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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6535
Experience:  14 years as clinician in the field of Family Practice
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Ive been to the hospital five times within the past week. My

Resolved Question:

Ive been to the hospital five times within the past week. My symptoms at first were chest pain, tightness of chest, dizziness, shortness of breath, and tingles from my elbows to my fingers. I was seen 3 days in a row before finally being admitted for two days. Ive had Cardiac Enzyme tests, Liver Enzyme tests, EchoCardiograph, CT scans of my brain, and chest, an ultrasound of my heart, and three different EKG tests. but everything came back as normal. So I was dismissed with a severe case of Anxiety.

I have been as calm as possible over the last three days, with no special excitement. Yet i continue to have an acute pain behind my left pectoral muscle.roughly an inch above the left nipple and centered within my ribcage. It has not radiated towards my sternum. I also am getting a radiating heat and tingling feeling from the base of my neck to the base of my skull, along with frequent dizziness. BP is 122/80 HR is 60. Dizziness gets worse with physical exertion. Any ideas?
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello!

Anthony Bray MD :

I think the persisting pain in the chest may be some costochondritis >> this is a condition of inflammation of one or more segments of cartilage that bridge between the sternum (breatbone) and the ribs... it is a common problem .. it would be much more likley at your age to have this vs a heart problem for example...

Anthony Bray MD :

I think that many of your symptoms would be due to panic attacks >> Panic attacks are part of an anxiety disorder>> they feel awful to the patient having one and frequently lead to panic, shortness of breath, dizziness and paresthesIAS ( ABNORMAL SENSATIONS SUCH AS NUMB / TINGLING) The panic attack may cause some of the symptoms such as the abnormal sensations due to hyperventilaation syndrome... the hyperventialting blows off CO2 and this changes the pH of the blood and this causes the numb / tingling sensations...

Anthony Bray MD :

I have had a nurse with a panic attack whom feared that she was having a stroke at the time for example...

Anthony Bray MD :

Dizziness is also frequently a symptom of panic attacks but if this symptom should be more pervasive over time then other causes may be sought....

Anthony Bray MD :

If you feel light headed and feel faint with your dizziness then it may be associated with drops in your blood pressure as a possoble cause...

Anthony Bray MD :

If you have a sense of vertigo (the room spinning sensation) then that may be associated with the inner ear as a cause...

Anthony Bray MD :

If the pain in the chest is associated with tenderness over a specific spot then I would strongly suspect costochodritis as a possible casue of that symptom...

Anthony Bray MD :

If you should have costochondritis then this may benefit from taking an anti-inflammatory medicine such as Aleve for a few weeks...

Anthony Bray MD :

It usually settles down over several weeks time in the majority of cases...

Anthony Bray MD :

I hope that this information helps. If you have further questions or discussion then let me know and I will be happy to get back with you!

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'

Customer:

The dizziness can best be described as taking too much benadryl, not so much vertigo.

Anthony Bray MD :

OK so more of a foggy headed feeling ??

Anthony Bray MD :

I think that may be associated with anxiety as a possible cause although other such as a viral syndrome such as mono might be a possible suspect...

Anthony Bray MD :

Have you been sleeping normal?

Customer:

The chest pain isnt a specific spot i can pinpoint. I have not been sleeping normal. Thirty minute intervals all night.

Anthony Bray MD :

Sleep deprivation may be altering the way that you feel and certainly I would suspect this to be related to your foggy headed sensation...

Customer:

Yes i would say a foggy headed feeling for the dizziness. seems to worsen when i feel hunger.

Anthony Bray MD :

The meds for anxiety too could play a part in that >> I would watch how you feel in relation to the timing of your meds for example...

Anthony Bray MD :

Well hypoglycemia could be a cause too >> do you eat regular or skip long times between eating ??

Customer:

The medication was only making me feel worse. sort of distant from reality so I quit taking it. I am only allowing myself half of a .25 xanax when i am having "anxiety"

Anthony Bray MD :

You might try one of the anxiety pills at bedtime and that may help your sleep quality for the short term >> I think this use of the medicine may be helpful for you...

Customer:

I usually ate on a regular basis. but I just got back from a three month stay in texas. Sometimes I would get 2 meels a day , sometimes only one.

Anthony Bray MD :

Yes >> try to eat at regular intervals.. it may help...

Anthony Bray MD :

I know I would feel awful if I only ate once a day!!

Customer:

My mom has been an Rn for almost 30 years, I agree with her that the meds seemed pretty overkill.

So all in all Im having chest pains, but when it worsens, I focus on it too much, worsening my dizziness, giving mee the tingling in the neck and also causing the shortness of breath due to panic?

Anthony Bray MD :

Yes I think that is a likley scenario >> health concerns > especially the heart creat fear in many people so having non-cardiac chest pain I think would be likley to trigger a panic attack and hence the added symptoms...

