Why does the chest feel numb and tight every day?

Question

Hello doctor,

I am a 19-year-old female. I am having chest pains a lot, starting in the middle and spreading slowly, and I am experiencing this when I am overthinking. I have been experiencing this issue for the past three years, but it has occurred almost every day since two weeks ago. During this, I cannot control my emotions. The chest pain I am experiencing feels like numbing or something big pressing on it.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

These physical symptoms are strongly suggestive of anxiety and most likely generalized anxiety disorder or panic disorder. If multiple physical complaints, anxiety is free-floating, you cannot pinpoint, and you experience it every day in every domain, it is most likely generalized anxiety disorder. If mainly cardiac symptoms arise suddenly without any triggers and last for 20 to 30 minutes and then fade, but you are preoccupied by the fear of having another attack, it is most likely panic disorder.

In either case, management will be the same. You have two options available. One is to take medicines, a selective serotonin reuptake inhibitor (SSRI) such as Escitalopram, start with 5 mg, and after one week, titrate to 10 mg in the morning. Augment it with tablet Propranolol 10 mg (milligrams) in the morning and night for 10 to 14 days. Continue Escitalopram for at least 6 to 8 months.

The other option is cognitive behavioral therapy (CBT). This therapy will work on your dysfunctional thoughts and behaviors and will help you in the long term. You can augment cognitive behavioral therapy (CBT) with medicines for the best results.

Other measures that can be helpful include learning deep breathing, writing down triggers, thoughts, behaviors, and physical symptoms, and identifying safety behaviors. It will help you learn what safety behaviors you use, and these safety behaviors actually maintain the anxiety. Safety behaviors include calling someone, rushing to the doctor, undergoing laboratory tests, or electrocardiogram (ECG).

Do evening walks for 30 minutes, reduce caffeine, and follow sleep hygiene. Please check thyroid levels, as hyperthyroidism is also associated with anxiety.

If you have any other questions, please feel free to arrange a follow-up meeting. The probable causes are generalized anxiety disorder or panic disorder, and hyperthyroidism. Investigations to be done are thyroid profile and complete blood count (CBC). Differential diagnosis includes hyperthyroidism, mixed anxiety and depression, and substance abuse. The probable diagnosis is generalized anxiety disorder or panic disorder. The treatment plan is to start Escitalopram and tablet Propranolol, augment cognitive behavioral therapy (CBT), and make lifestyle modifications. If you have other questions in mind, please feel free to arrange a follow-up meeting. Preventive measures include avoiding caffeine, nicotine, or any other substance abuse.

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

Thank you.