Pediatric Heart Expert Forum
Could It Be More Than Anxiety and Panic?
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Could It Be More Than Anxiety and Panic?

Hello again! I’m 17 years old and I was just diagnosed with GAD and Panic Disorder. Everyday I get a pain, tingling, burning, or fullness in my chest. It happens everyday but it does go away throughout the day. Something that does not go away are my heart palpitations. I have them ALL day long no matter what I’m doing. I can be in bed reading or simply walking to the bathroom slowly and there they are. They NEVER go away! Sometimes the heart rate feels a bit slower, but it’s still beating very hard. I can ALWAYS feel my heart beating when I place my hand over it. Also after I eat a meal, even if it’s very small, I feel like I have a brick in my stomach and entire chest area. It makes it difficult to breathe or to stand up and I have to go lie on the couch. I have had 3 EKGs, 2 chest x-rays, and blood work done; all normal. I will be getting an Echocardiogram in a couple of weeks, followed by wearing a Holter Monitor for a day. If the results are normal on both of those tests as well, should I just stop worrying about my heart? I’m asking because it just doesn’t feel normal to have heart palpitations CONSTANTLY and to not be able to stand up after I barely eat. Yet the doctors don’t seem to understand what I go through and they all keep telling me its just anxiety. I also mentioned having Dysautonmia or POTS but my doctor didn’t seem to even consider them as the cause. I’m also curious about having Mitral Valve Prolaspe, IST, or an Enlarged Heart but if they chest x-rays are normal I don’t know what to think anymore. My doctor just wants to put me on anti-depressants to help the anxiety but I told her I’ll hold off till I see a physiatrist. Do anti-depressants even help with chest pain and to stabilize the heart rate? Anyway, if the results are normal on the tests I will be getting, should I stop and accept that its anxiety? Or should I demand more tests? Heart palpitations ALL day doesn’t seem like it should be normal for anxiety; can they be dangerous to my heart?
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773637_tn?1327450515
Dear Chrissy,

It sounds like the initial part of the evaluation has taken place, which is good.  I can say that you likely don’t have an enlarged heart if the chest X-ray is normal.  And, mitral valve prolapse is not likely in this case if your doctor didn’t hear a click on examination, although the echocardiogram will be able to assess the function of your mitral valve.  That said, I think that there is poor data correlating mitral valve prolapse with chest fullness UNLESS you are having an arrhythmia.  The Holter monitor should be helpful in determining your resting heart rate range.  However, if you don’t have any symptoms in the 24 hours that you have your Holter monitor, there are other 30-day monitors that can be used which record only when you have a specific event and you activate the recorder.

Having said all that, it is not clear what is going on with you still.  Palpitations all day can occur with anxiety if you are untreated.  But, I think that dysautonomia is not an unreasonable diagnosis here.  I will say that if your providers do not understand what dysautonomia is or how to evaluate for it, you should definitely find another provider who does.  That does not necessarily mean travelling to another state, but the majority of providers is not familiar with, or wants to care for patients with, dysautonomia.  I would look online at one of two websites:  www.dynakids.org and www.dinet.org.  These list providers that can care for this; hopefully there is one in your area.  As well, they list various symptoms that may be similar to what you are experiencing, or not.  Look these over and see if this is consistent with your own experience.

Finally, since I haven’t performed a complete evaluation of you, I am not sure what the cause of your chest pain is, nor can I say what other further testing you will need; this will depend on your primary care provider.
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994817_tn?1249741878
Thank you very much for replying to my question. I truly appreciate it. I looked up all the symptoms of dysautonomia and I experience ALL of them. I will definitely go to another Dr. to be evaluated for dysautonomia and to get whatever other tests that need to be done; I just feel very hopeless and lost because everything keeps coming back normal. Its making me feel so alone, worried, and confused because I feel that something bad is going to happen to me soon because whatever is causing me such pain just cant seem to be found. And as far as my chest pain goes, it lasts all day but it comes in semi-short episodes. It sometimes hurts when I exercise and move or when I breathe in or laugh. Yet it can also happen when I'm at rest just sitting. It feels like either a quick stabbing pain or a dull throbbing pain. It is mostly left sided, right under my breast, yet it can occur on the right side as well. I get a lot of back pain too. There is also a vibrating/quivering feeling in my chest quite frequently as well. I'm 5'10'' and 132lbs with no history of heart problems in my family except my uncle who had a heart attack very recently at 53. I don't know if that information gives anymore clues to what it might be or not. Thank you again for all your help; you are more helpful than most doctors I have seen.
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
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