/ Anxiety and Chest Pain?

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L Steeple - on 05 Mar 2019

Hello,  just wondering if anyone has experienced quite severe chest pains that come and go with anxiety?

I have been to the GP and had an ecg which was clear and blood tests (not sure what for)

Still getting this crushing pain in the chest/sternum that comes and goes.  I am not sure if it's causing anxiety or anxiety causing the pain and making me feel strange as well!?

I haven't got a history of anxiety but I guess that if I have had an ECG then that's what it must be?

Just wondering if I should make another appointment at the risk of wasting nhs time?

Blood pressure all fine too. 

I expect advice would be to err on the safe side but any reassurance welcome.  GP doesn't seem overly concerned which I guess reassures?

I am 50 and fairly fit and carry no weight, don't smoke etc...

Thanks

abr1966 - on 05 Mar 2019
In reply to Steeple:

It can be pretty shocking just how 'physical' the body can be with anxiety....real pain and frequently very alarming. If all of your physical checks rule out any medical cause hopefully this can reassure you.

There's plenty of self help on line for anxiety.....some of it conflicting but have a look and see what may be helpful to you. Often lifestyle is the issue....stress and so on....anxiety has a habit of catching up with you after you have been through a tough time and you are on the better side of it...

Good luck.....

L Steeple - on 05 Mar 2019
In reply to Steeple:

Thanks for that. 

Amazing how real the pain feels, probably thinking about it too much makes me hypersensitive to any sensation.

Anxiety is a first for me and seems to have come out of the blue.

Mal Grey - on 05 Mar 2019
In reply to Steeple:

Has your doc mentioned things like acid reflux/gastric possibilities? I've had this, and on Christmas Eve my described symptoms, similar to yours, had the NHS111 handler call out the paramedics for me leading to an ambulance ride. It was worst in the centre of my chest, but with some pain out to the sides. The more stressed I got, the more it hurt. I was not remotely stressed or anxious before the pain started, but as it worsened and I got stressed, it absolutely seemed to accelerate the pain. 

As with yourself, ECG and numerous blood tests resulted in the all clear, and the symptoms reduced fairly quickly after that, though occasionally came back over the next few days. The most likely cause has now been suggested as a gastric thing, where the acid gets out of your stomach into your oesophagus. I'd completely forgotten, but I'd had something like this 15 years ago which was vaguely said to be acid reflux. In my case, Gaviscon liquid seemed to help, and I've had no recurrence since mid-Jan.

I am the same age, pretty fit and active mountain biker, canoeist and walker, and also a non-smoker. In fact, the paramedics said my ECG trace suggested the "heart of an athlete", something I have been quoting regularly ever since...

abr1966 - on 05 Mar 2019
In reply to Steeple:

> Thanks for that. 

> Amazing how real the pain feels, probably thinking about it too much makes me hypersensitive to any sensation.

This is very true! There's a real circularity about physiological sensation in anxiety and further anxious thoughts....one really does create the other and vice versa!!

If you can....keep reassuring yourself that it really is 'just' anxiety when you are experiencing those sensations....

Best wishes...

L Steeple - on 05 Mar 2019
In reply to Mal Grey:

Yes have been crunching Gaviscon like I've got shares in the company!

Might be doing some good?  I have had this for weeks but much less severe and now it seems to come on when I get up in the morning?  I feel fine when I wake up.

Could be a combination of anxiety and acid reflux?

The pain is right below the bony bit of my sternum and radiates out a bit.  I think I have worked myself into this state where I think every slight palpitation is the end!

AdrianC - on 05 Mar 2019
In reply to Steeple:

My first thought was the same as Mal's.  Sounds like the three of us are similar in age and general fitness / health and I get similar symptoms sometimes.  If you google "globus sensation" you'll find some stuff about it being associated with stress.  It used to be called globus hystericus for that reason, as far as I can tell.

L Steeple - on 05 Mar 2019
In reply to AdrianC:

Thanks for that, yes have just googled this and I expect to have the condition by tomorrow, Wednesday at the latest!

L Steeple - on 05 Mar 2019
In reply to Steeple:

Could also be some sort of strain in the chest?  Just seems to start in the centre of the chest and stretch across and round the back. 

Anxiety seems to be making me tense my upper body muscles which feeds in to the whole thing creating positive feedback ie. more tensing then more anxiety etc...

Ridge - on 05 Mar 2019
In reply to AdrianC:

> My first thought was the same as Mal's.  Sounds like the three of us are similar in age and general fitness / health and I get similar symptoms sometimes.  If you google "globus sensation" you'll find some stuff about it being associated with stress.  It used to be called globus hystericus for that reason, as far as I can tell.

