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sinus tachycardia, costochondritis, panic attacks or what?
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sinus tachycardia, costochondritis, panic attacks or what?

Hello everyone.
a bit of history on my health issues of lately.
I'm what I used to consider a healthy 36 yo female. Couple of weeks ago I ended up in the ER as my heart raced to 165 beats per minute out of the blue. I've had several other such episodes of racing heart ever since. I feel the pounding in my chest, in my throat ... in my fingertips sometimes, and in several instances I went to the ER as I was unable to calm down or slow down my heart to a comfortable rhythm. (Maybe I should mention that shortly after my heart slows down to normal my whole body shakes for 15 to 30 min even longer at times – I was told it could be an adrenaline reaction or so – is this correct? Is it “normal” to be like that?)
Every time I went to the ER they ran blood tests on me and everything came out fine;  they even did a thyroid test and it came back normal (so the thyroid was ruled out as being a problem). I also had chest X-rays done – all normal, a 24 h Holter monitor that showed no episodes of tachycardia or anything abnormal (some minor ectopic atrial and ventricular beats which to my understanding are nothing out of the ordinary), also I had an echocardiogram (I don’t have the results of that yet, but will soon). Also, the ECG’s showed sinus tachycardia, but otherwise normal sinus rhythm.
Based on all the tests I was diagnosed with sinus tachycardia and I was prescribed metoprolol (25 mg a day – ½ in the morning and ½ at night). The pills made my life miserable – I was dizzy, lightheaded, sleepy around the clock, so here I am back to see a doctor  who suggested I switch to bisoprolol (I’m taking 2.5 mg once a day) – the side effects of it are similar to those of the metoprolol; somewhat milder in my situation, but I still am unable to function normally – still dizzy, sleepy, lightheaded.
Aside from the racing heart I have these weird chest pains/aches. I can feel them mostly along my ribs in the upper part of the chest (but not only), sometimes along the sternum, sometimes they migrate to the back and I feel them somewhere between my shoulder blades, or even around my armpits or my breasts. They come and go, they are never very intense 1 or 2 (maybe a 3) on a 1 to 10 scale. I mentioned them to the ER doctors but they seemed to dismiss them and my questions about costochondritis (which I read about and thought might be what I am dealing with). Sometimes I feel the pain intensifying if I press against the ribs.
I do panic easily lately simply because I have no idea what is happening with me and I don’t know if my symptoms and problems are heart related or else. It is nerve-wracking and I have no idea what to do to return to normal. Lately I’ve even had nightmares that woke me up in the middle of the night and made my heart race.
What could this be? Are they panic attacks? Is this costochondritis? Am I just worrying over something that is not heart related? None of the doctors I have seen so far seem to be able to figure out what the problem might be. They call it sinus tachycardia and tell me to come back to the ER if I experience it again.
Ever since all these symptoms have started I have given up coffee( I used to drink 1 cup a day and I was an occasional pepsi drinker), I don’t smoke, I don’t drink, I eat a healthy, balanced diet, there is no history of heart disease or diabetes in my family, and I have a normal body weight (I’d say I’m even on the skinny side).
I’ll stop here as I feel I’m not even making sense at this point.
It’s been a horrible past couple of weeks and I’d appreciate any suggestions, comments, etc either from a professional or from someone who has/had a similar experience.
Please help.
Thank you!
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I have had costochondritis many years. It hurts when you press on the area. It comes and goes. Its very very  common in women and can cause chest pain even mimicing heart pain.
Did you have the racing hear during your holter? You need to catch it while its happening to know what is causing it.

Hello, I have had all 3 of what u are describing. It is scary and they all are different.
Thanks for your comment. Unfortunately my Holter came back perfectly fine - there was though one instance of the sinus tachycardia being recorded on ECG while I was riding the ambulance to the ER - but my heart was in normal sinus rhythm.
It is scary and I have no idea what I'm dealing with here. The part that scares me even more is that the doctors don't know what they are dealing with either.
I had that too and more
After 2 years and many heart analyses (ok)
I concluded COSTOCHONDRITIS  or Thiel Syndrome
completely harmless but the source of all that panick
I'm now since 15 years completely free from it
after doing exercises for the muscles concerned there.
In BATH I do isometric exercises
Put your elbows on the bottom or on the edge (slightly more difficult)
and push your breast (sternum) as high as you can above the water
Start counting and leave it so
When  you feel the pain there , push half an inch higher
and count up to 20
The whole day you will feel that muscles AND the muscles of your back and it's a proof that they are getting stronger.
After 5 days or so You will never come awake at 04:00 and think you are dying - It's over !!
And if it happens it will be for another reason after a fat meal to be treated
with an aspirin !
My past experience is that when the two backgrounds (meal+costo) come together at night
it really hurts -  and panicks -
What I had also was bad breathing ( inhaling ) there are many exercises ( yoga ) for that and to complete my story : Yes I concluded afterwards that when I had those symptoms
I also almost stopped breathing which of course is not OK.
