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Chest discomfort, palpitation, arm and face pain, tingling in face and legs, sweating. Normal blood work. Anxiety?

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Cardiologist
Practicing since : 1981
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Dear Doctor,
My age is 23, male. I didn’t have any health issue in the past. I was healthy, went to gym, enjoyed my work in office, money and all. But, it started one night when there was a weird kind of pain in my chest for the whole night. But that was a mild on and off pain and didn’t had any kind of related symptoms ( only very mild pain in chest ). But after that day, I started to think that I am having some heart disease. I am a very much hypochondriac in nature from my childhood. Then I started browsing about heart attack and disease symptoms in the net and slowly one after another I started to get most of the symptoms that I found out on web. I got myself in that vicious cycle and remain depressed always. I also stopped gymming.
It has been 5 months that I have all these symptoms daily ( I feel these symptoms about 7-8 hrs/day ) I am having chest discomfort , palpitations, arm and face pain, sometimes tingling sensations in face, head, legs, buzzing sensation in legs and hands( feels like blood flowing inside very fast ), always sweating in hands, sometimes numbness( I am not sure about numbness as I feel like I have some kind of numbness in hands but not sure whether I actually have it or not, it may be my fear or thinking as I am having it).Sometimes, I wake up in the night and try to sleep and cannot. But , I don’t get dizziness mostly, pain come and go and don’t come at a single time but come at different times, and also the pain doesn't radiate. I also have had occasional shortness of breath, doctors said I got panic attacks. It does not feel while exercising. However, I feel heavy acid reflux almost always, burping and all. I have consulted many cardiologists from reputed heart institutes . They did a bunch of tests.All my tests have come back normal as follows:
TESTS AND RESULTS
Bloodwork: Normal, Vit B12 : 183 pg/mol, Cholestrol: 165, creatine: 0.8, Na : 147, K:4.9, Cl: 106, Ca : 10.4, Ph : 3.4, Albumin: 4.5, ESR : 2
4 resting ECGs: All Normal and WNL
Echocardiogram Color doppler : Normal: No RMWA, No PAH,MIP and IVC : Normal, Normal LV fn, LVef: 67 %, all parameters normal, no clot/veg/pe
2 TMT( Treadmill Tests ) : All Negative ( Normal ): Good exercise tol, no sig ST-T changes, normal bp response, no arrhythmia, no angina, no S3,S4 heard. target heart achieved both times( >200 bpm)
Carotid doppler : Normal
Holter : Normal
Chest X XXXXXXX : Normal
320 slice CT coronary angiography done in Apollo Heart Centre, Chennai : Normal: Calcium score:0, All coronary arteries normal in course and calibre. No stenosis/anamolous artery noted.
Thyroid : Normal
BP: remains 115/75 almost always
Sugar : 103
•     Every where while having all these tests my resting heart rate was around 100-110 bpm. Doctors said it was my anxiety.
No family heart disease history, non smoker, non drinker ( drink once in 2 months ), non diabetic, BMI : 22, Diagnosed with G.E.R.D. last year. I have severe acid reflux and gas. This might be the cause of chest pain sometimes.
Even after having all these tests normal, I get to panic even with a small sensation in my body. Every sensation in any part of my body I get, I think it as heart related. I have consulted 13 renowned cardiologists and each and every one has said its anxiety. A reputed cardiologist from Apollo Delhi even told that I am not going to get heart attack in next 50 yrs or so and he was even ready to stamp and sign on legal paper!!!
Another thing I want to say that, I was to have the CT angio in Apollo Delhi 64 slice CT, but they tried 6-7 times after giving beta blockers also my heart rate didn’t come under 65 bpm. When I was under scanner it jumped to the 80s and 90s. They said test could only be performed in 320 slice CT scanner in Apollo Chennai. And I had to fly to Chennai to have this test. People, there after evaluating my past test results which were absolutely normal, laughed on me and my father. However, all came back perfectly fine and normal.Doc said that people of my age often start to have small/mild blockages, but in my case it was all clear, I don’t even have a mild blockage.
IS THIS ANXIETY??? Please answer. Because if it would have been anxiety , then when I know I am fine at heart, the symptoms should go away. How can it cause these kind of ( all heart related ) symptoms even when I am not anxious at all like I can get these symptoms while watching a comedy film on a TV and while being involved on a serious issue in office? Please explain
(1)     how can anxiety cause these symptoms. I really need an explanation for each of my symptoms listed above.
(2)     Can I still have heart disease after these results come back normal.
I have summarised the test results, but you may revert for any other info/question about myself and regarding the tests. I can elaborate the results.
Thank You very much!!!