Make that four of us at a certain age. A course of Nexium is probably the best OTC medicine, rather than gaviscon. Certainly knocked my problem on the head.

L Steeple - on 05 Mar 2019
In reply to Steeple:

Thanks I haven't tried that, will get hold of some tomorrow.

Time of year probably doesn't help much.  I'd probably feel a lot better if the sun was shining and I was on the hills or coast.

Mal Grey - on 05 Mar 2019
In reply to Steeple:

> Yes have been crunching Gaviscon like I've got shares in the company!

My doc told me liquid was better than tablets, as it would sit on top of the stomach acid. 

Sound like there are a fair few of us of a similar age and condition. Perhaps we should now start comparing dodgy knee joints, elbow joints, any joints...  I'm not convinced I like this ageing thing!

Timmd on 05 Mar 2019
In reply to Steeple:

I know of somebody who has had anxiety related chest pains, and gone to hospital in a panic/been taken as a precaution a couple of times, and (as far as I gather) it's only ever been as straight forward as anxiety*.

* Which is bad enough, but nothing heart related to do with blood clots or malfunction etc... 

Post edited at 20:54
freeflyer - on 05 Mar 2019
In reply to Steeple:

As I can't see any mention of it, there's a chance it could be referred pain from your back? I say this because I turned up at the doctor once convinced I was having a heart attack, and having done the usual checks he made me lie down and pressed on the middle of my spine, and Lo! my heart attack stopped.

L Steeple - on 05 Mar 2019
In reply to Mal Grey:

Yes, don't get me started on my other ailments...

Ridge - on 05 Mar 2019
In reply to Mal Grey:

I'm a martyr to my gout...

I'm turning into an old man

AdrianC - on 05 Mar 2019
In reply to freeflyer:

What an entertaining thread this has turned out to be.

oldie - on 05 Mar 2019
In reply to Steeple:

I'm late 60s. Have occasionally suffered from chest pains for at least 15 years(including tonight) mainly on left hand side. I put it down to indigestion. Nothing serious has ever occured, I still get good results from the regular NHS checkups on offer. Incidentally I take everything they do offer including flu jabs and can't wait for my shingles jab when I reach 70 (one in four get shingles and private jab is about £200). They've flattered me too with "heart of an athlete" as mentioned in an earlier post. So don't worry overmuch.
Just a slight warning. Wife's uncle had chest pains, had ECG which showed nothing but he died of heart attack soon after. I'm told, not by someone with medical knowledge, that the ECG can sometimes be OK when pains are not occuring. So if you have real worries it might be worth getting another checkup in the future. Incidentally the uncle had an atrocious lifestyle including heavy smoker, little exercise, meek character, bad industrial shift work, bullying foreman and stressed out with long drive to do up his distant bungalow: which all almost certainly contributed to his condition.

Best of luck. Its nice to know there are lots of us in the same boat! Its the none serious things like bunion and minor accidental fractures which I actually find more annoying, though I've personally found our health service really good.

Timmd on 05 Mar 2019
In reply to Ridge:

> I'm a martyr to my gout...

> I'm turning into an old man

A family friend got gout, and cured it by changing whatever it was he was eating and drinking. 

52 is too young to be feeling old.

Post edited at 22:06
1
dr evil - on 05 Mar 2019
In reply to Steeple:

Anxiety is an unlikely explanation for crushing chest pain experienced for the first time at 50 years of age. Hopefully it’s musculoskeletal but I would suggest seeking another opinion in case it’s cardiac which a normal ECG will not necessarily exclude

wercat on 05 Mar 2019
In reply to Steeple:

CBT might help you with this as there are tecniques you are taught to deal with panic attacks that can also be applied to self induced stress.  If you ask your GP and explain that you are falling victim to anxiety and stress you may be able to be referred.  

I have had physical symptoms that have worried me into panic attacks that ended me up in A & E (never associated with climbing I'm glad to say)  - I rather think the symptoms were something physically wrong at the time that I responded badly to by panicking (my father and his brother both dropped dead early of heart attacks, younger than my present age by a year or two, so I could be considered on borrowed time).  I can tell you that the CBT techniques I was taught helped me to stop this misinterpretation and panic.

Post edited at 22:26
wercat on 05 Mar 2019
In reply to Timmd:

it isn't old!

syv_k - on 05 Mar 2019
In reply to wercat:

It isn’t old, but it is getting to the age where all meet-ups, family reunions, etc., are obliged to begin with an organ recital.

