Heart & Cardiology/chest pain
I am 51yo female. When I was about 30 years old I started having bouts of random heart racing and skipped beats. I saw a cardiologist and had a full work up, all was normal and I was put on propranolol. I have been taking it since then. For about 15 years I didnt have any tachycardia episodes but continued to have the skipped beats which my doctor says is normal , not to worry. About five years ago I began having the tacycardia episodes again, not often, maybe 3 or 4 times a year and continue to have them. I have developed major anxiety worrying about my heart and have started taking clonazepam for that which helps but doesnt eliminate the anxiety. I also have GERD and take omeprazole for that. I have months where i have no symptoms or any problems then for some reason I will have flare ups lasting for days or weeks of burning chest pain with tingling in my left arm, burping, and high anxiety I convince myself I am going to have a heart attack and die. This has been going on for at least 10 years now. My cardiologist says he does not think its my heart. I would love to hear your thoughts on the matter. Do you think I should have further testing or not?
The possible causes of your chest pain are chest wall, GERD, and heart. Chest wall pain is 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. 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. You'd probably know if it was GERD, but when you have the pain, swallow some milk or Maalox or Gelusil on the chance that will make the pain go away. Heart pain usually comes with exertion and is relieved in 5 minutes by rest, but can be brought on by anxiety. Heart pain almost never lasts more than a few minutes unless you're having a heart attack, which you obviously haven't had. Ask for a stress test monitored by echo or radioisotopes (EKG monitoring is not sensitive enough), and if the test is suspicious, go ahead with coronary angiography to be sure your coronary arteries are not narrowed. Or maybe get CT or MRI angiography, which show narrow places without invading the body.
Please write back if this note doesnít answer all your questions, and PLEASE let me know what you dicover.