Am I having chest pain due to discontinuing atenolol?

Question

Hello doctor,

I am a 25-year-old male seeking a second opinion about symptoms that started after I stopped taking Atenolol, which I had been using regularly but discontinued two to three days ago. Since then, I have experienced varying left-sided chest pain, sometimes sharp and sudden, other times stinging or nerve-like, that occasionally radiates to my left arm, upper back, or leg. I also feel a pounding sensation in my chest, internal vibrations, sudden sweating unrelated to heat or exertion, burping, and throat discomfort after heavy meals (with a history of gastric ulcers), and occasional stinging sensations in my left hand that may be nerve-related. So far, an ECG (Electrocardiogram) and chest X-ray were normal, but no blood tests or endoscopy have been done. I have no diagnosed history of hypertension or heart disease and am currently on no medication. My concerns are whether these symptoms could be due to a rebound effect from stopping Atenolol, if the cause is cardiac, gastric, neurological, or anxiety-related, and what urgent tests I should request (like troponin, endoscopy, or echocardiogram). I also want to know if it is safe to restart Atenolol and whether these symptoms require urgent medical evaluation. Given limited access to specialist care, I appreciate any guidance on the next best steps for diagnosis and management.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You are right to seek clarification, especially after stopping a beta-blocker like Atenolol, which affects both the heart and nervous system. Sudden discontinuation can cause rebound sympathetic overactivity, leading to symptoms such as chest pain, palpitations, increased blood pressure and heart rate, sweating, internal tremors, and anxiety-like feelings. These typically appear within one to three days and are more common in those with underlying heart or anxiety conditions, even if undiagnosed. Given your normal electrocardiogram (ECG) and no known heart disease, serious cardiac issues are unlikely, but rebound symptoms are probable.

Your history of gastric ulcers and burping after meals suggests acid reflux or dyspepsia, which can mimic chest pain, while the stinging sensations might be nerve-related or due to anxiety. It is important to get blood tests such as troponin, complete blood count (CBC), thyroid function tests, and electrolytes, as well as consider an echocardiogram and possibly an upper gastrointestinal endoscopy if symptoms worsen. Do not restart Atenolol without medical advice, especially if you are still having chest discomfort; your doctor may suggest alternative treatments based on your condition.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.