Bristoldave - on 06 Mar 2019
In reply to dr evil:

Anxiety is an unlikely explanation for crushing chest pain experienced for the first time at 50 years of age. Hopefully it’s musculoskeletal but I would suggest seeking another opinion in case it’s cardiac which a normal ECG will not necessarily exclude.

This is good advice

Post edited at 02:47
mountain.martin - on 06 Mar 2019
In reply to Steeple:

Another example of someone who experienced this in middle age. Mid 40's for me with breathing issues, palpitations, chest pain. Completely convinced myself that I was about to die, but 10 years later I'm still here and still very fit for my age. Many vists to doctors, ECG tests etc. Diagnosis was anxiety and muscular skeletal pain, but it took a long time for me to believe this and stop panicking.

Once you have had thorough medical checks to ensure nothing is wrong, relaxation, breathing techniques and or CBT can help. Getting into a pattern of anxiety/panic is not nice and can be debilitating long term if not treated, it effected me badly for several years.

ben b - on 06 Mar 2019
In reply to Steeple:

Anxiety and chest pain usually co-exist - it's a pretty normal response to get anxious when you get chest pain. If the pain comes first, or if it predictably happens under certain situations (lifting, running uphill, whatever) then there's a few extra things that might need doing. 

ECGs are OK for picking up heart problems when the pain is present (or more accurately, a normal ECG when you are having the pain is pretty reassuring that it isn't a dangerous problem) and a troponin (blood) test might pick up if any damage has been done recently. However, the NHS is pretty good at assessing risk in this situation - most hospitals of any size will have a fast track cardiac assessment pathway which will probably involve a run on the treadmill with the ECG leads on.

 If it keeps happening, then I would pop back to see your GP and discuss if this is a good idea in your case. 

Best wishes,

b

PS Your comments re gaviscon make me think you need to talk to your GP about some omeprazole anyway!

Post edited at 07:19
Rigid Raider - on 06 Mar 2019
In reply to Steeple:

My broken ribs six months ago taught me what a flexible thing the ribcage is and how much it actually moves and bends as you move. The actual impact caused it to flex quite dramatically I think, which caused residual discomfort for several weeks in areas quite distant from the two ribs. Think of when you're chewing a pork or lamb rib and all that muscle and thin connective tissue between the ribs and imagine how easily it must get damaged then how slowly it repairs itself. 

cb294 - on 06 Mar 2019
In reply to Steeple:

Yes, welcome to the club. I guess the pain gets stronger when inhaling deeply?

I had this for a while (negative ECG and all), then nothing for ten years or so, and recently again for a day. When I had these heart palpitations regularly I would carry an emergency pack of two or three benzodiazepine tablets my GP presxcribed. Usually just touching the pack would normally be enough to relive my anxiety or panic attack. I think I still have most of the strip I got first time round.

CB

wercat on 06 Mar 2019
In reply to syv_k:

yes that is true

Aly - on 06 Mar 2019
In reply to Steeple:

Whilst anxiety is a not-uncommon cause of chest pain, new central crushing chest pain in someone of your age should be taken very seriously. 

As dr evil points out above, a normal ECG, blood pressure and blood tests does not exclude a cardiac cause of your pain.  One can be having a heart attack with a completely normal ECG.  The tests are only useful as part of the picture combining your risk profile and the nature of the pain.  If you are concerned then it would be completely reasonable to seek a second opinion.  Most NHS trusts should have some kind of (in theory) 'rapid-access' chest pain clinic for exactly this sort of thing which can usually be accessed from primary care as well as through A&E.

Hopefully it is nothing of concern and you get to the bottom of it.

Neil Williams - on 06 Mar 2019
In reply to Steeple:

Yes, I have had that during extreme stress.  I think it's tightening of muscles rather than anything really serious - though it did feel for all the world like what I'd imagine a (minor) heart attack to feel like.

Post edited at 09:16
wercat on 06 Mar 2019
In reply to wercat:

just to clarify, I didn't turn up at A & E "worried well" - I had been unconscious and the paramedics suggested A & E would be the wisest place

ben b - on 06 Mar 2019
In reply to Aly:

Incidence of truly normal ECG during acute MI in a 50 year old is probably about 1-2%, so very unlikely. But still a complete bugger if you are in the 1-2% of course. 

