More anxiety or maybe something I should pursue with a cardiologist?

[Joshua804]

Im a 25 year old male and have had issues with anxiety for years that comes and goes. In December of 2015 I started to notice that my heart rate was high all the time and went to see the doctor who wrote it off as stress after doing a blood panel and thyroid test that all came back normal. from January-March of 2016 I started to get random chest pains throughout the day that would come and go and weren't all that painful 2,3-10 on the pain scale. I went back to the doctor who did an EKG and put me on a 24 hour holder monitor again she said it was stress or maybe some GERD  and told me to try and relax. The chest pain went away in April of 2016 and didn't come back until late in 2016 around November. No over the summer I felt mostly fine except for some worries that I was having some sort of muscle weakness that was not the case. In December 2016 the chest pains and high heart rate came back I went back to the doctor and she put me on Lexapro which I took until April of 2017. It seemed to help a lot with my anxiety and most of my symptoms went away except for the chest pains which were a lot more random and went a lot or all together but the side effects that I was experiencing eventually led me to wean myself off it. Summer of 2017 was fairly normal with no real symptoms and little anxiety. Around early November of 2017 I  my chest pains were back and and so was the heart rate and other anxiety symptoms. I tried to shrug it off as anxiety which I knew in the back of my head was most likely the cause. In December of 2017 I went back to the doctor and she told me that in the two+ years that Ive been seeing her she hasn't seen a normal 60-100 heart rate during a visit. I told her that I was just nervous and caused it to go up in the office. I also wear an Apple Watch and most of the time my heart rate is in the normal range and sleeping its in the low 60s to upper 50s. Still she put me on 10mg of Propranolol to slow it down and help me relax. The beta blocker has helped a lot with the fast heart rate and keeping me a little calmer however my chest pains are still there and haven't eased up at all. my last blood tests were in December of 2015 and everything was normal like blood pressure, cholesterol, TSH, etc. Im 6'1" and weigh about 185 which is a little high for my hight according to my doc but is most likely due to diet or the medicines I was/am on. I tend to eat fairly healthy with lots of salads and veggies, fruits. I used to exercise fairly regularly but haven't in quite some time as Im a little scarred ill have a heart attack. I don't have any of the traditional risk factors of heart disease other than chronic high anxiety. Im really tired of living like this all the time. to be honest I would be greatly relieved if I could get my doc to get me a full heart checkup but I know she won't because of my age. my chest pains are usually around my sternum and vary in pain levels and types most of the time they are just dullish to sharper discomfort nothing thats caused me to have to pause what I'm doing. going up stairs and walking around don't tend to cause it which further makes me think its just anxiety. Its really only the chest discomfort thats bothering me and causing me to think I have atherosclerosis even at 25. what do you guys think?

[TND89]

Dude you are me wow. I’m 28 and I could have wrote this post. My anxiety and panic disorder over the years has completely deflected to my health. And almost every single day I feels aches or pains or general feelings of not being well, and I’m set into constant worry, it’s an awful loop. My heart has become my biggest concern that I am always latching onto and going back to. I have been to 2 different cardiologists, and had every heart workup you can imagine, 2 times over. We’re talking about countless ekgs, blood tests, 2 stress tests, 2 echocardiograms, 2 holter monitors, calcium score ct scan, and not to mention the few trips to the ER and all the tests they afministered. All has come back normal of course, yet I still find myself here so I started CBT several months ago. Definitely helped for a few months, then around holiday time I reverted back to where I was. I decided enough was enough and under the guidance of a psychatrist was recommended lexapro was the necessary next step to get my quality of life back. I’ve been on the lexapro now for only a week at 5 mg. I’m doing 2 weeks at 5 before going up to 10 mg. Since you’re so similar to me I was wondering how you felt that first week or so on the lexapro, for me it has generally made me feel very weird. That’s the only way I can describe it my body just feels weird and sometimes my mind goes through a quick weird spell. Lots of different sensations I’m not even used to. Curious to hear from your end

[TND89]

And I should add to this that I too recently started using an at home ekg monitorign device that I would use with my finger tips, much like you said the Apple Watch. However it became an obsession so I am sending it back.

[Paxiled]

Good decision.  The Apple Watch is not accurate -- nothing wrong with Apple or their device, nobody has an accurate enough monitor you can wear on your wrist and that's a good thing because the stress of constantly checking one's heart when there's no actual reason to do so isn't good for anyone.  The fact is, heart problems are very hard to diagnose until something really bad happens or you have a surgeon go inside and take a look at the condition of your blood vessels, which like every surgery adds a risk.  It's just not worth the worry for so many really young people who have absolutely no true evidence of a heart problem to try to find one -- those EKGs are only accurate if you take a stress test, by the way.  As for the Lexapro, it made me feel weird too.  Strange stuff.  Hope it goes away and it works for you, but I also hope you go back to your CBT and keep working on it until it sticks, since you had some initial success with it.  

[TND89]

Did the lexapro also make you tired. I’m still on 5 mg but the past few days before I even take the lexapro I am waking up extremely tired, and hitting some heavy tired spells during the day

[Joshua804]

yes it made me tired but It eventually went away or I just adapted to it.

[AnxiousNoMore]

It seems unlikely if you are taking it in the morning that it is making you tired before you take it, but that is between you and your doc to figure out. A side effect of Lexapro is insomnia, so perhaps that is your situation and you are not realizing you aren't getting a good night's sleep? What time do you go to bed and wake up?

