Persistent Chest Pain and Breathing Issues: A Psychiatric Perspective

Prolonged chest pain with difficulty breathing?

Hello Doctor: I have issues with autonomic nervous system dysfunction and mitral valve prolapse.
Currently, I am experiencing headaches, dizziness, shortness of breath, wheezing, intercostal neuralgia, chest pain, and insomnia.
I take one tablet of Kangxuping 32.5 mg every night and have Xnax XR medication on hand, as well as sleep aids.
I have undergone gastroscopy, laryngoscopy, electrocardiogram, and X-rays, all of which showed no problems.
I would like to ask if the medication dosage is insufficient.
Why do I still experience these issues every day? This has been troubling me for a long time, and I feel that my life is being affected.
I would appreciate your help in answering my questions.
Thank you!

You, 20~29 year old female. Ask Date: 2018/03/21

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and distress due to your autonomic nervous system dysfunction and mitral valve prolapse.
Therefore, regular outpatient follow-ups and discussions are very important.
Regarding your concerns about physical discomfort and medication dosage adjustments, it is necessary to consider your current condition, so I cannot provide direct responses or recommendations here.
I kindly ask you to discuss this directly with your attending physician.
Wishing you good physical and mental health.
Sincerely,
Dr.
Fang-Rong Chang, Psychiatry

Reply Date: 2018/03/21

More Info

Persistent chest pain and breathing issues can be distressing and may significantly impact your quality of life. Based on your description, it seems that you are experiencing a combination of physical and psychological symptoms, which can often be interrelated. Your history of autonomic nervous system dysregulation and mitral valve prolapse, along with the symptoms of headaches, dizziness, shortness of breath, intercostal neuralgia, chest pain, and insomnia, suggests a complex interplay between physiological and psychological factors.

From a psychiatric perspective, it is essential to consider how anxiety and stress can manifest as physical symptoms. Conditions such as panic disorder, generalized anxiety disorder, or somatic symptom disorder can lead to persistent physical complaints, including chest pain and breathing difficulties, even when medical evaluations (like ECGs, X-rays, and endoscopies) show no significant abnormalities. The mind and body are closely connected, and psychological distress can lead to heightened awareness of bodily sensations, which may exacerbate feelings of discomfort.

Your use of medications like 康緒平 (a form of antidepressant or anxiolytic) and Xnax XR (a benzodiazepine) indicates that you are under treatment for anxiety or mood disorders. However, if you are still experiencing significant symptoms, it may be worth discussing the following points with your healthcare provider:
1. Medication Adjustment: The dosage of your current medications may need to be reassessed. Sometimes, individuals may require higher doses or a combination of medications to achieve optimal symptom relief. Additionally, the effectiveness of medications can vary from person to person, and it may take time to find the right regimen.

2. Therapeutic Approaches: In addition to medication, cognitive-behavioral therapy (CBT) or other forms of psychotherapy can be beneficial in addressing the underlying anxiety and stress that may be contributing to your physical symptoms. Therapy can help you develop coping strategies, challenge negative thought patterns, and reduce the overall impact of anxiety on your life.

3. Lifestyle Modifications: Incorporating stress-reduction techniques such as mindfulness, meditation, yoga, or regular physical activity can also help manage symptoms. These practices can promote relaxation and improve your overall sense of well-being.

4. Follow-Up Evaluations: Since you have undergone various medical tests that returned normal results, it may be helpful to continue monitoring your symptoms and maintaining open communication with your healthcare provider. If new symptoms arise or existing ones worsen, further evaluation may be warranted.

5. Support Systems: Engaging with support groups or talking to friends and family about your experiences can provide emotional relief and help you feel less isolated in your struggles.

It's important to remember that recovery is often a gradual process, and it may take time to find the right combination of treatments that work for you. If you feel that your current treatment plan is not adequately addressing your symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and support. Your well-being is paramount, and there are resources available to help you navigate through this challenging time.

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