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What Causes Severe Chest Pain And Heart Palpitations?
Question: I've continuously have chest pain and horrible palpitations and It really worries me. I'm not sure if o should /be worried or if something could have been missed or changed because In the last year or two I have had 2 normal stress tests, 2 normal echos, and 2 normal 30 day monitors. But as I stated the fear of something being missed or changed scares me.. I read up on SCAD so that causes more fear for me. I've attached a picture showing where the pain is. and I have severe palpitations as previously stated. It will not allow me to attach the picture but it's center upper chest area and spreads to the left a little.
Brief Answer:
Most likely panic attacks.
Detailed Answer:
Hello,
Have gone through your details As per the history given by you all the tests to rule out cardiac pathology are normal.So most likely these palpitations are non cardiac in origin.
It can be due to increased levels of anxiety causing Panic attacks.Severe palpitation and chest pain can be the presenting symptoms of a panic attack.
Stress test and 2d echo are almost 80% sensitive to rule out coronary artery disease.However as you are having severe left sided pain along with palpitations initially i would recommend you to go for a test called stress thallium.This is almost 98% sensitive to rule out coronary artery disease.Once this test is normal you are free from cardiac side and should see a psychiatrist for therapy regarding Panic attacks.
SSRI's like Paroxetine along with anxiolytics will be given for prescribed by psychiatrist for few months and most likely you would start feeling better with in 2-4 weeks.
In case of any other query feel free to ask.
Thanks.
Most likely panic attacks.
Detailed Answer:
Hello,
Have gone through your details As per the history given by you all the tests to rule out cardiac pathology are normal.So most likely these palpitations are non cardiac in origin.
It can be due to increased levels of anxiety causing Panic attacks.Severe palpitation and chest pain can be the presenting symptoms of a panic attack.
Stress test and 2d echo are almost 80% sensitive to rule out coronary artery disease.However as you are having severe left sided pain along with palpitations initially i would recommend you to go for a test called stress thallium.This is almost 98% sensitive to rule out coronary artery disease.Once this test is normal you are free from cardiac side and should see a psychiatrist for therapy regarding Panic attacks.
SSRI's like Paroxetine along with anxiolytics will be given for prescribed by psychiatrist for few months and most likely you would start feeling better with in 2-4 weeks.
In case of any other query feel free to ask.
Thanks.
Above answer was peer-reviewed by :
Dr. Remy Koshy
What if I've already had a stress echo?
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
If stress echo was normal its not cardiac. Sensitivity of stress echo is almost 90%.
Please consult a Psychiatrist most likely you are having spells of panic attacks.
Only test i would advice is Throid profile.Problem with levels of thyroid hormones can cause palpitations.If Thyroid profile is normal,Its panic spell.
Please mention do you have any history of Gastritis,Acid peptic disorder or Heart burn.Some time Gastric problem can mimic cardiac origin of pain.
Please reply.
Waiting.
Thanks
Follow up answer.
Detailed Answer:
Hi again,
If stress echo was normal its not cardiac. Sensitivity of stress echo is almost 90%.
Please consult a Psychiatrist most likely you are having spells of panic attacks.
Only test i would advice is Throid profile.Problem with levels of thyroid hormones can cause palpitations.If Thyroid profile is normal,Its panic spell.
Please mention do you have any history of Gastritis,Acid peptic disorder or Heart burn.Some time Gastric problem can mimic cardiac origin of pain.
Please reply.
Waiting.
Thanks
Above answer was peer-reviewed by :
Dr. Remy Koshy
I have had thorough testing with a gastroenterologist as well as an endoscopy and everything was normal. I've also had my thyroid tested and that was normal as well. My only concern is that I read the set sometimes stress Echoes can only be 60% accurate and I don't feel like such pain can be related to anxiety or stress what can I do to reassure that it's not a heart issue or something being missed because my doctors won't order any more tests because of my age.
Brief Answer:
Follow up answer.
Detailed Answer:
Hello again,
After stress echo there are only two more tests left to rule out the possibility of coronary artery disease.Tests are-
Stress Thallium-Over 97% sensitive to rule out CAD.
Angiogram- Gold standard test to rule out CAD with sensitivity more then 99%.
As per your query regarding stress echo as it is a manual test so accuracy of results depends on the experience of technician and quality of machine.
