Exercise ECG: Addressing Heart Concerns and Anxiety

Exercise Electrocardiogram (Exercise ECG)

Hello, doctor.
I'm sorry to bother you again.
I'm still feeling a bit uneasy, so I went for an exercise electrocardiogram and a cardiac ultrasound.
This time I went to the Veterans General Hospital, making it four major hospitals I've visited.
I've had all the basic tests done, including the exercise electrocardiogram.
All the doctors have looked at my results and said everything is fine.
The only tests I haven't done are a few that cost several thousand dollars.
I initially told the doctor I wanted to do a $6,000 coronary artery calcium scan, but he said it wasn't necessary.
I asked him if a normal electrocardiogram meant my heart was normal, and seeing my concern, he arranged for the exercise electrocardiogram, which also came back normal.
However, the next day I still felt a tightness in my chest, a heaviness in my left back, and numbness in my left arm.
I'm wondering if this is a heart issue or if it could be autonomic nervous system dysregulation, as the symptoms overlap with heart disease.
It's quite distressing.
Is this a psychological issue or a physical one, and how can I rule it out? There are no major hospitals nearby, and I constantly worry about having a heart attack or a blocked artery.
Sometimes I feel anxious and shaky when I talk, and I feel depressed.
Since the first time I experienced a sudden increase in heart rate and a feeling of my heart being locked, along with full-body tremors and a strong sense of impending doom, I've become very fearful that it might happen again.
So, whenever I feel unwell, I keep going to the hospital, but they always tell me there's nothing wrong.
What's the issue? Is it something in my mind? In the past, I would lie in bed at night thinking about dying one day, which led to fear and panic, causing insomnia.
Am I overthinking things? I'm so tired and just want to know if my heart is truly okay before I can relax.
Is my inability to let go of these thoughts a form of illness? Almost every night I feel anxious, and since the issues started in April and continued into May, I haven't slept well.
I work in a job similar to a shipping clerk, often lifting heavy items in a factory.
I feel like I have no pressure, but maybe I’m putting pressure on myself, leading to these heart issues.
I used to enjoy watching videos and playing games, but now I have no interest.
Sometimes I feel hungry, and other times I have no appetite.
For example, I didn't eat lunch today and felt nauseous.
Is it just the heat, or could it be another illness? I feel uneasy and lethargic every day, especially with chest tightness and anxiety.
How can I let go of these thoughts and not overthink? It's so difficult to achieve relaxation and a good night's sleep.
Is my nervous system too sensitive, or do I really have an illness that hasn't been detected? My family and coworkers say I’m overthinking, but I genuinely feel discomfort in my body, and the more I think about it, the more I feel it.
Sometimes I feel my heart beating strongly, and my body reacts.
Is there a danger? I'm so scared.
What conditions indicate danger? Please help me, doctor.
I'm really confused and scaring myself.
I've gone through so many tests already, and I truly can't afford more extensive examinations.
I'm 31 years old, have prehypertension, am 177 cm tall, and weigh 118 kg.
I'm actively trying to lose weight.
Each doctor prescribes different medications, and I was worried about having angina, which led me to the Veterans General Hospital, but the doctor only prescribed muscle relaxants and one medication for hypertension.
Does the doctor think it's not serious, or does he believe there's nothing wrong? I keep wondering if only expensive tests can reveal issues.
I only have a few thousand dollars' worth of tests left to do.
Is it true that those without financial means can only worry themselves to death? I've had six electrocardiograms, two echocardiograms, one X-ray, one blood test, one exercise electrocardiogram, and one carotid ultrasound.
The first echocardiogram included two scans of my carotid arteries, and everything was normal.
Is there still a problem that just isn't severe enough to detect? I hope the doctor can review my situation.
I'm sincerely expressing my condition.
Thank you for your time, doctor.

Xiao Jie, 30~39 year old female. Ask Date: 2021/05/27

Dr. He Dongjin reply Cardiology

Hello, it seems that you are experiencing symptoms similar to panic disorder.
I recommend that you consult a psychiatrist and consider medication.
The doctors you have seen at four medical centers have indicated that there is nothing wrong, so please try not to scare yourself further.
I pray for your peace and well-being.
Changhua Hospital cares about you.

Reply Date: 2021/05/27

More Info

It sounds like you are experiencing a significant amount of anxiety related to your heart health, which is understandable given your recent experiences and the various tests you've undergone. Let's break down your concerns and provide some clarity regarding your situation.

From what you've described, you've had multiple cardiac evaluations, including ECGs, echocardiograms, and exercise stress tests, all of which have returned normal results. This is a positive indication that your heart is functioning well. The presence of occasional premature ventricular complexes (PVCs) noted in your tests is common and often benign, especially in young, otherwise healthy individuals. While they can cause discomfort or anxiety, they are not typically associated with serious heart conditions.

Your anxiety seems to be exacerbated by the physical sensations you are experiencing, such as chest tightness, back discomfort, and feelings of lightheadedness or numbness. These symptoms can indeed be linked to anxiety and stress, particularly if you have a history of anxiety disorders or autonomic nervous system dysregulation. The mind-body connection is powerful; anxiety can manifest physically, leading to sensations that may feel alarming but are not necessarily indicative of a heart problem.

It's important to recognize that your fear of having a heart condition, despite normal test results, can create a cycle of anxiety that makes you more sensitive to bodily sensations. This heightened awareness can lead to misinterpretations of normal physiological responses, such as increased heart rate during physical activity or stress.
Regarding your concerns about the need for further testing, it's crucial to trust the medical professionals who have evaluated you. If they have deemed your condition stable and not requiring further immediate investigation, it is likely that they believe there is no significant underlying issue. However, if your anxiety continues to be overwhelming, it may be beneficial to seek support from a mental health professional who can help you develop coping strategies and address the anxiety directly.

In terms of lifestyle changes, regular physical activity can indeed help alleviate anxiety and improve overall well-being. It seems you have already started jogging, which is excellent. Exercise releases endorphins, which can improve your mood and reduce feelings of anxiety. Additionally, practicing relaxation techniques such as deep breathing, meditation, or yoga can also be beneficial in managing anxiety symptoms.

As for your concerns about medication, if your doctor has prescribed a medication like carvedilol, it is likely intended to help manage your heart rate and reduce anxiety related to your heart's rhythm. It's essential to discuss any concerns about medication duration and side effects with your healthcare provider, as they can provide personalized advice based on your specific situation.

Lastly, it's important to remember that while it is natural to worry about your health, excessive worry can lead to a diminished quality of life. Finding ways to manage your anxiety, whether through exercise, therapy, or relaxation techniques, can help you feel more in control and less fearful of your symptoms.

In summary, based on your extensive evaluations and the normal results you've received, it appears that your heart is healthy. Your symptoms may be more related to anxiety than to any underlying heart condition. Seeking support for your anxiety and continuing to engage in healthy lifestyle practices will be beneficial for your overall well-being. If you continue to have concerns, don't hesitate to reach out to your healthcare provider for further guidance.

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