Posted Thu, 27 Sep 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Anil Grover 11 hours later
Hello AAAA
Thanks for writing in.
I am qualified and certified cardiologist.
What you have we encountered as third year medical student, we would read about a disease it's symptoms, signs and some how it would fit in one's self to the last dot. Next month it would happen to other disease. So, we lived on now to tell you the truth 40 year later.
You do not have any heart disease or even anxiety. Just try to think over it get the thought out of your mind. Please stop wasting money on investigations. If you have straight question please ask. I have been practicing cardiology for three decades you ought to have that much trust. You question(s) will be answered at the soonest.
Good Luck.
With best wishes.
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
 
Follow-up: Chest discomfort, palpitation, arm and face pain, tingling in face and legs, sweating. Normal blood work. Anxiety? 10 hours later
Thank you very much sir, for your reply. But, with due respect to you, I want to say that every one has said the same thing but no one ever explained the causes of my symptoms. i would like you to answer my following questions for my peace of mind:

1. how do these strange and fearful symptoms crop up without even being anxious?Like when I am watching a comedy film or laughing on someone's joke?what causes the face and neck pain?

2. can I have any kind of heart disease even after these tests coming back normal?

3. From last 2 weeks I have been encountering head zaps/ tremors the duration being 1 sec, sometimes numbness in hands, head etc.What could be the reason?The doc told that that may be due to withdrawal of beta blockers and anxiety medicines that I took for 4-5 days during the CT angio.Can this short term withdrawal can cause such symptoms for 2 weeks or so?

4. i have a doubt on my carotid ultrasound report, while it says everything is normal, but I have some doubt on the PSV :
Right : CCA = 52.1 cm/s , ICA = 46.0 cm/s , ECA = 87 cm/s
Left : CCA = 63.2 cm/s , ICA = 39.4 CM/S, ECA = 31.1 cm/s
The ECA is varying so much. Is that an issue or is it normal?

Kindly answer these questions to just keep me at ease.

Thanx
 
 
Answered by Dr. Anil Grover 10 hours later

Thanks for writing back. I will answer your questions as suggested by you.

1. how do these strange and fearful symptoms crop up without even being anxious?Like when I am watching a comedy film or laughing on someone's joke?what causes the face and neck pain?

Our thinking make us believe many things. You have insight of that. Only investigation you need is cervical spine x-ray. If that is normal. I would say it is all in mind. Because of absence of other name doctors are calling it anxiety. But in your description cogent and eloquent you did not display any anxiety. I would say lack of belief in doctors would be a better word. Have faith in a single doctor whom you have known for long time. Trust him then trust his/her word.

2. can I have any kind of heart disease even after these tests coming back normal?

With a single test yes that would be possible. Now we have series of tests and they are proving normal heart. Therefore, the answer is NO.

3. From last 2 weeks I have been encountering head zaps/ tremors the duration being 1 sec, sometimes numbness in hands, head etc.What could be the reason?The doc told that that may be due to withdrawal of beta blockers and anxiety medicines that I took for 4-5 days during the CT angio.Can this short term withdrawal can cause such symptoms for 2 weeks or so?

Your doctor is right b blocker withdrawal can produce tremors.

4. i have a doubt on my carotid ultrasound report, while it says everything is normal, but I have some doubt on the PSV :
Right : CCA = 52.1 cm/s , ICA = 46.0 cm/s , ECA = 87 cm/s
Left : CCA = 63.2 cm/s , ICA = 39.4 CM/S, ECA = 31.1 cm/s
The ECA is varying so much. Is that an issue or is it normal?

Variability is life and only dead things are static. Variation within normal limits do not denote disease.
What are you doing why do not you read Yoga books and try some Asnas. Try swasana for 10 minutes a day for 15 days. You will fee better.

You have learn to develop faith in people otherwise life will be very difficult.


With Best wishes and regards.