I remember that these pains at the time often occurred when I did some really intensive work or at the computer while concentrating and already in a bad body position
I also almost stopped respiration  :):)
Thats all
Sorry for the bad english (france) and if you regain your life, please give me a good point on my OBAMA BLUES on keyboard on YOUTUBE
and if you copy paste my texte in other medical blogs or forums
add that musical note too - Voila - Thanks a lot .  .
It is possible that your issues all go back to anxiety which can cause all the symptoms you describe including the costochondritis. I'm actually surprised they didn't suggest this at the ER because they often do when they can't find anything else causing the issues. Not sure what to suggest beyond the points in ankhaton's post. There are many resources for dealing with anxiety including meditation, deep breathing, guided relaxation etc.  If it is anxiety my advice would be to avoid the drug route. Too much possibility of dependency/addiction.
Thank you both for your answers.
The ER did suggest anxiety and gave me a prescription for ativan ... which I have started taking as needed ... does it help ... I don't know.
Lately it seems that my problem is the chest pain which the doctors have constantly dismissed every time I went to the ER. I am taking ibuprofen for that but it doesn't always help and the pain is here now on an almost daily basis, and it's as if it's getting worse and worse. I have no support from my fam doctor - I was simply told that the ER docs are better at dealing with this kind of stuff and meanwhile I am in horrible pain. The strange thing is that the pain comes and goes, it also seems like it has a different location every time, and it doesn't always show its ugly face if I press on the rib joints (which I was told is the main criteria for diagnosing costo, after ruling out other possible causes of chest pain). Also sometimes the pain radiates to the back, to the arms, to the neck and the back of my head.
I will try the exercises suggested by you ankhaton, it does seem that a hot bath ot a hot pad aleviates the pain - at least for as long as the heat is on (so to speak), but there are times when I can't even stand the touch of a t-shirt, let alone a hot pad on the area that hurts.
It *****, and what makes it worse is that there is no "good" treatment for it and we all respond different to painkillers and such.
Again, many many thanks.
I am nearly in tears now because other than just a few years in age difference (I am 32) and a few extra trips to the ER and prescription drugs, I could have written this tonight.  Mine started nearly two months ago with a trip to the ER after what felt like heart palpitations and chest pain.  I was given the same treatment - chest x, EKG, heart monitor, etc., thyroid levels, blood tests, all came back healthy.  I was dismissed to my local doc who considered thyroid (I had a history), and was also given the strong suggestion for anti-anxiety.  After a few days of pain and symptoms (and a return ER visit), I gave into the anti-anxiety pills.  The Celexa nearly ruined my life; I was in a fog, exhausted, could barely function, and ended up back in the ER again.  It was finally suggested that I try a Holter monitor for 48 hours.  I had a few PACs and PVS, but other than that, like you, mine came back with no major concerns.  There was some concern of costochondritis, but not enough to treat me.  Eight doctors later (including ER and local), I have finally found a doctor willing to work with me.  I've now had a full Echo (clear) and have been wearing an Event monitor (like a holter only with two leads and I can take it off) for nearly a month.  They are  seeing moments of tachycardia (the racing you've been experiencing), but again, nothing of great concern, so I too am on Metoprolol.  I am tired and nauseous, but nothing like it was when I was on the Celexa, so I am putting up with it to see where it leads.  Meanwhile, I am experiencing the same chest pain, which comes and goes, and yet from time to time feels so horrendous I almost go back to the ER.  Like you, it seems to travel (center of my chest, between my shoulder blades, shooting pains on either side but more active on the left).... and like you I loaded on anti-inflammatories for over a week, but experienced more of the racing symptoms so I quit those too.   I was given Xanax (I haven't felt much difference between the Adivan and Xanax) but I don't know if it's doing  a bit of difference either.  I'm anxious because no-one seems to have any idea how these symptoms all fit together and I'm tired of being in pain.  I just noticed that you posted this a year ago.  Please, please tell me how you're doing.  Give me some hope here! And I'm praying for you and everyone else on here in pain.  
I'm 21 years old and I have just gone through very similar symptoms. I walked to class and when I got settled in my seat I started feeling weak, my heart was racing, and I felt a few stabs of pain in my chest. I tried to calm down but I couldn't focus in class and I was feeling terrible so I went to the ER. They did blood tests, x-ray, EKG, CT scan, and thyroid all with normal results. They gave me a short term prescription for metoprolol and told me to see a cardiologist. I went back to the ER the next night because my heart rate was over 100 after I had slept for an hour. They ran the same tests and had nothing to tell me. I saw a cardiologist and he had me do and echo and treadmill stress test. Those came back normal too. I diagnosed myself with costochondritis after the ER visits and started icing it every night, which helped a lot. That all happened a few weeks ago and the chest pain has gone away for the most part, but my heart is still running fast, typically around 100 when I'm just sitting still on my computer. The doctors say I'm normal and perfectly healthy but they can give me beta blockers for the heart rate, but the short time I took it after the ER made me feel awful, and honestly I don't think it even reduced my heart rate. I just don't know what to do. I've found articles saying that I can live a normal healthy life with  this heart rate, but it worries me. I hope some answer can be found for us all.
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