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Question
I need to know if I'm on the verge of a heart attack or some kind of anxiety induced breakdown. I am a 35 year morbidly obese female with type 2 diabetes and hypertension. My last A1C was 6.2% My blood pressure is an ongoing battle. My last cholesterol test was over a year ago but was 209. I have been having numbness in my arms at night for 2 years. I am a side sleeper and left handed. I get the numbness in both arms but primarily left hand. My career and past time for the last 10 years has me on the computer at least 50-60 hours a week.

I occasionally get these anxious feelings where I feel like I'm having a heart attack. No chest pain but an odd feeling 'wave' comes over me. It is literally a wave of 'something' that starts in my stomach and spreads throughout my chest. I keep waiting for the 'heart attack pain or pressure' but it never comes. I sometimes feel faint or nauseous but never lose consciousness or vomit. Sometimes I have headaches or head 'tension' during these times. I have been to the ER at least 6 times in the past 2-3 years for these episodes...convinced I'm having a stroke or heart attack. During these episodes my blood sugar ticks up and my blood pressure goes sky high but no heart attack no stroke. The only discovery was that one time my potassium was low.  I thought maybe I had MS but an MRI showed no signs of MS or previous stroke. My physician said marks on the scan were consistent with someone that has migraines. But I don't have headaches like they appear to be on tv.
Am I losing my mind or am I about to have heart attack?

Answer
Hi, there is a lot of helpful reading at http://blog.myheart.net.

The symptoms you describe are atypical and don't sound like classic heart related symptoms. However if i were you, rather than continuously going to the ER each time this happens and getting sent home without the answers to reassure you, go and get a regular check up from a cardiologist who can assess your symptoms and perform relevant tests to help risk stratify your symptoms. At least this way, if the tests come back normal you will not be as fearful of having a heart attack and you would have had an appropriate work up.

The most important thing in your case however, particularly if heart disease is ruled out as a cause of your symptoms, is addressing your risk factors for heart disease. Your obesity, blood pressure, and diabetes are all risk factors than can be addressed and if managed appropriately with the help of a good primary care physician, can lead to improved outcomes.

Here are appropriate general recommendations in addition to your diabetes management:
1. Blood pressure goal of <140/90 mm Hg
2. Total cholesterol <170 mg/dL
3. Weight management to a BMI <25
4. No tobacco use
5. Diet - low sodium, low sugar-sweetened beverage, high fiber, and increased fruit and vegetable intake
6. Exercise - stay physically active for at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity each week
7. Influenza vaccine when available

Hope that was helpful,

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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