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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10047
Experience:  14 years as clinician in the field of Family Practice
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Hello, I am a 31 year old female. 127 lbs. No medical history.

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Hello, I am a 31 year old female. 127 lbs. No medical history. About a year and a half ago, I began having shortness of breath, heart palpitations, lightheadedness, nausea, and a wide range of aches and pains. I was very concerned that something was wrong with my heart although my primary care doctor felt that my symptoms were anxiety as did the dr. that examined me in the emergency room when I went thinking I was having heart attack. They did a chest CT scan, chest x-ray, and EKG at the ER. All was normal. They told me that anxiety is likely causing my symptoms. This was about a month after I had another EKG, holter monitor, and an echocardiogram due to my worries about my heart. All of those tests were normal as well. Was told by my PCP, ER doctor, and my ob/gyn that it was anxiety. Well I was fine for about 10 months, then this past December, I began experiencing the same symptoms again. It started off as a tight feeling in my throat, like there was a lump in my throat. I went to my ob/gyn thinking I might have a lump or knot on my thyroid. She felt it and did a thyroid blood test and everything was normal. Well over the past four months since that started, I have been getting more and more symptoms and having some panic attacks. The symptoms that I am having now including shortness of breath, not constant, but everyday, shooting pains in my chest, left arm, jaw, which scare me the most because I worry so much about my heart. Also occassional lightheadedness and intermittent nausea. I have had 3 EKG's done in the past two months. All normal. Also went back to the ER because of the left arm and jaw pain. They did an EKG, cardiac enzyme bloodtest, and chest x-ray. All normal. Again I was told that i am suffering from anxiety and I don't need any further cardiac work-up. I have no risk factors for heart disease other than I have smoked for 7 years. I am now done to a pack every 2-3 days almost quitting. My questions are: is it possible for anxiety to cause shooting pains in my left arm and jaw or does it sound more heart-related? With all my tests, both a little over a year ago and within the past 2 months coming back normal (chest CT scan, multiple EKG's, cardiac enzyme blood test, echocardiogram, chest x-ray, holter monitor) does it sound like I have coronary artery disease or a blocked artery? This is my main concern. It has gotten so bad that I will go to the hospital and sit in the parking lot when I feel these symptoms in case I have to go into the ER. I am also very nervous and anxious most of the time. I don't deny that I have anxiety. I just don't see how anxiety could cause all of these scary and weird symptoms that I am having. Thank you for your help. I would appreciate any advise you can give me.

Anthony Bray MD : Hello!
Anthony Bray MD : yes-- it is possible and fairly frequent for anxiety and panic attacks in particular to cause a wide range if disturbing symptoms....
Anthony Bray MD : chest pains, shortness of breath, dizziness, tingling around the mouth and fingers are common feelings with panic attacks...
Anthony Bray MD : panoc attacks most typically produce severe symptoms for about 30 minutes and then abate....
Anthony Bray MD : panic attacks frequently cause hyperventilation and this may cause the dizziness and tingling sensations ( if you have had these)
Anthony Bray MD : panic attacks are caused by over-activity within the lyric system in the brain and this emotional center interacts with other parts if the brain associated with various bodily symptoms....
Anthony Bray MD : so panic attacks frequently cause a broad range of symptoms at the same time which is often a clue ....
Anthony Bray MD : people often describe them as " feeling as though I were about to die"

Thank you Dr. Bray for your response. What about generalized anxiety? Is it possible to feel short of breath and have the pains that I described (shooting pains in left arm, shoulder, and jaw/chin) if I'm not having a full-blown panic attack? Also, I have been having a intermittent burning sensation across the top of my chest and shoulders that goes up into my neck and chin area. Could this also be related to anxiety?

Anthony Bray MD : of course we always have to keep an open mind with regard to symptoms as other problems may be at the heart of the issue ... I find it helpful to always second guess and watch the pattern over time in a case as you describe....

Given the cardiac work-up that I have had, is it likely that my symptoms are due to coronary artery disease or a heart problem?

Anthony Bray MD : Ok well generalized anxiety may cause certain symptoms such as a heavy feeling in the chest... Shortness of breath as well,,,
Anthony Bray MD : the sharp shooting pains DO NOT sound consistent with typical cardiac NOR typical anxiety related symptoms...
Anthony Bray MD : This latter symptom sounds more consistent with a pinched nerve in the neck or perhaps the brachial plexus in the neck....

ok. do you feel that I need to have any further testing done to rule out heart issues or is what i have had done sufficient, given my symptoms, risk factors, and age?

Anthony Bray MD : No your symptoms are atypical in character for cardiac pain and with your negative work up and low risk profile I think it VERY unlikely that you have heart related symptoms....
Anthony Bray MD : i hope this information helps! Let me know if you have further questions and I will be happy to get back with you!

ok that eases my mind some. Thank you so much for your time and assistance!

Anthony Bray MD : If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank you and best regards,
Anthony Bray MD : Anthony Bray MD
Anthony Bray MD : You are very welcome!!
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10047
Experience: 14 years as clinician in the field of Family Practice
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