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Chest discomfort, heart racing, nauseous. Was diagnosed with panic attacks and bronchitis. Heart attack?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Stinging pain in the center of the chest. pounding heart beat, dizziness, nauseous after exercise or and strenuous activity. i am 32 years old, 6'5" and around 170 lbs. I am not an active person, I have a job where i sit for long periods of time, an also have horrible eating habits. I been to the physician many times and been diagnosed with panic disorder and also been to a cardiologist a few years ago for the stress test and EKG and halter monitor which also came back with the panic attack diagnosis. about 3 weeks ago I went to a walk in clinic for chest discomfort and was diagnosed with bronchitis. This has also made me stop smoking. It is now 3 weeks later and I am still getting the chest discomfort and the stinging pain the the center of my chest and is causing my to have panic attacks thinking I am having a heart attack. Please help!!
Posted Sat, 28 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 21 hours later
Thank you for your query.

Sedentary lifestyle and smoking are certainly risk factors for heart disease and heart attacks. Chest pain of the type that you have described is atypical pain and may not be related to the heart.

However, in view of the risk factors, it is essential that you get an ECG done during the pain. A normal ECG during ongoing chest pain makes ischemic heart disease unlikely. Also, it is better for you to do a stress thallium/technitium sestamibi study or a dobutamine stress echo once you have recovered from the bronchitis. This is necessary since some years have passed since your last stress test.If you are excessively worried about blockages in the coronaries, a CT coronary angiography can be done. If this is negative, you can rest assured that you are unlikely to get a heart attack in the near future (assuming you don't start smoking again!)

Your eating habits and sedentary lifestyle may also mean that you may be suffering from Gastro-esophageal reflux disorder (GERD). This can be diagnosed by means of an upper GI endoscopy and associated tests. After the diagnosis is confirmed, appropriate medicines can be given by a gastro-enterologist.

Since you have been smoking for some years and it is only 3 weeks since you have stopped, it will take some more time for the benefits of cessation of smoking to accrue. I would like to re-inforce the absolute necessity of avoiding smoking altogether and also to stay away from passive smoking (your friends and colleagues can be urged to help you).

You will also benefit from walking at least half an hour daily. You can walk at any comfortable pace. The time spent in walking is important, rather than the speed.

Counselling sessions can help to relieve your panic attacks. Also, if there is underlying anxiety/stress, a small dose of an appropriate anxiolytic can help.

I hope this answers your query. Feel free to contact me if you need any further clarifications.
With regards,
Dr RS Varma

Above answer was peer-reviewed by
Follow-up: Chest discomfort, heart racing, nauseous. Was diagnosed with panic attacks and bronchitis. Heart attack? 5 hours later
Thank you for answering my question, I have a follow up question. You say to exercise for at least an hour a day? I would love too but in my first question I said when I exercise my heart pounds really hard where I can feel it in my stomach and I feel nauseous and sometimes dizzy. I think the pounding heart is such an uncomfortable feeling that it sends me into a panic attack and that's where the sick to my stomach and dizzy feelings come from. my question is why do I feel this way and how can i stop it. Also the stinging feeling in my chest has been happening every day for about 3 weeks so far and is not happening from any exercise. Primary Dr said it was bronchitis but all the symptoms of this have gone away except the chest pain.Why does my chest still hurt?
Answered by Dr. Raja Sekhar Varma 9 hours later
Thank you for the follow-up.

You can start with walking for a lesser amount of time initially, let us say 5 minutes. Over a period of weeks, you can build up to 30 minutes per day. Let me stress again that you dont need to walk rapidly or strain yourself in any way. Walk slowly at a comfortable pace, keep your mind free of stressful thoughts, enjoy the sights and sounds around you. It should be an enjoyable experience, not an ordeal. Once you develop this habit, you will really enjoy the time that you spend in walking - a time to be in harmony with nature and a positive investment on your health.

The chest pain that you are experiencing might have many different causes like cardiac, musculo-skeletal, neurologic, GERD, etc. As pointed out in my earlier post, you need to be investigated for these different causes for a proper diagnosis to be made.

I hope this answers your doubts. I wish you all the best for a happy and healthy life.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Chest discomfort, heart racing, nauseous. Was diagnosed with panic attacks and bronchitis. Heart attack? 5 hours later
Thanks again for answering my question i just have one more. It seems that when I have these chest pains I get little stinging feelings in my left arm pit and sometimes down my left arm. Also I experience some tingling in both my feet and sometimes my legs feel like they are burning like sunburn. Could this be related to the chest pains or am I imagining things. What could this be?
Answered by Dr. Raja Sekhar Varma 1 hour later
Hello again,

Thank you for the follow up.

The cause of the chest pain is likely to be the cause of the pain in the arm pit and the pain on the sides of the arm. Tingling of the hands fingers and feet are likely to be related to the nerves of the region or due to anxiety, hyperventilation, etc.

Before deciding that you are imagining things, it would be wise to rule out any physical causes. Also, when you stop smoking, you can experience these tingling pains.

I would suggest that you do the relevant investigations and reach an accurate diagnosis. The treatment will then be more effective.

I hope this answers your query. Please accept my answer in case you have no follow up queries.

Wish you good health.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Chest discomfort, heart racing, nauseous. Was diagnosed with panic attacks and bronchitis. Heart attack? 26 minutes later
You have been very helpful Thank You so much. What kind of Dr would you suggest to have these tests done?
Answered by Dr. Raja Sekhar Varma 14 hours later
Thank you for the feedback.

The ECG during chest pain, and the stress tests are done by a cardiologist, though your primary physician can co-ordinate things. A CT angio is usually done by a radiologist and reported jointly by the radiologist and cardiologist.

GI endoscopies are done by a gastro-enterologist. A dietician can help to plan your diet. The primary care physician/family physician can help to diagnose musculo-skeletal pains, while a neurologist's help may be needed if it is a neuralgia.

A clinical psychologist will help in sorting out your panic reactions, while a drug prescription, if needed, will be given by a psychiatrist.

Since the diagnosis needs a multi-disciplinary effort by specialists from various categories, it is better to have your primary care physician/family physician or an XXXXXXX medicine specialist to co-ordinate things and guide you properly. After the diagnosis is made, he/she can also help you with the treatment options.

I hope, this answers your query. Please accept my answer in case you do not have follow up queries.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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