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Overweight, borderline high BP, tonsilitis, amoxicillin, fever, nyquil, chest pain, ER, EKG, chest x-ray, GERD, PPI, benzo

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Hello. I am a 23 year old male, ~40 pounds overweight, borderline high BP, exercise ~5 times a week, non-smoker, occasional marijuana usage, ~5 drinks per week, and with a family history of heart disease (father has had two heart attacks before the age of 60).

Three weeks ago when I had a bad case of tonsillitis and was prescribed Amoxicillin for 10 days. During the tonsillitis I had a fever of 104 and was coughing almost non-stop for a week; I went through nearly a whole bottle of Nyquil and a pack of Halls menthol cough drops. Towards the end of the antibiotic treatment, when my throat was finally feeling better, I developed chest pain. This chest pain was rather alarming and I worked myself into a panic thinking about it, causing more symptoms of heart failure (sweating, shaking, racing heart, stomach pain, etc.). I went to the ER and they did a EKG and stress echo, which were both clean. I was confused why I had pain so they put me on a 24 hour halter monitor, which also came back clean.

I was extremely confused about the results and over the next two weeks I was still experiencing the pains, which caused me great distress. So much distress, that I would often have panic attacks thinking that I was having heart failure. These symptoms included: sweating, racing heart, chest tension and pressure, stomach problems, shaking, tingling in the extremities, etc.

After two weeks of feeling chest discomfort and having recurring panic attacks I decided to get a second opinion. I took all my test results to a local walk-in clinic and the doc there agreed with their results. He took a chest x-ray to see if there was any possibility of other issues, but he found nothing on the x-ray. He then suggested that I might have "chest wall syndrome" or GERD. He prescribed me a PPI for the GERD and a benzo to help calm down.

I've come to terms with the chest pain and have stopped having panic attacks these last few days, but the pain hasn't receded. I'm still very anxious that the docs missed something... I've been on the PPI for three days now and still do not have any relief. I've tried taking Tums, Gaviscon, Gas-X, etc. and nothing helps the pain.

It is generally slightly off center to the left side, beneath the breast area. Sometimes it can radiate around my left ribcage, up into my shoulder, down my left arm, and into my neck. The pain is not severe, it is just dull pressure with a pain scale of ~3 (from 1-10). Sometimes the chest pressure will move to the right side of my chest, but I have not yet had radiating pains into the right ribcage/shoulder/arm. 99% of the time the chest pain will be present without other symptoms of heart failure (sweating/racing heart/etc.). It often feels like I have gas that I can't pass, but even if I do manage to pass gas the chest pain does not go away completely.

Could this really be the result of GERD or "chest wall syndrome"? Or possibly due to the panic attacks? Suffice it to say that I am quite worried about this.
Posted Sat, 21 Apr 2012 in General Health
Answered by Dr. Robert Galamaga 2 hours later
Hi XXXXXXX and thank you for your query.

Let me provide you with some additional information, considerations and reassurance regarding your symptoms. I am quite confident with the history you have given me and the workup you have had so far that this is certainly NOT a cardiac illness or heart failure that you are dealing with.

The EKG and stress echo are highly sensitive ways of examining the heart function and anatomy and the fact that you have had both done with no obvious abnormalities makes me very confident again that you are not dealing with a cardiac syndrome.

Let's talk about chest wall syndrome and GERD. A number of non-cardiac things can cause chest pain. There is a condition known as costochondritis which is an inflammation of the chest wall muscles and cartilage which can trigger symptoms of chest pain. This is particularly a consideration when a physician can reproduce the pain when pressing on the patients chest. It does not sound like this is the case for you.

Regarding GERD - 3 days is really not enough time to assess the efficacy of a PPI. We usually give these for 4 to 6 weeks before thinking about reassessing a patient in this regard. I woud continue the PPI for now.

We can't discount the contribution of anxiety in this case as well. General worry and thinking about these symptoms can create a type of snowball effect as far as anxiety goes. I have to urge you to try to clear your mind with meditation or yoga. In addition, regyular exercise is absolutely imperative for you - it will maintain your physical health as well as your mental balance. You need to be exercising for at least 30 minutes 4 to 5 days per week to establish the positive effects of physical fitness.

Some things may exacerbate this as well - including alcohol and caffeine or stimulants. I recommend you eliminate alcohol intake and caffeine if they are at all in your diet. If you are experiencing any sources of stress in your life - personally or professionally at work, it's also important to get those under control as well.

I realize this is extremely stressful for you but again, let me reassure you that I am quite confident that you are very healthy and without any risk for cardiac failure. I think these symptoms will eventually pass in the coming weeks.

I thank you again for your query and hope I have provided you with some adequate and reassuring information. I am available for your followups if needed.