However consistently normal ECGs whilst having symptoms AND normal hs-TnT is a very, very low risk situation. Especially if no family history or other risk factors.

b

Jamie Wakeham - on 06 Mar 2019
In reply to Steeple:

I went throught something like this a few years ago.  38 at the time, so younger than the OP, and less of actual pain but instead horrendous palpitations.  One morning when they were really bad I called 101 for advice, and (in retrospect unsurprisingly) found that telling them that I was having all sorts of interesting caridac symptoms whilst alone in the house resulted in an ambulance being dispatched!

With me it's entirely stress related - I'd let my work get far too far on top of me.  Moderating caffeine and alcohol consumption has helped a lot, and I've been prescribed propranolol (a beta-blocker) to manage the symptoms - they're now a once-every-few-weeks thing.

But I remain astonished at just how physical the whole thing was, given it was entirely stress generated.

Dave Garnett - on 06 Mar 2019
In reply to Aly:

> Whilst anxiety is a not-uncommon cause of chest pain, new central crushing chest pain in someone of your age should be taken very seriously. 

This.

There's a circular relationship between chest pain and anxiety, and a lot depends on whether you have some reason to fear heart disease.  If this is because of family history (as in my case) then, of course, both the fear and an organic cause can occur together.

I once had an episode of chest pain which obviously caused quite a lot of concern.  A panic attack was an obvious possibility but when I got to hospital I did have an abnormal ECG.  Fortunately, it turned out not to be what I feared, and not serious, but it's not an experience I'm likely to forget.  

The obvious conclusion is that you should be checked out thoroughly.  By luck, as part of taking part in the UK BioBank project, I had the experience of watching my heart filling and pumping on functional MRI, plotted alongside my ECG and blood pressure.  It was fascinating and hugely reassuring!  

Aly - on 06 Mar 2019
In reply to ben b:

> Incidence of truly normal ECG during acute MI in a 50 year old is probably about 1-2%, so very unlikely. But still a complete bugger if you are in the 1-2% of course.

Have you got a good reference for this (genuine question as I'm interested)?  Having seen it, those are the ones you remember I guess.  I can recall reading somewhere that around 7% of acute MIs (of all ages) have a normal initial ECG (though all hospital based I think, and there will be variability regarding when they present and even what constitutes 'normal').  I'll have to try and find the study.

> However consistently normal ECGs whilst having symptoms AND normal hs-TnT is a very, very low risk situation. Especially if no family history or other risk factors.

Yes, completely agree.  Serial ECGs in a patient with ongoing pain is really useful, and reassuring in ED but I find often pain has settled by that time, and I suspect this is even harder to do in primary care but I may be wrong?  A low HEART score, for example, is good at ruling out adverse events within 30 days, but proportion of these people will need outpatient follow-up rather than no follow-up. 

I'm not trying to disagree with you at all btw (nor was I trying to hijack the thread), I just didn't want the OP to not seek more advice/follow-up if (s)he had ongoing pain or worries.

Timmd on 06 Mar 2019
In reply to wercat:

> it isn't old!

Exactly/indeed/agreed...   

L Steeple - on 06 Mar 2019
In reply to Steeple:

Just an update.  I went back to the docs this morning and they listened to my heart and took blood pressure again and then a blood sample and another ECG.

All still normal.  Doctor thinks it's most likely anxiety.

Still getting episodes of pressure and pain in the chest but reassured that the doctor doesn't feel it necessary to take it further.

L Steeple - on 06 Mar 2019
In reply to Aly:

That's interesting.  By the time my ECG's were taken the crushing pain or cramp had subsided.

I'm trusting that any problems would have shown up.  Presumably they wouldn't take any chances with potential cardiac stuff?

DNS on 06 Mar 2019
In reply to Steeple:

I'm early 50's and have suffered from severe anxiety three times in my life. Other than being overweight and drinking more than my GP, I'm 'fat but fit'. When I'm anxious, I can get severe central chest pains. Nothing on the scale of a cardiac arrest, but bad enough to compound the anxiety.

Meditation and 'attention focus' CBT worked wonders for me. I wish I'd come across the techniques 30 years ago.

Not being flippant - but trapped wind can be excruciating also.

Post edited at 23:05
ben b - on 07 Mar 2019
In reply to Aly:

Thanks Aly - yes difficult to walk a line between alarmism and reassurance online! Professionally probably best not to get involved but difficult to not get involved in some cases, especially when advice is quite variable.

