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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33839
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have this constant palpitation in my throat and my chest

Customer Question

I have this constant palpitation in my throat and my chest along with occasional pain at my shoulders and top part of my back. It cuts off my breath at times. I have been to the emergency room over 6 times and 3 times to urgent care along with going to my doctor. I have had 3 ekg's in one week, Free T3 & Free T4 test no one can find what's wrong with me. I am to take an ultra sound of my throat on Monday, but I DON'T think I can make it until Monday, this is so annoying and frightening. Can't tell if this is the onset of a heart attack. I have had this for 3 years off and on, but recently it's been constant. I had breast reconstruction (flap) three years ago and every since I had that surgery I have had this condition. 6 days after I went home from ICU, I came back to the emergency room with this problem and they could not find anything. I don't know what else to do, I can't take this anymore. I sometimes cough or blow out wind (like you do when the doctor tells you to blow in then out) to get my breath. Please help with any advice.
JA: How long have you had the symptoms? Do you have a fever?
Customer: I do not have a fever and I have had this for 3 years off and on but it's never lasted 2 1/2 weeks before constantly
JA: Anything else in your medical history you think the doctor should know?
Customer: When I had my last reconstruction surgery 3 years ago, which was suppose to be 8 hours lasted for 23 hours. The doctor told me that he had to take a vein from my groin area and attach and the blood was flowing to my heart but not out, and every since I have not been the same, I truly believe that surgery had something to do with my condition now. I never had this until I had the surgery, one week after being released from the hospital.
Submitted: 7 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 7 months ago.

Hello,
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

3) Esophagitis

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;

http://www.mayoclinic.com/health/costochondritis/DS00626

5) Esophageal spasm

6) Pleurodynia

7) Polychondritis

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.

3) Hypnosis

4) Acupuncture and acupressure

5) Yoga

6) Meditation

7) Group sporting activities

8) St. John's wort

9) Melatonin
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.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 7 months ago.

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Thank you.

Expert:  Dr. Arun Phophalia replied 7 months ago.

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Thank you very much for the opportunity to be of help!

Expert:  Dr. Arun Phophalia replied 7 months ago.

Best wishes,
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