I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.
Since cardiac causes are ruled out by your extensive work up; non cardiac causes of chest pain should be considered for your present symptom. Following could be the possibilities;
1) GERD would be prime consideration as it is one of the commonest cause for non cardiac chest pain.
2) Hiatus hernia
4) Costochondritis; it is inflammation at the junctions of rib and cartilage or with the breast bone / sternum. Local analgesic ointment, or spray, chest brace and warm compresses with Ibuprofen is helpful. Another possibility is muscle sprain. Please read about the costochondritis;
5) Esophageal spasm
Investigations like Barium esophagogram, Esophagogastroduodenoscopy (EGD; camera exam), Esophageal manometry, Ambulatory 24-hour pH monitoring may be the next step of evaluation by your doctor. Anxiety and stress can increase any condition. Chest x-ray is helpful for pleurodynia and polychondritis and if not already done should be ordered.
It maybe that your excessively prolonged surgery with a vein issue is playing on your unconscious mind, which may trigger panic attack. The best way to deal with panic is a comprehensive approach. It can be treated by the following measures by yourself;
1) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT); done by a psychologist but there are internet based approach nowadays too. CBT has higher efficacy and lower relapse rates.
2) Relaxation training and biofeedback.
4) Acupuncture and acupressure
7) Group sporting activities
8) St. John's wort
10) Valerian root
11) Deep breathing exercises.
A major component of therapy involves understanding and assuring yourself that the symptoms are neither from a serious medical condition nor from a mental deficiency but rather from a chemical imbalance in the fight or flight response. Alprazolam (Xanax) has been widely used for panic disorder, but it is currently discouraged because of its higher dependence potential. CBT helps to understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as panic, and how they can lead to secondary behavioral consequences. Cognitive restructuring involves substituting positive thoughts and getting rid of negative thoughts. Some studies have suggested that high importance to religion and religious practices also improve panic symptoms and prevent recurrences.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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