The study I recalled dimly is below (I was a cardiology SHO at the time) - 4.4% all comers, so lower for younger etc.

cheers

b

Prognostic Value of a Normal or Nonspecific Initial Electrocardiogram in Acute Myocardial Infarction
Robert D. Welch, MD; Robert J. Zalenski, MD; Paul D. Frederick, MPH, MBA; et alJudith A. Malmgren, PhD; Scott Compton, PhD; Mary Grzybowski, PhD, MPH; Sophia Thomas, MD; Terry Kowalenko, MD; Nathan R. Every, MD, MPH; for the National Registry of Myocardial Infarction 2 and 3 Investigators
JAMA. 2001;286(16):1977-1984. doi:10.1001/jama.286.16.1977
ben b - on 07 Mar 2019
In reply to Steeple:

> I'm trusting that any problems would have shown up.  

Not necessarily on the ECG, but if significant issues the blood tests would have shown some changes.

There's also the GP's assessment which is not infallible, but they do see an awful lot of chest pain and so get pretty good about picking up the cardiac stuff.

Best wishes

b

L Steeple - on 07 Mar 2019
In reply to ben b:

Thanks to everyone for this.  I am going to find out a bit more about CBT.

My heart rate never seems to vary dramatically and I can have the pain when resting so I think all the indications are anxiety?

Michael Hood - on 07 Mar 2019
In reply to Steeple:

I don't think your symptoms quite fit what I used to get which is atrial fibrillation, feeling fluttery and out of breath rather than pain. I used to describe it as feeling like I was going uphill very high altitude mountaineering without oxygen (never done this but my uphill pace and out of breath looked similar to films of such ).

Easy way to check, is your pulse normal when you have this pain?

If you have real trouble finding a proper pulse then AF may be a possibility. Doesn't usually show up in an ECG unless you're actually in AF.

Q: are you on any anti anxiety meds. AF is a known side effect of some, eg venlefaxine (had to reduce my dosage).

Aly - on 07 Mar 2019
In reply to Steeple:

> That's interesting.  By the time my ECG's were taken the crushing pain or cramp had subsided.

That’s often the case, hence doing blood tests and taking a good history which it sounds like your GP has done.  

> I'm trusting that any problems would have shown up.  Presumably they wouldn't take any chances with potential cardiac stuff?

Look, your doctor is in the best place to judge that and it’s clearly been considered given the tests you’ve had.  Unfortunately there no crystal ball to tell the future, but if you feel reassured then that’s important.  If you’re still worried, or having ongoing symptoms then it wouldn’t be unreasonable to get another opinion.

Martin W on 07 Mar 2019
In reply to Aly:

It's not clear to me that the OP has had any advice/guidance/medication from the GP regarding their anxiety.  Have they even mentioned it to the GP?  If not, and the chest pains are a symptom of that and nothing more serious, then the anxiety is what needs addressing IMO.

The GP should also be able to refer the OP towards CBT if that is felt to be the best way to treat the anxiety.  (Personally I have concerns about the apparent tendency these days to regard CBT as a panacea for all minor mental ailments.  I certainly wouldn't self-prescribe it as some here seem to be suggesting.  It's not clear to me whether an aerial assault course - which seems to be one of the go-to activities for CBT pratictioners - would do much to alter the mental state of someone who participates in a climbing forum...)

Post edited at 11:12
Pan Ron - on 07 Mar 2019
In reply to Steeple:

Does it happen towards the end of a deep breath, and relieved by exhaling slightly at the point when the pain starts?

bruce - on 07 Mar 2019
In reply to Pan Ron:

Not on any anti anxiety meds and deep breath doesn't affect things.  

Thought I was feeling a bit better earlier then had a very painful cramps right across my chest that lasted around 15 mins and was quite distressing.  Easily the worse so far.

Feel exhausted now!  

I have some Beta Blockers prescribed by the doc but haven't touched them yet.  Hoping it will all pass with a little time.

cb294 - on 07 Mar 2019
In reply to bruce:

Take the beta blockers, they act on your heart and your nervous system! You can always wean off them later, they are not some opioid pain killer.

CB

Aly - on 08 Mar 2019
In reply to ben b:

Thanks, that looks right, I think it's the same one I had read at some point.  The 7.9% was for only those included in the study, though even skimmming it again it's hard to work out exactly who they'd excluded and at what point and why!

Timmd on 12 Mar 2019
In reply to Steeple:

Oh yeah, my brother had chest pains and went to the docs and was told it was anxiety. 

Rob Exile Ward on 13 Mar 2019
In reply to Ridge:

Gout can be managed with alpurinol - it's a life changer! (I speak from experience.)


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