Should I See a Doctor for Anxiety and Chest Pain Concerns?

Should I see a doctor?

Hello, Doctor.
I would like to ask a few questions.
Over the past six months, I have frequently experienced chest pain, sometimes as sharp pain and other times as a sensation of pressure on my chest, as if someone were pressing down with their fingers.
I also often have back pain.
I have seen both a family physician and an orthopedic specialist, who suggested that it might be caused by scoliosis.
However, the curvature is not significant enough to require mandatory rehabilitation; they advised me to pay more attention to my posture, but there has been no improvement.
In addition to the chest pain, I have been dealing with stomach pain, which has become more frequent over the past six months.
I had previously stopped taking medication for it, but due to the frequent episodes, I had to start taking stomach medication again.
Because of these ongoing health issues, I have started to feel increasingly anxious, worrying about various things and constantly feeling on edge.
I tend to get nervous easily, and often experience anxiety attacks, during which I feel restless, overheated, and as if I need to exert effort just to breathe.
In the past two weeks, I have also been experiencing palpitations and often feel like my heart is racing.
This has led me to worry that there might be an issue with my heart, but I have been hesitant to see a doctor.
I am reluctant to tell my family; I mentioned it briefly once, but they just thought I was overthinking things.
Now, I often feel fatigued and am reluctant to go out, fearing that something might happen if I do.
Should I see a cardiologist first? Do I have autonomic nervous system dysfunction?

CJ, 20~29 year old female. Ask Date: 2016/05/02

Dr. Wu Enliang reply Psychiatry

It sounds like you have been experiencing various physical discomforts over the past six months, such as chest pain, back pain, stomach pain, and palpitations, along with anxiety, tension, and restlessness, which can be quite overwhelming.
It must be frustrating that even after seeing a doctor, you haven't found relief.
Have any tests been arranged by your doctor during your previous visits, such as blood tests, physical examinations, or endoscopy? It would be advisable to consult a cardiologist and inform them of all your symptoms, requesting a thorough evaluation to rule out any endocrine or cardiac issues.
If all tests come back normal, it may be worth considering the possibility of autonomic nervous system dysregulation, which could be related to anxiety or depression.
If this is the case, lifestyle adjustments and stress reduction techniques should be considered, or you might think about seeking help from a psychiatrist.

Reply Date: 2016/05/02

More Info

It sounds like you are experiencing a combination of physical symptoms and anxiety that is significantly impacting your daily life. Given the complexity of your symptoms, it is essential to approach this situation holistically.
First and foremost, your chest pain, back pain, and gastrointestinal issues (like frequent stomach pain) warrant a thorough medical evaluation. While you have already consulted with a family physician and an orthopedic specialist regarding your back pain, it may be beneficial to revisit these concerns, especially since your symptoms have persisted for six months. It’s crucial to rule out any underlying medical conditions that could be contributing to your symptoms, particularly the chest pain.
Chest pain can arise from various causes, including musculoskeletal issues, gastrointestinal problems, and, in some cases, cardiac conditions. Given your description of the pain as sometimes sharp and other times feeling like pressure, it is advisable to consult a cardiologist to ensure that there are no heart-related issues. Even if your previous evaluations did not indicate a problem, it’s important to communicate the progression of your symptoms, including the recent onset of palpitations and increased anxiety.
Your anxiety symptoms, including feelings of restlessness, difficulty breathing, and a heightened state of worry, suggest that you may be experiencing anxiety or panic attacks. This is not uncommon, especially when dealing with chronic physical symptoms. Anxiety can exacerbate physical discomfort and create a vicious cycle where physical symptoms lead to increased anxiety, which in turn leads to more physical symptoms.
You mentioned that you have a history of being easily anxious and that your anxiety has intensified recently. It might be beneficial to seek help from a mental health professional, such as a psychologist or psychiatrist, who can provide you with coping strategies and possibly recommend cognitive-behavioral therapy (CBT). CBT is an effective treatment for anxiety and can help you manage your symptoms by changing negative thought patterns and behaviors.
Additionally, you should consider discussing your symptoms with your primary care physician, who can coordinate your care and possibly refer you to a mental health specialist. They can also help you manage your gastrointestinal issues, which may be contributing to your overall discomfort and anxiety.
In summary, I recommend the following steps:
1. Consult a Cardiologist: Given your chest pain and palpitations, it is crucial to rule out any cardiac issues. A thorough evaluation, including an ECG or echocardiogram, may be warranted.

2. Seek Mental Health Support: A mental health professional can help you address your anxiety and provide coping strategies. They can also assess whether you might benefit from medication or therapy.

3. Follow Up on Gastrointestinal Issues: Since you have a history of stomach pain, it may be worthwhile to revisit this with your primary care physician or a gastroenterologist.

4. Practice Self-Care: Engage in relaxation techniques such as deep breathing exercises, mindfulness, or yoga, which can help manage anxiety and improve your overall well-being.

5. Communicate with Family: While it can be challenging, consider sharing your concerns with your family. They may be more supportive than you anticipate, and having a support system can be beneficial.

Remember, it’s essential to address both your physical and mental health concerns simultaneously for a comprehensive approach to your well-being. Taking these steps can help you gain clarity on your symptoms and improve your quality of life.

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