Brief Answer:
It is most likely due to anxiety.

Detailed Answer:

Hello,

I read your query and understand your concerns.

From the available description it is clear that the palpitations, chest pain and anxiety are related. It will not be wrong to say that the palpitations are result of anxiety other than anything else.

The points in favour of above opinion are as follows
1. Palpitations and chest pain are are well known anxiety symptoms
2. Comorbidity with anxiety is very common with bipolar disorder (almost 60%)
3. Response to lorazepam indicates that anti-anxiety medications help the problem which again supports anxiety as the cause
4. Poor response to ongoing medications indicates that conventional medications are ineffective.
5. Worsening of symptoms in morning indicates weaning effect of medication.

In my opinion you need to follow your psychiatrist and psychologist.

I hope this helps you.

Feel free to write back to me if you have more questions.

Thanks and regards.

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Brief Answer:
Follow up

Detailed Answer:

Hello,

Thanks for follow up.

I like to assure you that pounding in the chest in association with anxiety and chest pain is palpitations rather than anything else. It does not mean that everyone should call it palpitations but it is important to state that this is most likely anxiety symptoms as explained above.

Regarding weaning effect of the medication, I like to state that the serum concentration is at the lowest level during morning hours which causes increase burden of a symptom during morning hours.

I hope this helps you further.

Feel free to write back to me if you have more clarifications.

Thanks again.

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Brief Answer:
Follow up.

Detailed Answer:

Hello,

Thanks for the information.

I am glad to know that the new medication helping you and hope that the improvement will be much better with the progress of time.

Thanks and regards,
Dr. Ashok Kumar, Psychiatrist

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