Dr. Robert Galamaga
Above answer was peer-reviewed by
Follow-up: Overweight, borderline high BP, tonsilitis, amoxicillin, fever, nyquil, chest pain, ER, EKG, chest x-ray, GERD, PPI, benzo 36 minutes later
Firstly, I want to thank you for your time Dr. XXXXXXX

I was prescribed a 10 day treatment of Klonopin to help with the anxiety and panic (.5mg bi-daily) while my physical symptoms go away. I took one this morning and I actually noticed a decrease in chest tightness, which is only further proving that this is likely psychosomatic.

I make sure to get my 45 minutes of exercise 5 days a week, but I have yet to see any psychological benefits from this; however, I know that there are boundless health benefits to exercise, so I will continue with my routine.

I have cut caffeine out of my diet entirely, but this has had little effect on my baseline anxiety as well.

The strange part is that before this incident I would have guessed that my baseline anxiety level would be as low as humanly possible. I don't worry about bills, family problems, or any of that normal stuff. My anxiety and panic was all cardiac related (my father had his second heart attack a few months ago, so I suppose I might be hypersensitive to those issues now).

I have purchased the "Linden Method" to help with my anxiety and through CBT I am starting to change the way I think and behave. Through his help I have been panic attack free for 3 days (I know most of you won't find this to be impressive, but after having 5-10 panic attacks each day over the last week it has been quite a reprieve for me).

Even though the panic attacks are gone, I am still suffering from some of the worse symptoms of extreme anxiety. The chest tightness lingers and my stomach problems seem endless, regardless of how much antacid I take. I go to bed at night with relative ease, but wake up after only two or three hours and am unable to get back to sleep. I toss and turn in bed, but can never get back to sleep. Eventually the sun comes up and I resign to another night of poor sleep, starting my day. But the extreme lack of sleep has left me quite drained and anxious in the morning.

I go about all day feeling this general unease in my body; it's a mixture of feeling that something isn't right and the feeling of being unsettled, as if I need to go somewhere or do something. I try to keep my mind distracted and think positive thoughts, but the symptoms generally remain. Even after returning from rigorous exercise I feel unsettled, with the constant need to move or do something. I find it very difficult to relax, and when I am trying to do something as simple as watch TV or read my brain starts to wander back to my health.

I don't know if this is diagnostically important, but I have been very achy recently all over my body, but most specifically in my arms.

I thank you profusely for giving me my third and final opinion on my heart. As a 23 year old with clean test results I think you are probably all correct and I must trust in your diagnosis of a healthy heart. I as well do not think "chest wall syndrome" is likely, because my chest and ribs are not sensitive to the touch. The pain seems to be coming from within.

I have been very gaseous lately, which makes me think that it may in fact be a severe case of GERD (perhaps a hiatal hernia from when I was coughing non-stop during the tonsillitis?) I have also been reading that anxiety and panic sufferers have many of the same symptoms of GERD and IBS sufferers. Perhaps everything wrong with me may be self induced? Thank you again for your time.
Answered by Dr. Robert Galamaga 3 hours later

I am very inclined to think you are dealing with something that is related to a variant of panic disorder. This does not mean that for the rest of your life that you will need to be medicated for it. It does mean, however, that for a short time you may have to work with things like meditation and CBT and possibly medication to help minimize the disabling aspect which the panic causes.

Klonopin can be used for a short period of time so i would consider continuing to use it for now on an as needed basis. ALSO - good restful sleep is important to help you manage this and if you are only sleeping a couple of hours at a time it can make it all the more difficult.

One other consideration would be to think about a medication such as Zoloft which taken on a daily basis for a period of weeks to months can really improve the well being of a person struggling with panic symptoms.

Let me tell you something else - most if not all people struggle at certain points in their lives with anxiety, panic depression and so forth. Some more than others of course. I can guarantee you also that there will be a point in the coming months where you will look back on how you feel today and say "Wow, I feel a lot better right now." Stay positive, think good thoughts, surround yourself with good people good friends and family and their support will give you strength as well.

Again I hope this has been helpful for you XXXXXXX If you have additional followups, please let me know.

Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Overweight, borderline high BP, tonsilitis, amoxicillin, fever, nyquil, chest pain, ER, EKG, chest x-ray, GERD, PPI, benzo 58 minutes later

Once again, thank you for your time. I am inclined to think that panic disorder is the appropriate diagnosis. I suffered a six month episode of PD in my last year at University, but the physical symptoms were never this bad. I recovered and have been living happily until this recent episode. I am sure I will make a full recovery. Thanks again.
Answered by Dr. Robert Galamaga 1 hour later
You are very welcome. Keep in touch if we can help you with any additional health concerns in the future.

Dr. Galamaga
Above answer was peer-reviewed by
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