[23F] With upper left chest pain and anxiety

Patient Description

A 23-year-old female experienced a sudden onset of dull and burning pain in the upper left chest that lasted for about 25 minutes. The pain was rated as 4-5 out of 10 in severity and resolved on its own. The patient was at a bar when the pain started and had only consumed water. Alongside the chest pain, she experienced belly bubbles and anxiety, which has been present for the past three days. The anxiety episodes make her feel like zoning out and counting her pulse due to a sensation of fainting. She also reported shortness of breath, potentially induced by panic, and dizziness or lightheadedness, possibly from dissociation. She experienced palpitations on Monday but not today. There were no associated nausea, vomiting, changes in bowel movements, or swelling in the legs or feet. The patient uses a nicotine vape daily without recent changes in usage. She has a family history of pre-diabetes but no other significant medical history or chronic illnesses. Her menstrual periods are fairly light, and she is not currently taking any medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Anxiety or Panic Attack: Anxiety can manifest with physical symptoms such as chest pain, shortness of breath, and a feeling of faintness. The fact that you felt anxious and experienced palpitations earlier in the week supports this possibility.

    • Treatment: Managing anxiety often involves a combination of lifestyle changes, therapy, and sometimes medication. Techniques such as deep breathing exercises, mindfulness, and regular physical activity can be helpful.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause a burning sensation in the chest, often referred to as heartburn. This can sometimes be mistaken for heart-related pain.

    • Treatment: Over-the-counter antacids, dietary changes (avoiding spicy and fatty foods), and not lying down immediately after eating can help manage symptoms.
  • Musculoskeletal Pain: Sometimes, chest pain can be due to muscle strain or inflammation, especially if there was no specific trigger or activity that caused it.

    • Treatment: Rest, over-the-counter pain relievers, and gentle stretching can help alleviate musculoskeletal pain.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis, here are some steps you can take to manage your symptoms:

  1. Practice Relaxation Techniques: Since anxiety might be contributing to your symptoms, try deep breathing exercises, meditation, or yoga to help manage stress.
  2. Monitor Your Diet: Avoid foods and drinks that can trigger GERD, such as spicy foods, caffeine, and alcohol. Eating smaller, more frequent meals can also help.
  3. Stay Hydrated: Drink plenty of water, especially if you experience belly bubbles or discomfort.
  4. Avoid Nicotine: Nicotine can exacerbate anxiety and GERD symptoms. Consider reducing or quitting vaping.
  5. Use MDandMe: Journal your symptoms, track your progress, and get insights. This can help you and your healthcare provider understand your condition better.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or Worsening Chest Pain: If the pain becomes more intense or doesn't go away, seek immediate medical help.
  • Shortness of Breath: If you have difficulty breathing that doesn't improve with relaxation techniques.
  • Fainting or Severe Dizziness: If you feel like you might faint or experience severe dizziness.
  • New or Worsening Symptoms: Any new symptoms or a significant change in your current symptoms should be evaluated by a healthcare professional.

Remember, while these suggestions can help manage your symptoms, they are not a substitute for professional medical advice. Please consult a healthcare provider for a thorough evaluation and appropriate treatment.

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3 mo ago


People Also Ask


What are the common symptoms of a panic attack?

Common symptoms of a panic attack include sudden overwhelming fear, palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a feeling of detachment from reality.


How can anxiety cause physical symptoms like chest pain and shortness of breath?

Anxiety can trigger the body's fight-or-flight response, leading to physical symptoms such as increased heart rate, muscle tension, and hyperventilation, which can cause chest pain and shortness of breath.


What lifestyle changes can help manage GERD symptoms?

Lifestyle changes to manage GERD include avoiding trigger foods (like spicy or fatty foods), eating smaller meals, not lying down immediately after eating, maintaining a healthy weight, and avoiding smoking and alcohol.


Is vaping linked to increased anxiety or GERD symptoms?

Yes, nicotine from vaping can increase anxiety levels and exacerbate GERD symptoms by relaxing the lower esophageal sphincter, which can lead to acid reflux.


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