Customer:

It seems odd because the dizziness is a constant. the intensity is the only variable

Anthony Bray MD :

Well if constant then the dizziness may have more than that factor as part of it... no doubt that a panic attack would be predictied to make this worse...

Anthony Bray MD :

It sounds from your history that the poor sleep quality of late may be a strong factor in your sense of dizziness...

Anthony Bray MD :

I agree that you do not need all those meds for anxiety (certainly NOT TOGETHER!!) but one at bedtime I think may help you to get back in a good sleep pattern...

Customer:

Last night was different, I actually got to sleep in 2 hour intervals, haha big difference.

Anthony Bray MD :

Try going to bed at consistent time with one Xanax at bedtime adn do this for 2 weeks to reset your sleep clock... you may not need further medciation beyond that < hopefully...

Customer:

and im on an asprin regiment for the chest pain . 2 Ecotrin every couple of hours as pain persists. sometimes ill add some Ibuprophen

Anthony Bray MD :

Well at your age I would not really consider you at risk for heart attack at all ...

Anthony Bray MD :

Other heart conditions such as arythmia might be possible...

Anthony Bray MD :

If rapid or irregular heart beat then a holter monitor may be useful test...

Customer:

I have smoked a pack a day for 5 years.

Anthony Bray MD :

Do the anti-inflammatory meds seem to help the chest pain ??

Anthony Bray MD :

You may have some bronchospasm of large airways too as a possible cause... do you cough??

Customer:

How about a fluxuating heartbeat, rapid increase on inhale, and severe decrease on exhale

Customer:

Yes they help with the chest pain

Anthony Bray MD :

The smoking would be a concern for chronic bronchitis....

Anthony Bray MD :

If the anti-inflammatory meds help with the chest pain then that sounds more likley to be due with chest wall inflammation >> costochodritis or pleuritis as possible causes...

Anthony Bray MD :

Does it hurt to take a deep breath??

Customer:

I quit smoking both Marijuana and cigarettes last friday on my first trip to the hospital. ive had some horrible withdrawls.

Anthony Bray MD :

It is normal to have variation of the heart rate with inspiration adn expiration...

Customer:

plus the citalopram 20mg. i had my one and only on tuesday. it caused tremors when I slept.

Anthony Bray MD :

Well it is great for your health to stop all smoking!! Congrats on that and keep it up!!

Anthony Bray MD :

You will extend your life expectancy greatly to stay stopped from smoking!!

Anthony Bray MD :

Well the nicotine withdrawal also probably adds to your sense of anxiety >> this will pass though..,. the first two weeks are the worst adn the road gets easier...

Customer:

It causes discomfort to take a deep breath but it doesnot hurt

Anthony Bray MD :

I see... you may have some degree of chronic bronchitis and this could well be a part of the chest discomfort and your sense of shertness of breath...

Customer:

I am sorry to take so much of your time but this has severly been concerning me for the past few days

Anthony Bray MD :

I am happy to discuss this with you!

Anthony Bray MD :

I hope that it is helpful for you!

Anthony Bray MD :

Let me know if you have further questions at this time or later and i will be happy to get back with you!

Customer:

Coughing has become regular. sometimes accompanied by a dark grey/brown mucus.

Anthony Bray MD :

I think that the pieces of the puzzle seem to be coming together...

Anthony Bray MD :

It is common when quitting to have a couple of weeks of INCREASED cough >> the cilia in the airways begin to come back and clear the airways...

Customer:

Chronic bronchitis, costochondroitis, and possibly pleuitis? Spelling?

Anthony Bray MD :

If you should fall off the wagon and restart smoking then you might ask your doctor about Chantix as a help...

Anthony Bray MD :

Pleuritis >> that would be inflammation between the lung and the chest wall...

Customer:

Im going to get myself A PCP to follow up with on monday.

Anthony Bray MD :

OK good luck to you!

Anthony Bray MD :

I think that you will be fine >> just hang in there!!

Anthony Bray MD :

Let me know if I may be of further help!!

Customer:

Thank you so much Dr. Bray . I greatly appreciate your time

Anthony Bray MD :

You are very welcome!

Customer:

Wait, one more thing, the shortness of breath isnt a constriction of the airway, it feels like im not absorbing any of the oxygen

Customer:

any ideas on that?

Anthony Bray MD :

The sense of shortness of breath may be caused by 1) panic as one possible cause >> this increased your snse of air hunger and you feel short of breath but pulse ox on someone with a panic attack is usually 99% (high) 2) constriction of small airways causes shortness of breath with wheezing adn this is usually recognized. 3) constriction of large airways may feel like tightness but this type does not cause the classic wheezing and so it is often more confusing...

Anthony Bray MD :

Other causes are possible but I suspect that 1 adn 3 are related to your causes...

Customer:

Thank you very much Dr Bray

Anthony Bray MD :

You are very welcome!

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6535
Experience: 14 years as clinician in the field of Family Practice
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