possible heart issues or just continued anxiety?

[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. What do you guys think?

[djd1990]

There's really no way to know for sure, although just statistically speaking it's pretty unlikely someone your age would have a major structural heart defect, especially if there is no family history of cardiac issues at unusually young ages. If you really feel your symptoms warrant such you should probably just go to a cardiologist. Someone complaining of persistent chest pain would probably warrant a stress test and echo. If the echo shows your heart to be structurally normal and the stress test produces a normal response that will be that. If the stress test is abnormal they might start to suspect coronary issues and may do an angiogram. The echo would really be the biggest test, though. It would easily reveal if your heart is dilated, hypertrophic, or if you have any valve or aorta issues, as well as identifying any of the relatively rare congenital cardiomyopathies (HCM, ARVC, etc) that could cause symptoms. So, if you have a PPO and don't need a referral you could just make an appointment with a cardiologist. But like I said, it's all so unlikely at your age, the tests they would run are very costly and time consuming, but if your symptoms are really that bad, or you are really that concerned, making that first cardiologist appointment ought to be your first step.