Heart & Cardiology/heart vs. anxiety


I'm a 39 Y.O. female, with no significant risk factors, heart disease history.  Recently I began suffering from what was diagnosed with anxiety and panic.  Primary cardio symptoms were chest pain/pressure and palpitations.  Also felt lightheaded and nauseous.  

During my anxiety diagnosis, I saw a cardiologist and was given an echo, stress echo, a 24hr holter and a number of EKGs and blood tests.  All were normal.  My ejection fraction was 65%, and I had rare pvcs/pacs.  Stress test reached 11min and 189 HR with no concerns.   BP is normal, resting HR is low 60s.  

My questions are:
1) Can I take comfort that this work-up is comprehensive and indicative of good heart health?  
2) I continue to experience some episodes of chest pain, sometimes brief lasting a few seconds that feel more like pressure and tightness, and some that are more prolonged aches in my upper chest and under my ribs--these are sometimes worse when I press on them or laugh/cough.  Would you say that these are likely attributed to anxiety and/or muscular tension?
3) Given my test results/symptoms, do any other tests seem warranted?

Many thanks.

Hello Kristen,

1. Yes.
2. Skeletal muscle cramping.  Chest pain in a young person is usually cramping of muscles in the chest wall.  If pushing on the painful area modifies the pain (makes it better or worse), or if the pain is relieved by bending the body away from the painful area, that proves the pain is from chest  wall.  Even if these maneuvers donít affect the pain, itís still probably chest wall.  Pain caused by narrowing of the coronary arteries that supply blood to the heart is extremely rare below age 40. Chest wall pain is no threat to life or health, just a big nuisance.  Safest management is just to ignore the pain, though Tylenol, aspirin or ibuprofren usually help.
3. No other tests are needid.

Please write back if this doesnít answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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