Slight occasional 'sting' in chest, extra beat,... history of anxiety

[Dr. Jim]

History: 36yr old male. No BP issues, good cholestoral,..etc. Had stress related panic attacks a few years back, felt cardiac.  All testing, stress-test, echo,ekg...came back fine.  Diagnosed with anxiety disorder, put on Klonopin.  Also have undefined hypercoagulative state, on Coumidan therapy, INR of 1.6.
Active, workout 6xweekly, eat very well, drink a few beers on weekends, cup of coffee in morning, and worst:smoke about 2-3 cigars a day for last 2 years.

A  week ago when in the midst of a huge stressful career situation, I began to feel the occasional (2-4 times) daily sting or tinge in my chest area...duration 2-3 seconds.   That is all.  No other symptoms.  In fact, it has started to subside greatly as soon as work deadline/situation was resolved. I am hoping this is anxiety/stress related, and looking to confirm this.

Saw cardiologist yesterday who did xray/ekg. All was perfect. He said he did 'hear' an extra beat, and it could easily be the morning coffee or such.  Concerned with 'my' stress over this he offered an echocardiogram and Holter test which I will do.

1) Since he heard the 'extra' beat prior to the EKG, and EKG was fine was the extra beat still present? Would an EKG reveal an extra beat?

2) As I am looking to abate my stress over this as quickly as possible, what opinion might you have over such an odd symptom, considering my overall situation?

3) And how 'reassuring' should an EKG be?

Thanks greatly for your time.

[Cleveland Clinic]

Jim,

Thanks for the post.

1) Since he heard the 'extra' beat prior to the EKG, and EKG was fine was the extra beat still present? Would an EKG reveal an extra beat?

Not unless the beat occured during the ECG. However, an extra beat, would generally be a PAC or a PVC and with a notmal cardiac evaluation is nothing to worr about.


2) As I am looking to abate my stress over this as quickly as possible, what opinion might you have over such an odd symptom, considering my overall situation?

Your symptoms sound atypical for cardiac ischemia and with a normal cardiac evaluation, the likelyhood that the symptoms are coming from a cardiac source is quite low.


3) And how 'reassuring' should an EKG be?

The EKG will only potentially show changes with symptoms or if there has been prior or underlying structural heart disease. The most important evaluation a physician can do is to take a thorough history and physical. A normal stress and echo and lack of any significant cardiac risk factors, would be quite reassuring.  

Good luck

[CollegeGirl143]

"extra beats" are completely harmless.. a kind of stinging or tingly sensation is something i often get when i have an adrenaline rush. its probably stress related. :)

[mrbh]

I can't comment on the heart issues, but I will say that the cigars and the beer MUST go. The coffee should likely go as well.

[LukeL]

An EKG is very usefull in diagonosing EP problems and have a high success rate but can miss some serious things every now and then. But with repeated EKGs odds are if anything was serious it would show up. Also extra beats will only be shown on the EKG if you have them  during the test which is very unlikely. You may want to have a holter or event monitor as a last resort to put your mind at rest.