Long-Term Chest Tightness and Anxiety Symptoms

Q: Long-Term Chest Tightness and Anxiety Symptoms

Hello： If you visit the pulmonology clinic to check for asthma or post-COVID sequelae and find none, it is advised to be kind to yourself. <br>Wishing you peace and safety.

Long-term chest tightness and hypochondriasis?

About seven years ago, the patient sought medical attention due to sudden shortness of breath, feeling unable to take a full breath, especially during physical activity, which caused some wheezing.
After undergoing several tests, the doctor diagnosed mild asthma attributed to excessive allergens and prescribed medication.
However, the patient did not use the medication for seven years, as they maintained regular exercise and seemed to adapt to occasional episodes of breathing difficulties, which could last from 3 to 5 days.
Seven years later, during the COVID-19 pandemic, the patient experienced a prolonged period without exercise.
Two years ago, after testing positive for COVID-19, they encountered their most severe breathing difficulties, feeling completely constricted and breathless with even minimal movement.
Being in an unfamiliar city heightened their anxiety about falling ill, and they planned to visit the emergency room in Taipei the following day.
Miraculously, after sleeping for a day, all symptoms resolved.
Following that experience, the patient coughed persistently for two months.
Eventually, they experienced extreme shortness of breath again and went to the emergency department.
After examination, the doctor found everything to be normal and inquired about asthma and coughing, prescribing an inhaler.
Remarkably, after that emergency visit, the persistent cough that lasted two months suddenly improved, along with the shortness of breath.
A year after the COVID-19 diagnosis, last year, the patient experienced sudden, widespread fatigue, which triggered their health anxiety.
This fatigue was accompanied by rib pain, leading them to suspect liver issues.
However, just as they considered getting checked, the pain disappeared, although the fatigue persisted.
Since that episode of sudden fatigue, they have experienced various body pains (having felt pain in nearly every part of the body) along with occasional chest tightness.
They also experienced significant facial pain and severe dryness in the eyes, making it impossible to wear contact lenses without discomfort.
Additionally, they had a sensation of esophageal blockage that lasted two to three weeks, which suddenly resolved, followed by gastrointestinal discomfort (excessive gas and diarrhea).
Currently, the main issues over the past two months have been chest tightness, shortness of breath during movement, back pain (intermittent), and rib pain.
Last month, after experiencing symptoms resembling those of a COVID-19 infection, the patient began to experience more severe wheezing accompanied by a cough producing clear phlegm.
They have been coughing for a month without improvement, and the intermittent back pain has caused significant anxiety.
With a history of health anxiety, the patient worries that each new pain signifies a serious illness, particularly fearing that they may have an undiagnosed severe lung condition, which has led to considerable distress.

Lin, 30~39 year old female. Ask Date: 2024/07/07

Dr. Shen Bochan reply Pulmonology

Hello: If you visit the pulmonology clinic to check for asthma or post-COVID sequelae and find none, it is advised to be kind to yourself.
Wishing you peace and safety.

Reply Date: 2024/07/07

More Info

It sounds like you have been experiencing a complex array of physical symptoms that are causing you significant distress, particularly in relation to your breathing and chest tightness. Given your history of asthma and the recent exacerbation of symptoms following a COVID-19 infection, it is understandable that you are feeling anxious about your health.
Firstly, it is important to recognize that anxiety can manifest in various physical symptoms, including chest tightness, shortness of breath, and even pain in different parts of the body. This phenomenon is often referred to as somatic symptom disorder, where psychological distress is expressed through physical symptoms. Your experience of feeling unable to breathe, especially during stressful situations or after a respiratory illness, may be exacerbated by anxiety.
The symptoms you describe, such as chest tightness, back pain, and fatigue, can be linked to both anxiety and physical health issues. Anxiety can lead to hyperventilation, which may cause feelings of breathlessness and chest discomfort. Additionally, the stress of worrying about your health can create a cycle of anxiety that makes your symptoms feel more pronounced.
In terms of your breathing difficulties, it is crucial to consult with a healthcare provider who can perform a thorough evaluation, including pulmonary function tests, to assess your lung capacity and rule out any underlying conditions. Given your history of asthma, it may be beneficial to discuss the possibility of a management plan that includes the use of bronchodilators or inhalers, especially if you are experiencing wheezing or persistent cough.

Moreover, the psychological aspect of your symptoms should not be overlooked. Cognitive-behavioral therapy (CBT) is an effective treatment for anxiety disorders and can help you develop coping strategies to manage your symptoms. CBT focuses on identifying and changing negative thought patterns that contribute to anxiety, which may help alleviate your fears about your health and reduce the physical symptoms associated with anxiety.

Additionally, practicing relaxation techniques such as deep breathing exercises, mindfulness meditation, or progressive muscle relaxation can be beneficial. These techniques can help calm your nervous system and reduce the physical sensations of anxiety, such as chest tightness and shortness of breath.

It is also essential to maintain a healthy lifestyle, including regular physical activity, a balanced diet, and adequate sleep. Engaging in moderate exercise can improve your overall well-being and may help reduce anxiety levels. However, if you find that exercise exacerbates your symptoms, it is advisable to consult with a healthcare professional to tailor an appropriate exercise plan.

Lastly, it is important to address your fears regarding serious health conditions. While it is natural to worry about potential illnesses, excessive rumination can lead to increased anxiety and distress. Keeping a journal to track your symptoms and thoughts may help you identify patterns and triggers, allowing you to discuss these with your healthcare provider more effectively.

In summary, your symptoms of chest tightness, shortness of breath, and anxiety are interconnected and warrant a comprehensive approach that includes both medical evaluation and psychological support. Seeking help from both a primary care physician and a mental health professional can provide you with the tools and strategies needed to manage your symptoms effectively. Remember, you are not alone in this, and there are resources available to help you navigate these challenges.

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