Brief Answer:
Obsessive-Compulsive Disorder

Detailed Answer:


Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.In your case obsession is your fear to get heart attack and compulsion is your mind thinking again and again ,despite of repeated clearance from cardiology side.
But a person with OCD generally:

Some features of ocd are-
Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
Spends at least 1 hour a day on these thoughts or behaviors
Experiences significant problems in their daily life due to these thoughts or behaviors

So my first suggestion will suppress your obsession to get a heart attack;

Get a STRESS THALLIUM done , Stress thallium is 98% sensitive test , in 98 out of 100 patient stress thallium rules out the cardiac cause correctly, so even if there is a remotest possibility of myocardial infarction in your case it will find out; Though its not required in your case but it will give you a clearance from cardiac side, hence this fear will end up.Once your obsession for cardiac disease ends your compulsion will also end.Over anxiety due to obsession is causing chest pain ,wrist and back ache.

Advise
Stop fludac and Start paroxetine at low doses to be increased every 14 days to maximum doses.(to be prescribed by a psychiatrist)
Ask him to add tab clonazepam or Lorazepam ( benzodiazepenes), to lessen your anxiety levels.
These drugs should be discussed with your psychiatrist before use.
Try to take 8 hours sleep,try strenuous exercises 45 minutes a day, yoga can be done to relieve your mind.

Follow these advises for 3 months,and you will be fine .

In case you have any other query ,feel free to ask i would be happy to help you.

Dr Rishu Saxena
Cardiologist XXXXXXX hospital XXXXXXX ,New XXXXXXX
( YYYY@YYYY )

---

Brief Answer:
no its not smoking withdrawal symptoms its OCD.

Detailed Answer:
Hi XXXX,


U wrote-

1) I get afraid and very scared that I may get heart attack-obsession

2) But my doctor said I will not get but not able to tell that to my mind - compulsion, despite of clearance given by doctor with multiple repeated normal tests your mind is not satisfied that you are normal..

Chest pain is because of severe anxiety, because of obsessive compulsive behavior, anxiety is one of the most common cause of chest pains.

If your stress thallium test is normal; this pain is not at all cardiac in origin.

Your primary problem is psychological and it is called obsessive compulsive disorder .
Start the medications which I have advised in consultation with a psychiatrist .
Don't worry you will be fine soon.
Withdrawal symptoms of smoking are not associated with chest pains; its your anxiety .
Thanks

---

Brief Answer:
Give answers in detail

Detailed Answer:
Hi
At a age of 25 , with normal ecg ,echo and other tests the chances of getting a heart attack in near future are very very rare , The golden rule of medical science is that there is no rule, so rare thing do occur but they occur very rarely.

Anxiety is a very important cause of myocardial infarction in young people, take it seriously if you are not going to take care of your raised anxiety level you can have a unexpected myocardial infarction.

You say your stress test is normal ,please be sure about it ;as STRESS test and STRESS THALLIUM test are totally different things , Sensitivity of stress test is 60% while sensitivity of stress thallium is 98% .

If you want you can mail me the scanned copies of your stress test,ecg echo and all, i would like to have a look on it.

please answer the following questions

Any history of pyschiatric illness in relatives
how long did u smoked
are you alcoholic
what is your sleep cycle
do you have disturbed sleep
sedantry or active life style
vegetarian or non veg
answer to these question are required before giving you clearance from cardiac side.
Your VLDL levels
hdl/total cholestrol ratio
Do you have gastritis ,heart burn or acid peptic problems?

You can mail reports on YYYY@YYYY , in case you cant upload them on HCM.

---