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History of anxiety. Have breathlessness, pain in shoulder, arm, jaw. Burning chest. Tests normal. Due to anxiety again?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
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.
Posted Mon, 8 Apr 2013 in Anxiety and Stress
Answered by Dr. Nsah Bernard 2 hours later

Thanks for posting on XXXXXXX

I am most pleased to be able to assist you with my opinion about your health problems.
From your description, my impression is that you are having two psychosocial conditions that will require only psychotherapy and those are anxiety disorder and depression. Let me be more elaborate, your anxiety disorder is the onset of your symptoms (yes anxiety can cause all of those symptoms and in your case since all other possible causes of your symptoms have been ruled out by a series of laboratory exams, anxiety remains the most probable cause). The anxiety gave rise to those symptoms and the fact that you are aware of the symptoms and anxious about them result to more anxiety (associated to panic attacks) and this acts as a positive feedback mechanism whereby one results to the other. Now you feel depressed because your anxiety and the fact that you are worried about your health condition. To be simple, anxiety lead to symptoms, symptoms lead to more anxiety and finally depression.
I do not think it will be necessary to go through any more tests but rather seek for a solution to manage your anxious state (which obviously will have not cause as in most anxieties). The doctor that can help you now is a psychiatrist and you will need to seek ones attention as soon as you can before you feel any more worst.
At home, you can practice meditation (and if possible yoga). When you feel worried, take a deep breath and count up to 10seconds before releasing, repeat that at least 3 times and then relax. You will feel much relieve.
Since your anxiety seems to be severe and becoming worst, I suggest you see a doctor for prescription of an anxiolytics and antidepressive medications (i propose that should be done for a short term to avoid future withdrawal syndrome).

I hope as was able to help and if you have any more questions, please feel free to write back.
Dr. Bernard
Above answer was peer-reviewed by
Follow-up: History of anxiety. Have breathlessness, pain in shoulder, arm, jaw. Burning chest. Tests normal. Due to anxiety again? 14 hours later
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.
Answered by Dr. Nsah Bernard 20 minutes later

There is one more thing related to your pains, it is possible that stable angina pectoris can be the cause of your pain and will show negative results for all tests since it occurs episodically. But if with medications for angina you still have the pain, then you are most definitely suffering from a severe form of anxiety. If a psychiatrist can start treatment for anxiety and depression, then evolution will tell us whether or not it is anxiety. Also, your psychiatrist could also rule out anxiety and send you to an internist should it not be anxiety.

Hope this helps further and wish you a better health.
Dr. Bernard
Above answer was peer-reviewed by
Follow-up: History of anxiety. Have breathlessness, pain in shoulder, arm, jaw. Burning chest. Tests normal. Due to anxiety again? 13 minutes later
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.
Answered by Dr. Nsah Bernard 12 minutes later

Thanks for updating,
You have said it all. If the pain was heart related, it will be distinct and you will have tendency of "shouting out for help" when it comes. Anxiety is the most probable cause of your pains and I wish you can follow my advise and consult a psychiatrist.
You will need to start practicing meditation and some yoga (if you can provide time for those) and start taking anxiolytics per your psychiatrist's prescription (if any).
Hope this helps and please if you are satisfied with my answer, do accept it.

Thank you
Dr. Bernard
Above answer was peer-reviewed by
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