Q. Can anxiety and panic attacks cause chest pain and tingling sensation in the left arm?

Hello doctor.

I have been experiencing hot flushes, tight achy chest pain, and tingling or ache-like tension in my left arm. This mainly comes on if I get very anxious or angry during argument. Sometimes if I run I get tingling in my left finger or hand. I had an echo one year ago and the results were normal. All ECGs have always been normal and the last ECG was done two months back. I have been diagnosed with generalized anxiety disorder and GERD. The MRI neck showed a bulging disc at C5 or C6. My blood pressure is 125/85 mmHg. But during a panic attack when I called an ambulance it went up to 168/100 mmHg but then came down to 130/90 mmHg within 10 minutes. I am seeing a counselor now. But the chest pain when I am angry is making me think again of heart disease. Kindly help.

Hello doctor,

I have attached the MRI reports below. An MRI scan was performed last week, which I was able to view. It shows that the cervical spine is generally healthy, However, I do have a broad-based disc bulge at the C5 to C6 level which is causing mild contact of the anterior thecal sac centrally and narrowing of the left C5 or C6 neural foramen causing impingement of the left C6 nerve. I discussed the findings with a physician, which explains the symptoms I have been experiencing. I do not have a first-line cardiac family history. My grandmother had heart disease and died aged 80. Vitamin B12 is normal. Cholesterol tests are usually normal or borderline high but controlled with diet. There is no chest pain during walking and some days I walk for hours. It is more when I am very anxious, angry, or arguing.

Hello doctor,

Thank you for your reply.

The doctor did a stress ECG test today. The result was normal and he got me to over 100 % of my target heart rate to push me. I had no chest pain during the test only a small amount of hand tingling which he thinks is related to the neck. They have reassured me it does not sound cardiac. What are your thoughts? Should I also do further tests?

Hello doctor,

Thank you for your reply.

I got the report today. It is saying 13.5 METs achieved.

CONCLUSION: Patient asymptomatic. No chest pain or dyspnoea. The exercise ECG showed no obvious ischaemic changes or arrhythmias on a high workload. Appropriate HR/BP response to exercise. Excellent effort capacity.

It does say that if I have any further concerns I could consider coronary CT. But if echo and testing ECG is fine, is this clinically indicated?

Hope this helps.

Thank you and take care.