Good Morning,

A little back history: I am a 26 yeard old male 6' 255 pounds (at the time) woke up on Sept 23rd with crushing chest pain in the middle of the night. I made my way to the bathroom and my heart rate was through the roof. I woke up my girlfriend and told her what I was feeling. She calmed me down which took over an hour and we ruled it a panic attack. Later that week this happened again after taking a test at school and on my walk back to the car I got SOB, got back girlfriend calmed me down and went to sleep. The next morning while at work I got a panic feeling and went for a walk and I decided to go to an urgent care where they did an EKG and said they saw an abnormality and sent me by ambulance to the hospital. The tests performed while I was their was an EKG, Chest X-Ray, D-Dimer, Troponin, CBC blood work which all came back fine. The doctor came in and laughed at me for coming in and said the EKG was fine but I was just a little tachy and couldn't believe the urgent care sent me over this. He recommended me a GP who I followed up with and the GP did another EKG and prescribed me xanax on as needed basis and ruled it as anxiety. Well we are now in October and on my way to work I get another crushing chest pain and I decide to drive myself to the ER again. They do the same tests and chalk it up to anxiety. My GP sees I am not happy and tells me to calm my thoughts I should see a cardio to convince myself I am fine. I see the Cardio he does EKG/Echo/7 Day Holter/Stress test and diagnoses me with Inappropriate Sinus Tachycardia and places me on 25mg of Toprol XL. This has seemed to help but I still get pain and sob from time to time and I do feel palpitations as well. During the Course of these 2 and a half months I changed my diet and have lost near 30 pounds.

With everything I have been through can I thoroughly say I am fine? I get a myriad of symptoms that come and go and I am working on my anxiety issues through counseling. This whole process has been really hard on me and I can really just use some reassurance or guidance. I don't want to be on medication forever, why does Inappropriate Sinus Tachycardia happen out of no where? Could the doctor be mistaken and this just all be anxiety? I have already had my thryoid checked out... Any suggestions would be helpful, Thank you!

Well I am looking for more answers myself, but from what my Cardio explained my heart rate is too high at rest and increases greatly with exertion. It is puzzling to me that this onset seems sudden and I was hoping someone on this forum can help us with more answers.

He said I should stay on them but it is ultimately up to me or get an ablation which is not always successful. It has kept me from exercising outside the treadmill which I keep at a 4MPH pace. Even though my heart doesn't race I still get weird sensations with exertion. However my resting pulse sometimes now is under 60 which is worrisome to me. It seems like since it is dismissed as not being life threatening that it makes it not important. This has affected me tremendously and I wish I was provided with more information. I still fear that their is something else wrong with my heart and that is why I was reaching out here.

BDS wrote on Dec 7^th, 2012, 1:55pm:


Well this scared me, how do I know when and what testing is enough? I want to believe the doctors and be done with it but when I get weird symptoms such as palps, chest pain, or sob feeling (which I can't tell if it is real or fake) do I need to follow up with more testing or do I just continue with counseling and chalk it up to anxiety?

Thanks!

Thank you! I sent my question that way but am still open to people's opinions here as well.

I agree, but I have my good days and bad days just like anyone else I guess. When I am feeling good everything is logical and I believe my doctors wholeheartedly, however, when I get intense chest pains or feelings of SOB at times I disregard their diagnosis and logic is out the window. That is what I am addressing in counseling but thank you for your reassurance as well. Thanks!.

Also, I don't mean any disrepsect to BDR or whoever told you to get another test just incase of some rare situation....

NO. DONT DO IT.

If you do you won't get off the carousel. You'll then need "another test". And the "another". No tests will ever be enough.

The guys who have checked you had to go through so many procedures to get their licenses for YEARS. They are adequete enough. BELIEVE THEM. Don't get an opinion from Dr Richardson etc. You don't need it.

Looking back on this forum and not being anxious anymore I can see exactly what keeps it going and it's so painful to read.

You need to just SNAP OUT OF IT. Just accept any so called "symptoms" because that's all they are. That is the ONLY WAY OUT of this hell you are in.

If you keep searching you will never leave. It will be a lifelong journey.

Okay, welcome to the forum and I've read your complaint and concerns.

It's important for you to realize that simply because a clinical sign is defined by testing does not equate with an origin in pathology. In other words, the presentation of a clinical symptom does not necessarily mean you have a problem. The appearance of a heart block, or altered conductivity, can commonly arise in the presence of sinus tachycardia and it is likely the feature which sent you via ambulance to the ER. Since the heart anomaly was not evidenced on re-testing, it is of no significance.

The presence of pectoral angina can be difficult to define at some point after the event and the fact that your cardiac enzymes have been consistently normal, you can rest easy in knowing that the discomfort was not true angina. There are several causes and the most common for persons with significant anxiety is DaCosta's Syndrome. Put simply, it is chest wall pain that is musculoskeletal in origin and yet can somewhat mimic the clinical patterns of angina.

The other factor to consider is whether it is esophageal spasm, which can occur from reflux in some patients and is quite painful. Heart rate is also increased during the episodes as well but merely secondary to a change in sympathetic tone and not because the heart's performance is being challenged.

Panic threshold events, or panic attacks, can indeed produce rather remarkable physiological changes which include tachycardia, light-headedness, confusion, sweating and a host of other events. Pain, however, is seldom encountered although not entirely unreported. I note that you are going to school and I'll make brief comment here that experiencing significant anxiety, even panic disorder, is not uncommon and due mainly to distorted perspectives regarding the challenges of academia. In other words, many people find test scores, grades, professional school entry requirements and other features of secondary education to represent an ultimatum and that they must meet certain objectives within the prescribed timeframe. This sort of perspective very readily sets in motion a challenge to one's self-confidence and apprehensions regarding failure of any type. Self-doubts can loom large in some instances and feeling trapped not altogether uncommon.

The first point I wish to make clear here is that you are in no actual danger at all. The symptoms you are experiencing are quite common and inconsistent with heart disease. While Inappropriate Sinus Tachycardia can arise ideopathically, or from unknown origin, I question whether someone of your age, circumstances and general health suffers from the condition. I would more submit that anxiety regarding your health fears is the driving force behind your increased resting rate and largely due to mild dysautonomia as a consequence of the influence of somatic anxiety.

You're going to be just fine. If you find that the challenges of your academic pursuits may be challenged by irrational perspectives, this may well be the source of your troubles. School and learning is supposed to be fun and you should never let the weight of your future ride on tests or grades. At 26, you have your entire life ahead of you and at a far contrast of 93 years of age myself, I'm here to tell you that the journey is long and fulfilling. Never place overwhelming importance on matters which actually have options rather than ultimatums commonly self-imposed. Take your time in school and direct more effort toward understanding than mere matriculation to a profession.

Best regards,

Rutheford Rane, MD (ret.)