Question: Hello, I am in desperate need of some guidance and reassurance. Here is my situation. About a year and a half ago, I began experiencing anxiety symptoms: panic attacks, lightheadedness, nausea, racing heart, shortness of breath, tingling sensations, etc. My primary care doctor as well as my OB/GYN both diagnosed it as anxiety. I eventually went to the ER because of the symptoms. They did an EKG, bloodwork, chest CT scan, and everything was normal and the doctor at the ER told me that it was all anxiety as well. I also had a 24-hour holter monitor and echocardiogram done and they were normal as well. Well after that, the symptoms and sensations went away for about 10 months, now they have come back with a vengeance the past 3 months. I am so worried about my heart again. I have been back to my primary care doctor and my OB/GYN as well as the emergency room twice within the last three months and have had numerous EKG's, bloodwork (including cardiac enzymes), and chest x-ray. Everything is normal. The symptoms that I am having are shortness of breath, nausea, pretty much all throughout the day although the severity comes and goes, pain in my left shoulder and in my left arm, pain in my left jaw and chin at times, a burning sensation across the top of my breasts and chest which I can also feel in my chin and around my lips, and pain in my back, particularly in my left shoulder blade. My question is: can anxiety cause all of these odd symptoms and sensations that I am feeling or do they sound cardiac in nature?? I am not denying that I have bad anxiety, as I feel nervous and anxious most all the time, but it is just so hard for me to differentiate whether the anxiety is causing the symptoms or the symptoms are causing the anxiety. I have also had my thyroid checked as well and it is normal. I have been assured by all my doctors as well as the doctors in the ER as recently as two weeks ago that my heart is fine. Do you feel I need any further cardiac workup, or has what I have had: echocardiogram, multiple (and I do mean multiple) EKGs, chest CT scan, cardiac bloodwork, and holter monitor enough to rule out that heart problems are causing these symptoms? I am constantly worried that I am going to have a heart attack and it has severely affected my quality of life. It is so bad that I will go and sit in the hospital parking lot when I feel these symptoms just in case I need to go into the ER. Please help. I would appreciate any advise you can give me.

Thank you so much Dr. XXXXXXX for your response and advice. I will plan to make an appointment with my primary care doctor to get a referral to a psychiatrist or therapist as I do feel my anxiety has gotten really bad at this point. I wanted to ask you one last question also. So it is possible that anxiety can cause me to feel pain in my left arm and shoulder and up into my jaw? That is what really worries me concerning my heart because I know that is a big sign of heart problems, particularly in women. I know anxiety can cause aches and pains, but it worries me so much when I feel the ache and sharp pains in my left arm and the burning sensation across my chest and into my chin and jaw. Just wanted to make sure that you do think that this is anxiety related, in the context of all the negative heart tests I have had. Again, thank you so much for your compassion and understanding and I look forward to getting your response.

Thank you again Dr. XXXXXXX I do feel, as you do and the countless other doctors that I have been to, that it is in fact anxiety related. When I do feel the pain, it is a vague sensation, almost like it is there, but not there if that makes any sense. I am assuming that if it were angina or something heart related, that the pain would be very distinct and very noticeable. Its almost like my mind is creating the pain if that makes sense, because like I said, its very vague and fleeting, almost like I'm imagining its there or something. I appreciate your help so much during this difficult time in my life.