[TND89]

Our son is 4 months now so sleep is definitely disturbed a lot of nights. But my sleep hasn’t changed much and although most nights I don’t get my full 8 hours, my sleep was not that different this past week starting the lexapro. I do notice a harder time falling asleep, I was just waking up extremely tired. Today I woke up feeling better on that end, although last night in the middle of the night I had to wake up and feed my son, and I was drenched in night sweats which has very rarely if ever happened to me. I saw some people say this happened to them on lexapro so seems like that’s the case for me too

[Paxiled]

This happened to me on Lexapro.  Sometimes I had to get up and take a shower and go back to bed again, and I always took a shower before going to bed.  One thing you can try, assuming the drug works for you, is divide the dose into two.  I did that on Paxil because of the sedation and it did help.

[Paxiled]

If the pain is in the sternum area that's not the chest, so that's one important thing as it suggests it is more like GERD than a heart problem.  Many anxiety sufferers have digestive problems, for example not thoroughly chewing their food because it's hard to relax and slow down while doing anything.  I'm not sure the anxiety you're describing is all that severe, however, and I'm wondering if anyone has referred you to therapy so you can stop thinking like this.  Meds can help with symptoms, but as you've discovered, meds always come with problems, and if you can fix it with therapy -- and there's certainly no guarantee you can -- it's gone.  It's never gone with meds, you just don't notice it as much until the med stops working.  As for the sternum pain, if it is digestive in nature, working on your diet can be helpful.  So can exercise.  Avoiding exercise because you fear a heart attack is backwards considering you don't have a problem so serious that your doc felt the need to send you to a cardiologist at this point.  I have had this sternum thing for a long time, and I deal with it by doing abs, which helps prevent bloat, and meditation.  As for your diet, while you may think it's healthy, it may not actually be healthy.  Salads, for example, are only healthy if what's in the salad is healthy.  I wonder as well if you're getting enough protein and sufficient electrolytes, especially magnesium and potassium, the lack of which can also cause nerve and muscle pain.  You might also try chamomile tea -- chamomile is not only a mild relaxant, it also helps to reduce inflammation in the digestive tract, so it's a double threat for what's bothering you.  Also make sure you don't eat within a couple of hours before lying down, assuming there is some reflux going on.  Don't take this as a diagnosis, I can't do that, and don't take this as disagreeing with the others that a full workup with a cardiologist might ease your mind -- the other advice already given is worth consideration.  I only got involved because you mentioned the pain is at the sternum, and that's not a typical area of heart problems, but it is a typical area where anxiety sufferers get pain from digestive problems caused by an anxious stomach and anxious eating habits and lack of exercise.  

[Joshua804]

I should add that the pain isn't just localized to the sternum it moves around the breastbone. sometimes its on the right, left or just spreads across the whole thing. I think im going to go back on the Lexapro and just deal with the side effects because I do believe that it did help quite a bit. something else thats added fuel to the fire is my grandfather died last week of a major heart attack/ cardiac arrest and they discovered his arteries were completely clogged and he had no prior warning signs that we knew about. it just makes me wonder that since it runs in the family that im starting to have CAD type effects.

[AnxiousNoMore]

At your age external factors are far greater risk than circulatory. fwiw http://www.dailymail.co.uk/health/article-3587061/Fascinating-graph-reveals-s-likely-kill-decade-life.html

[Paxiled]

The fact your grandfather died of heart disease seems irrelevant to you.  It doesn't mean it runs in the family.  This subject comes up so often on this forum but the fact is, everybody dies of heart failure.  No matter what the listed cause, we die when our heart stops.  Your grandfather, I'm presuming, was fairly old, as grandparents tend to be, and his heart condition suggests he didn't eat properly.  That's not "running in the family."  My Dad died of a heart attack, and my sister died of a blood clot, but they both smoked and so really died from smoking.  That isn't running in the family, as I don't smoke and never have.  I just wish you would give therapy a good hard try before meds, but it's your life and your choice and you know yourself a whole lot better than I do.

[specialmom]

Fear of cardiac issues is seemingly quite common and I have some myself!  I'm sorry you are also worrying about this.  It's been a couple of years since you had your cardiac work up.  I'd do another.  My husband has had chest pain and it was determined it was anxiety. Treating the anxiety makes that symptom less.  Why did you go off the Lexapro?  You may be a person who needs more long term usage of medication.  So, my recommendation is to get a full physical including cardiac work up and to consider a long term anxiety medication like Lexapro again.  Let us know what you think!

[Joshua804]

@specialmom, I went off the lexapro due to the sexual side effects  I think that the calming effect of the lexapro should outweigh the side effects but im young and in a new relationship. I agree that I should get another work up but im worried that ill be labeled ahypochondriac and not taken seriously. im going in tomorrow morning to get my blood panel redone so that should get some answers in terms on TSH and cholesterol levels. I just keep seeing all these stories in the news about how heart disease is affecting younger people now in their 30s and even late 20s and keep thinking that ive also developed CAD.

[specialmom]

You know, for peace of mind---  and to rule out true cardiac problems, that's important.  they know you are feeling something . . .  they will wan to help solve it.  Now, I'll tell you that I really don't suspect it is a heart issue.  But to be safe, you need to rule that out.  Maybe there is another ssri that you could try to see if it has less sexual side effects for you.  And remember, being anxious takes a toll on our partners as well.  So, hopefully you can find a way to be treated for anxiety that has the least impact on your life.  

[AnxiousNoMore]

I can't diagnose you but suggest you get the full heart review so you can end the question marks. It is unlikely you have anything as your doc says, however if it cures your anxiety it is worth doing so I am surprised she wont go for it.
I would ditch the heart checking devices like Apple watch if you get the full heart review and the doc finds your heart is ok. I never check my heart rate and imagine constantly reviewing data that you fear is increasing your anxiety, and will never allow you to accept the results.