Mild chest pain after SVT

[Antlion]

I'm a 20 year old male with a diagnosed heart condition. It is either WPW or a very similar condition. I have very irregular episodes of SVT (one or two a year at most), most of which terminate after a few minutes, but on occasion I have an episode that doesn't end on its own and I have to visit the ER to receive conversion medication. The last episode occurred Sunday morning, and I estimate the period of high heart rate (averaged at 180 bpm) lasted around an hour. I stayed in the ER for three hours or so for monitoring, after which I was discharged with a referral to several electrophysiologists, but I have no insurance and very little money, so I can't afford to see a doctor.

I have been having disturbing symptoms, however. Starting an hour or so before the episode began I experienced very mild, irregular pain just to the left (from my perspective) of center of my chest. It is a pulsing pain, almost mild enough to call discomfort, that lasts maybe a quarter-second. It doesn't seem to be in phase with my heartbeat, although it is about as long as one. I wouldn't describe it as "sharp" or "piercing" or even particularly strong, it's just persistent. It'll stop for several hours and then start for forty minutes or so, regardless of what I'm doing. I have no diagnostic experience but I feel that this has to be related to my heart. I don't know if it's possible for SVT to "bruise" heart muscle, but I'm hoping it's something along those lines. I've had at least one tachycardia episode lasting over an hour before and I didn't have the accompanying pain, which is what bothers me. I'm sure this isn't dangerous, since I've been to a cardiologist before, had an echocardiogram and no end of ECGs and nothing threw up any red flags, so I just need to know if I should hit the emergency room. Thank you for any input.

[Douglas Bogart, MD]

You should see an EP doctor and likely have an ablation to treat the tachycardia.  While the tachycardia in general does not produce the type of symptoms you describe an ablation can be curative of the tachycardia.  An event monitor might help determine if the symptoms are related to the tachycardia.

[Antlion]

I've actually had an ablation already which wasn't successful. The tachycardia doesn't particularly bother me at this stage in life anyway, so I'm not interested at the moment in any further operations unless the problem starts to really interfere with my life.

The real concern I have is the other symptoms that I haven't experienced before. Since Saturday night - so, for nearly four days now - I have been experiencing strange and disturbing sensations. I've had the mild, persistent chest pain I described above, which eventually became so worrying that I visited the ER again. My ECG looked absolutely fine, there were no disturbing problems in any of the blood tests they ran and I was told that they performed a test to determine if I was in danger of having a pulmonary embolism which came back negative. They discharged me after telling me that they couldn't give me any conclusive explanation for the pain.

After some research I've come to believe that I'm suffering from anxiety. The chest pain comes and goes and moves around, and from the moment I reached the ER until the moment I left I didn't experience it at all. I have a constant sensation of pressure in my chest which varies in intensity over the day. I have unusual aches and pains in my arms and wrists. All of these seem to go away if I can manage to put them all out of my mind and not worry about them for a while, and every day when I wake up I feel fine for a few hours and then it all starts again. From what I've read the symptoms I'm experiencing are classic symptoms of anxiety, and I would assume if there was something else going on with me that the ER doctors would have noticed it.

If I'm barking up the right tree, what should I do about it? Am I going to have to tough it out until I can get set up with insurance so I can see a doctor properly? Do you think that a local free clinic might prescribe an anti-anxiety medication for me? Is there somewhere else more appropriate for me to ask this question?

Thank you again for your advice.