“19F With Unexplained Chest Pain”

benign condition often associated with panic attacks. I cannot say if any of this is as result of your COVID infection but I.m afraid there is no specific treatment at this point. You have a new patient question! All you have to do is reply to this email

Answer: Your chest pain is not of primary cardiac nature. Any chest pain from ages 17-19 is secondary to another issue or process. The only myocardial abnormalities of any significance in your age group are congenital (you would have been born with the problem). But the symptoms are real. This is due to your underlying psychiatric issues, particularly the anxiety and panic attacks. You have years of significant mental health problems, including eating disorders. Bulimia-anorexia are ugly cousins and not to be taken lightly. In addition to that, you have untreated anxiety/depression/ panic attacks. You do need a psychiatrist and therapist in addition to a good support group at home. Mood altering chemicals like alcohol or MJ are not the answer. Im glad you stopped self medicating.. Now, what about the heart. Your pain is sharp and atypical and not due to any type of coronary disease. You have a problem with the autonomic nervous system as a result of your extreme anxiety and panic attacks. The symptoms are real but its your brain hijacking the cardiovascular system and your other organs. The most complex system in our body is the nervous system . We dont know more than we do know. The nervous system is under the control of the central nervous system , including the brain and spinal cord. Under the CNS umbrella you have a sensory nervous system (touch), motor nervous system to move our skeletal muscles. Smaller fibers of pain, temperature etc. our skeletal joints have proprioception to sense position. Then we have the special senses of sight, hearing, smell , taste etc via our cranial nerves. We have higher levels of motor function controlling our equilibrium and gait via the inner ear (8th cranial nerves) the basal ganglia and the cerebellum (old brain). All of these systems can be sensed by us and are somewhat under our control. The autonomic nervous system controls our bodily functions and is completely out of our consciousness or control. The brain autoregulates the heart, lungs, kidneys, liver , intestines etc. we cannot command our heart to beat, our lungs to breath, stomach to digest etc. Try holding your breath for 6 minutes. You will not be able to and your brain will make you breath due to CO 2 accumulation. The autonomic nervous system has 2 separate systems working in conjunction, the sympathetic and parasympathetic. In short, the neurotransmitter for the sympathetic nervous system is adrenaline and for the parasympathetic its acetylcholine. The 2 work in conjunction and the sympathetic is essentially our waking system and the parasympathetic system shuts everything down at night when we rest. So heart rate drops to 40s, breathing is 8-10x min, bowel and bladder function cease while we sleep. During day we need these organ on full blast and adrenaline does that. Fright-flight is the term commonly used to describe this. This is a very oversimplified depiction but it helps to understand the problem. The brain has trouble differentiating our internal organs , unlike our appendages for instance. You know left from right but gallbladder problems are referred to the shoulder, angina to the left arm or neck. This is referred to dermatomes that were formed in utero. Dysautonomia or autonomic dysreflexia is the disease of malfunction of this systems . If acetylcholine is released when we stand and gravity pulls blood to our feet, the arteries dilated and heart rate drop . The blood pressure and cardiac output drop and cerebral perfusion drops .. patients get dizzy and can actually have syncope ( pass out). Thats one form of dysautonomia called boss-vagal syncope or neurocardiogenic syncope. The brain is overriding the cardiovascular system. Theres a spectrum of symptoms from mild (palpitation and tachycardia at rest) to severe with cardio-inhibitor -vasodrepressor syncope requiring medications and occasionally pacemaker implants. Parkinsons disease is the most severe form of orthostatic blood pressure (bp drops when go from supine or sitting to standing). Anything more than a drop of 20 mmhg is abnormal and causes symptoms. PD patients will drop 100mmhg when its very severe. So what does this have to do with sharp chest pain in you? Your anxiety and panic attacks are triggering your dysautonomia.. your mind suffers the body will follow . The brain hijacks any and all , chest hurts, pulses quickens, skipped beats extra beats, hyperventilation, stomach cramps, diarrhea, nausea and even vomiting. Nothing is inherently wrong with any of your organs. Thats the brain referring its suffering to these organs . Treat the source. When the stress and anxiety are under control , these symptoms will resolve. Thats why they only occur when you are inside your head at quiet times. You dont feel this at exercise because the body releases endorphins, our natural anxiolytics. This needs to be addressed. A small dose of metoprolol can help ( beta blocker) for the cardiac manifestations. But the source is the psyche . Treat that and all will get better. Thats why people with this problem never have symptoms on vacation when out and about. !!!! As a cautionary note, while anxiety can mimic cardiac chest pain, long standing anxiety and stress can cause premature cardiovascular disease and death. The release of pro- inflammatory, harmful cytokines damage all of our organs. Thats what stress causes. It takes a several decades, but high stress folks dont see their 90s. Stress kills. Plus it robs the joy out of life. So quit worrying about your heart. Its fine. Focus on that head of yours !!! lol All joking aside, if you fix the mental issues the rest will follow. Dont fix it and feel like this for the long haul. And it will eventually get worse. So get get it treated. You got this. Good luck