Clinically its not feasible to differenciate the cause on the basis of history.
Thanks.
Follow up answer.
Detailed Answer:
Hello again,
After stress echo there are only two more tests left to rule out the possibility of coronary artery disease.Tests are-
Stress Thallium-Over 97% sensitive to rule out CAD.
Angiogram- Gold standard test to rule out CAD with sensitivity more then 99%.
As per your query regarding stress echo as it is a manual test so accuracy of results depends on the experience of technician and quality of machine.
Clinically its not feasible to differenciate the cause on the basis of history.
Thanks.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I'm sorry so I'm confused, you do think it can still be heart related??
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
My opinion is that the pain is non cardiac in origin most likely due to panic attacks.
This is my opinion after going through your test results and history.
However as i have explained above for full confirmation stress thallium is the best test for you.
Cardiac origin of chest pain is very rare in young females unless they are chain smokers.
please mention your smoking habits and who told you that you can have SCAD?
Waiting
Thanks.
Follow up answer.
Detailed Answer:
Hi again,
My opinion is that the pain is non cardiac in origin most likely due to panic attacks.
This is my opinion after going through your test results and history.
However as i have explained above for full confirmation stress thallium is the best test for you.
Cardiac origin of chest pain is very rare in young females unless they are chain smokers.
please mention your smoking habits and who told you that you can have SCAD?
Waiting
Thanks.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I have never smoked but I have seen a cardiologist that I was referred to and he explained to me that I don't have any current problems but that scad can be an issue
Brief Answer:
Follow up answer.
Detailed Answer:
Hi,
SCAD is a very rare condition a CT angiogram or Angiogram should be done if this condition is suspected. It's a emergency condition and most often patient presents with severe and sudden pain in chest.
Clinically in your case your pain is on and off, but pain in SCAD is acute in onset.
However, the only way to rule out SCAD are the tests mentioned above.
Your age is 26 and you are a non smoker, so chances of SCAD are very low.
Have you ever tried Xanax or other anxiolytic ?
Do you have history of sudden cardiac death in your family on or before 40 years age ?
What are the levels of your anxiety ?
How is your sleep cycle ?
How long does this pain last ? Any relieving factor ? Any factor which increases pain or palpitations ?
Please answer these questions, as SCAD is a rare diagnosis therefore we need to exclude all possibilities.
Will be looking forward to your follow up with the answers.
Regards
Follow up answer.
Detailed Answer:
Hi,
SCAD is a very rare condition a CT angiogram or Angiogram should be done if this condition is suspected. It's a emergency condition and most often patient presents with severe and sudden pain in chest.
Clinically in your case your pain is on and off, but pain in SCAD is acute in onset.
However, the only way to rule out SCAD are the tests mentioned above.
Your age is 26 and you are a non smoker, so chances of SCAD are very low.
Have you ever tried Xanax or other anxiolytic ?
Do you have history of sudden cardiac death in your family on or before 40 years age ?
What are the levels of your anxiety ?
How is your sleep cycle ?
How long does this pain last ? Any relieving factor ? Any factor which increases pain or palpitations ?
Please answer these questions, as SCAD is a rare diagnosis therefore we need to exclude all possibilities.
Will be looking forward to your follow up with the answers.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I am on xanax, I suffer with severe health anxiety. No cardiac deaths before 60. When the pain comes it's usually consistent all day with nothing that relieves or makes it worse. Palpitations always just come and go but I know my thinking is somewhat irrational due to my health anxiety but I don't want to overlook something that I'm genuinely feeling just because of it.
Brief Answer:
Panic attacks.
Detailed Answer:
Hi dear,
Sorry for a late reply.
As per you history its very likely that pain and palpitation are due to your grossly elevated anxiety levels.
Continous off and on pain is not characterstic of SCAD.As explained earlier SCAD is an emergency condition usully associated with severe acute onset chest pain.
I would strongly recommend you to see a pychiatrist for panic disorder.
Regards.
Panic attacks.
Detailed Answer:
Hi dear,
Sorry for a late reply.
As per you history its very likely that pain and palpitation are due to your grossly elevated anxiety levels.
Continous off and on pain is not characterstic of SCAD.As explained earlier SCAD is an emergency condition usully associated with severe acute onset chest pain.
I would strongly recommend you to see a pychiatrist for panic disorder.
Regards.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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