Hello ,

Thanks for your query.

The history provided does not provide the physical characteristics including the age, height , weight which might be essential for making a diagnosis.

Based on the symptoms of palpitations, chest discomfort, feeling of pulses in the arms and chest, as well as the normal blood tests and EKGs, the probable causes may be

1. Panic attacks
2. Cardiac arrthymias - that cannot be detected on the EKG and might need additional testing including a Holter EKG.
3. Anxiety related hyperventilation.
4. Gastroesophageal reflux disorder.

To help you more, additional information as requested below might be helpful.

1. Age, height, weight
2. Duration of symptoms
3. Occupation
4. Treatment provided or medications on
5. Any associated medical conditions
6. details of symptoms
Location of pain or discomfort
Severity - Mild, moderate or Severe
Any aggravating or relieving factors
Onset - sudden, gradual
Duration of the episode,
Mode of Resolution of the episode - spontaneous or via medications

Once the additional information is provided, I shall give you proper advice accordingly.

Waiting for your response.

Regards.

---

Hello,

Thanks for the follow up.

You have a very good BMI (Body height to weight ratio) of 22.7 and hence are physically fit.

Most of your symptoms could be very benign and due to panic attacks associated with anxiety disorder.

Let me give you some information about this condition:

Panic disorder is a type of anxiety disorder in which you have repeated attacks of intense fear that something bad will occur when not expected.

Symptoms usually begin before age 25, but may occur in the mid 30s.

A panic attack begins suddenly, and most often peaks within 10 - 20 minutes. Some symptoms may continue for an hour or more. A panic attack may be mistaken for a heart attack.

A person with panic disorder often lives in fear of another attack, and may be afraid to be alone or far from medical help.

People with panic disorder have at least four of the following symptoms during an attack:
1. Chest pain or discomfort
2. Dizziness or faintness
3. Fear of dying
4. Fear of losing control or impending doom
5. Feeling of choking
6. Feelings of detachment
7. Feelings of unreality
8. Nausea or upset stomach
9. Numbness or tingling in the hands, feet or face
10. Palpitations, fast heart rate or pounding heart
11. Sensation of shortness of breath or smothering
12. Sweating, chills or hot flashes
13. Trembling or shaking

Panic attacks may change behavior and function at home or work. People with the disorder often worry about the effects of their panic attacks.

You might benefit by a combination of medication and cognitive-behavioral therapy (CBT). Medications that can help in this condition include selective serotonin reuptake inhibitors (SSRIs) [ most useful]; serotonin-norepinephrine reuptake inhibitors (SNRIs); Benzodiazepines (For short term treatment).

Your symptoms should slowly get better over a few weeks with treatment.

You might consult your doctor or a psychiatrist who can examine you and initiate the necessary treatment.

I hope this answers your questions and clears your doubts. Please feel free to contact me, if you have additional doubts or questions.

Regards.

---

Hello XXXXXXX

Thank you for the additional information.

The additional history provided indicates the possibility of a organic condition involving the heart or the endocrine system.

The best way for the evaluation of your condition would be a Holter EKG monitoring, a Echocardiogram to detect any abnormality in the heart. Additional investigations can be done depending on the results of these tests.

In addition, tests to rule out endocrine conditions like thyroid conditions, adrenal insufficiency etc - which can present in the form of palpitations, restlessness, dehydration, lethargy and excessive thirst.

You might consult your doctor can prescribe you proper medications to control your symptoms and help you feel better.

I hope this clears your doubts.

Wish you good health.

Regards.

---