomach queasy, and strange feelings, so I stopped. Then,I felt my heart race, flushed, panicky and chest tightness. I went to another Er, again all was ok, and was released. My two doctors I go to feel it is just an anxiety disorder and that my heart is fine. I have had about 7 holter monitors, 5 or 6 echos, 8 0r 9 stress tests, including thalium and ultralite, and pretty much everything except a catherization. However, the last strss test were 4years ago at the Duke medical center. I continue to have reflux problems, my chest seems to ache during the stomach problems, sometimes pain  is sharp in the extreme left(where we thought the heart was when we were kids), my running has gotten better in the last fewdays, but I worry that a suden drop in my cardiovascular performance on the track signals ablockage to the heart. Also the almost continous aching of my back muscles, gurgling stomach, and overall weird feelings have me anxious allthe time. My ekg shows early repolarization, with elevated segments 1,2 and three. I am told thisis an athletic ekg, and it's normal for me. My blood pressure is usually about 130/72, but lately it seems low to me 100/80, or 112/68, could this indicate a reduction im my ejection ratio and that the eart is not working efficiently, hus causing my reduced stamina on the track? My drs. don't feel I need further heart tests, just anti-anxiety medications. I don't want to mask theproblem, if there is one. I cannot work or play, I,ve lost thousands of dollars in business in the last month because I cant concentrate, and my workouts are not bringing me joy, but apprehension. Can you help me?

[Cleveland Clinic, MD]

Dear  Frank,
You are describing  a complex problem that is beyond the scope of what we can address here.  The "gold standard" for the diagnosis of heart disease is a cardiac catheterization and it may be that your doctors will recommend one, if for nothing else for your peace of mind.  Hope things work out for you and post a follow-up when you and your doctors find a solution.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.