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    What causes chest pain every morning despite having normal cardiac reports?

Posted on Mon, 30 May 2016 in Lung and Chest disorders
Question: Hi Doctors,

I wanted to ask, every morning i have pain in my chest until i smoked my first cigarette where it can come from??i have pain on the left and sternum...i have done chest X ray couple of weeks ago and they find only a plate atelectasis on my LLL. they have looked for CEA marquor as well and there was nothing...so do i have a risk for lung cancer anyway?? i smoke and all morning wake up really bad before to take my atenolol 12,5mg i have tachycardia which of course is worst with cigarette but till i not have smoked i feel not good in my lung and my chest...i also sleep with a really bad position i put my arm under the pillow...i really try to reduce smoking and i do exercice as well, cardio and fitness and lifting weight...i have healthy food so i not understand...
I think i can exclude cardiac problem cause worry about my chest pain i have done EKG,Echo, Exercice Stress test and everything was normal except a sinus tachycardia...if i not take my medicine i easy go to 140 to 150 without effort but cardiologist seems to not be worry about it...So doctors please tell me where i should look and where it can come from if you have any ideas cause im still young have lot of projects and all those problems i have make me worry for my future...Thanks
Answered by Dr. Meriton Siqeca 5 hours later
Brief Answer:
General anxiety disorder

Detailed Answer:
Greetings again and welcome back to HCM.

I understand your concern and I recall we discussed your issue about three weeks ago, if I remember correctly.

I will explain again that since all your cardiac tests are normal, then there is no organic origin to your problem. The heart rate is a very variable parameter of the human organism. Actually, and this not apply you only, but all human organisms, it can go up to 200 beats per minute at your age, during physical exercise, excessive psychological stress, after drinking caffeine-containing beverages and energy drinks, after episodes of binge drinking.

At this point, I think you are suffering from generalized anxiety disorder accompanied with panic attacks. The etiology of the disorder is not known, but panic attacks may have specific triggers, such as staying alone, being in crowded places, before speeches, standing in small areas or narrow passages etc. Every episode of panic attack is accompanied with fear (also a type of anxiety, medically termed situational anxiety) that there is something terribly wrong with you. You also mentioned that this state is having a significant impact in your quality of life and work. Therefore, my strong recommendation is for you to see a psychiatrist, so that a combination of a benzodiazepine with an anti-psychotic drug can be started, as a short-term regimen.

I hope this information helps. If you have follow-up question(s), I would be happy to help.

Stay healthy.

Best regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. Meriton Siqeca 1 hour later
Hi Doctor,
I understand my questions can be boring , as you say i should consult a psychiatrist in order to take a combination of medicine.Since last time we talk i already have done a lot, i do exercice more than 30 minutes per day fitness and nordic walking...i think i control and dont make panic attack like before i can calm down a lot by myself but sure there is a general amxniety disorder behind than i need to control... i not suffer of anxiety when i stay alone or that kidn of stuff, i live abroad my home country, im from france living most of the time alone in bangkok so on that point i think im not that weak.My job is also stressful im a stock market trader and i play my life almost everyday on market even if controlled there is still lot of adrenalin behind it but thats my life and my passion.today my question was only about my chest pain, i feel a chest pain alnost every morning so i just wanted to know what can be the origin of that, i start to admit it cannot be cardiac after all the exams i have done but i still would like to know what can cause me tachycardia and chest pain in the morning...maybe its tobacco i dont know i try to reduce but cannot deal with 100% stop now so yes as you told me i will try to see a psychiastrist cause im mad maybe...im not happy to come compalin here and try to find explanation, do you think a gguy in my age living a crazy and fun life in bangkok is happy to come complain on website like this...i admit than i have a psychologist problem but i just trying to find issue if i could without too much medications.Medications have destroyed my brother ( valium, tercian and so many i cannot remember the name) after him quit alcohol, now he is nearly handicapped with really hard try to come back to reality so i hope you understand my point as well...i would like to find the triggers but actually nothing declare my panic attack its nore a permanent anxiety and hypocondria.if i could be healthy and finish with that chest pain it will help...i will go see a chiropractor as well who could maybe help me. by the way thank you for answer doctor
Answered by Dr. Meriton Siqeca 35 minutes later
Brief Answer:
This is not madness. Only stress

Detailed Answer:
Hello again.
Welcome back,

There are no bothering questions when it comes to health issues, so you did not bother me at all. I was only trying to help, as we doctors always do, and state that you are the master of your mind. I understand your worry about using medicine, but I was referring to a short-term, state-of-the-art treatment, so even you can be able to tell if "you feel better or not". I would also like to state that you are not mad. GAD is not a madness. It is classified as a psychiatric disorder merely because it affects a great deal on the life and work of the person having it. Yes, tobacco is one of the main factors that cause bronchial spasms especially during mornings, which would explain the pain, and stress explains the tachycardia. Try to reduce the cigarette smoking with clear-cut targets, for instance rescue three cigarettes a month, until you can finally quit it altogether.

I hope you find this of help.

Stay cool.

Dr. Meriton
Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. Meriton Siqeca 24 hours later
Ok thanks for your help doctor, i know i need to see that psychiatrist and stop to worry im just boring of that chest pain, i dont know where it can come from but i will try with psychiatrist...MY last questions is can it come from lungs or gastric system as well...I have done complete check up and everything was find there just have found a plate atelectasis on my left lung and i had too much uric acid...
Answered by Dr. Meriton Siqeca 19 hours later
Brief Answer:
No relation whatsoever

Detailed Answer:
Welcome back.

Well, there is no linkage whatsoever. Uric acid levels are easily brought to normal levels, in young ages, by restricting salt intake and eating less red or raw meat.
Yes, gastric and airway problems may be associated with these symptoms, theoretically, but they do not match in your case. The additional information they had it checked-up, even more confirms that there is nothing wrong.

I hope this additional information helps. Hopefully, you are doing great.

Kind regards,
Dr. Meriton
Above answer was peer-reviewed by : Dr. Prasad
Answered by
Dr. Meriton Siqeca


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