Hello and welcome to Healthcare Magic. Thanks for your query.

The likely possibilities for your symptoms of palpitations, fatigue, facial flushing and insomnia are:

1) Thyroid disorder:
Hyperthyroidism (an overactive thyroid gland) is one of the commonest causes for the above symptoms.

2) Anxiety disorder:
Anxiety can manifest with a variety of physical symptoms - palpitations, hot or cold sensations over the body, fatigue insomnia and headache are common manifestations of anxiety disorders.

3) Anemia - fatigue, palpitations and flushes can be symptoms suggestive of anemia also.

4) Rarely, heart problems can also present with similar symptoms.

The heartburn is indicative of an acid peptic disease. Hyperacidity can also result from excessive anxiety.

I would suggest that you have a proper medical examination and a few investigations (like thyroid function tests, hemoglobin, blood sugars, ECG, etc.) in order to establish a definitive diagnosis. Further treatment will depend on the diagnosis. For the heartburn, you can take antacids or anti-ulcer medication (like Ranitidine, Rabeprazole, etc.) and follow appropriate dietary modifications.

Wish you all the best.

Regards,
Dr. Sheeba Stephen
Emergency Medicine Specialist

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Hello again,

I understand that you must be going through a very distressing time due to your multiple symptoms. These symptoms are very unlikely to be due to early onset menopause - that's a very rare possibility. You have mentioned that all medical tests. including a detailed cardiac evaluation were negative, except for a low vitamin D and some variation in the WBC count - which cannot explain all your symptoms. Moreover, considering your age, you are unlikely to have any major medical risk factors also. In such cases, where there are medically unexplainable symptoms, one of the possibilities to be considered is an anxiety-related disorder. It is important to understand that anxiety can present with not only psychological symptoms but also with physical or somatic symptoms. Shakiness, dizziness, fast heart rate (palpitations), hot flushes, headaches, fatigue, feeling disconnected, etc. are symptoms which are commonly seen in anxiety disorders.

Now, this does NOT mean that 'everything is in your head' and that you are simply imagining the symptoms. Not at all. It has been found that anxiety disorders are associated with certain neuro-chemical imbalance in the brain and this can cause the person's pain and sensory threshold to get lowered and he / she can become 'hypersensitive' to sensory stimuli, and therefore have hyper-exaggerated symptoms. The underlying anxiety also causes a person to become more worried as to why his / her problems are undiagnosed after multiple tests, and then this worry / anxiety itself then starts worsening the symptoms more. Soon this becomes a viscious cycle, leaving the person with more symptoms and suffering.

Since you also say that you are very stressed out and unable to cope up, I would suggest that it would be worthwhile to consult a psychiatrist for a detailed psychological assessment. If your symptoms are predominantly anxiety-related, then there are effective treatment options - in the form of medication or counselling / psychotherapy which will help you overcome your problems.There are also several psychological techniques and relaxation therapies, for example, progressive muscle relaxation, applied relaxation, biofeedback, etc. which can yield effective and long-lasting results.

Additionally, you can also try simple relaxation techniques like XXXXXXX breathing, yoga, etc. which can be quite helpful. Regular physical exercise helps in relieving both the physical as well as psychological symptoms of anxiety and also helps you stay more functional.

Wish you all the best.

Regards,
Dr. Sheeba Stephen
Emergency Medicine Specialist

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