Anil Grover
Above answer was peer-reviewed by
 
Follow-up: Chest discomfort, palpitation, arm and face pain, tingling in face and legs, sweating. Normal blood work. Anxiety? 2 hours later
Dear Sir,
Thank you very much for the prompt reply.I am working as Project Engineer in a electrical-power transmission sector in a private comp from last 1 year.I am leaving alone. My home is far from where I live.Ya, my parents have told me to read mythological/yoga books and try yoga. Actually, my mind was potentially preoccupied with the fact of having disease before the tests, but after all these tests coming back normal ( especially 320 CT angio) I have regained and recovered much part of my mind slowly. Even then, the symptoms are occurring, that’s frustrating and sometimes again try to drag me into that hell of thinking again. Sir, you have been very kind to me listening to my unreal and wayward complaints, I would be glad if you answer these two queries more:

1.     If anxiety( or anything you call it) would have been the cause/case, then during my studying period (when I was preparing for IIT/NIT ) I should have encountered more severe symptoms than these, as I think I used to be very anxious during those days. But, there was nothing and everything was just cool and even being tensed while daily exams and schedules, I was normal and healthy. How can it just start one night and change everything? Also the night when the pain started, I don’t remember that I was depressed or something. This is my biggest question and worry that I could be having any disease!!!Also, in the same case each heart patient in this world who has undergone surgery or some treatment and has recovered would remain in anxious state forever in his life and would fear small sensations even though he knows he has been cured.Is this right?? Please answer.
2.     The holter I did 2 months ago, at that time I didn’t keep diary of my symptoms, so I think if I do another 24 hr Holter (this would be my last investigation) and write down all the symptoms felt in the whole period, in a diary and then compare with the results. If it shows no correlation of the symptoms with the holter results (no abnormalities are shown during the symptoms other than fast and normal sinus rhythm) then this would give me great relief, might help me recover also as; i.e; next time when I get those same symptoms I would not worry or panic anymore since I would be knowing that those sensations/ symptoms are not cardio related. The 24 hr holter would definitely diagnose my problem since there is no single day on which I don’t experience these symptoms for less than 5 hr.They are persistent everyday. Please tell me whether this is a good idea? Sir, don’t worry if I have spent so much money on investigations. Peace of mind is the ultimate and the last thing way above money. However, I have a decent and handsome income for a 23 old man, that’s not a concern.I need to get my happy days back at any cost.

I will do that spine test definitely and start doing yogasanas too from today.I will also start gymming from this week.I hope I will be in track.

Waiting impatiently for your reply!!!

Thank you very much.
 
 
Answered by Dr. Anil Grover 48 minutes later

Thanks for writing back.
Did I say you suffer from anxiety. You do not suffer from anxiety or any illness.
So, your first question is not relevant. Get the junk thoughts of a disease from your mind.
Your second point: I agree with your philosophy written towards end but what is the question.
I will tell you about steps of Swasana and I have taken this from English translation of our Yogic texts. And why delay in starting start today. I QUOTE:

No yoga session is complete without the final pose – Savasana. The body needs this time to understand the new information it has received through practicing yoga. Even though Savasana is a resting pose, it’s not the same a sleeping! You should stay present and aware during the five to ten minute duration of final relaxation.

Instructions:

1. Come to lie down on the back.

2. Let the feet fall out to either side.

3. Bring the arms alongside the body, but slightly separated from the body, and turn the palms to face upwards.

4. Relax the whole body, including the face. Let the body feel heavy.

5. Let the breath occur naturally.

6. To come out, first begin to the deepen the breath. Then move the fingers and toes, awakening the body.

7. Bring the knees into the chest and roll over to one side, keep the eyes closed.

8. Slowly bring yourself back up into a sitting position.

Here are some ideas on ways to use props during savasana to make this pose more comfortable and relaxing XXXXXXX

If there is any further query I will be most happy to answer asap. It is a pleasure interacting with you.
With Best Wishes.

Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
 
Follow-up: Chest discomfort, palpitation, arm and face pain, tingling in face and legs, sweating. Normal blood work. Anxiety? 1 hour later
Sir Thank you so much.I sincerly will obey what you have advised.You are the first doctor who has replied so patiently to all my queries.I feel so relieved from last two days.However you blame the hypochondraic / impatient / anxious nature of mine, but I really need explanations to my queries in my last followup.Please refer to the last folloup.Adding to the first question if m not anxious then why thats happening??Please answer my queries otherwise, I wont be able to take my mind off from this and end the thread.This is a very bad property of mine which is troubling my life.

Thank you so much for being so kind to me.
 
 
Answered by Dr. Anil Grover 4 hours later
Well, it is called somatization of our thoughts. In short, if we think we are happy a smile comes and vice versa. That is not anxiety. So good luck.

If you have no further query please give comments and close this chapter of junk thoughts.

With Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by
 
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