Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am panicking right now that I am about to have or am heading toward a heart attack. I am a 34-year-old guy with severe health anxiety, a non-smoker, and a non-drinker with no family history of heart disease. My worry is, yesterday during work I was getting pains in my chest and upper abdomen and felt a little sick. I did burp up some stomach acid as I often do, this slightly relieved it but was still there. During lunchtime I went for a meal and then returned to the ward (I work in a hospital) on return I felt the pain in my chest again and felt myself worry, I walked to the staff room, sat down, and checked my pulse and it was 144. This did come down while I was sitting, and I never felt faint, on return to the ward environment my pulse was 111 beats per minute, and my SPO2 was 98 % and stable. and stable. After my 12-hour shift, I returned home, still had some discomfort but went to bed, woke up this morning, and still alive all good. This has again worried me and my stomach is now making very loud gurgling noises, I have also had pain in my upper left breast area today. But again no fainting, no profuse sweating and I just hope I am panicking again. I have had numerous ECGs (electrocardiograms). I have just been discharged from a cardiologist (letter attached). This cardiologist performed a 24-hour Holter monitor (due to Q waves on my ECG), and this showed normal, no ectopic beats, and nothing else of concern, it reported my average BPM of 89, my sleeping BPM at 55, and my highest BPM while working was 135. My cardiologist also performed an echocardiogram and that too was normal. I had a scan to see if my coronary arteries were blocked, and this test result was zero coronary blockages. I am just so excessively worried that I will have a heart attack, I do understand it is an unreasonable belief but it worries me to the point I am yet again troubling doctors and contemplating ringing an ambulance. Please reassure me that it is not my heart and let me know what could be causing the pains, low pulse, and loud stomach noises. If it is just my anxiety, my consultant cardiologist prescribed me Propranolol. However, I have not yet started taking them as I am scared it will lower my heart rate too low and cause it to stop. Is this a rational belief or irrational? I know these pills do reduce your heart rate and my fear is that by me taking them three times per day when I am asleep, my pulse is only 55 beats per minute. Is it safe and will it lower this further? Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. I think you should stop thinking about heart disease. In all probabilities, you are free from heart disease. You are probably having gastritis and reflux disease which is causing symptoms, and secondarily leading to anxiety. Various symptoms one can have are upper abdominal pain, nausea, vomiting, bloating, burping, increase in pain on food, sour water feeling in the throat, chest pain, or burning. You should avoid fatty, oily, spicy, and junk diets. Go for a walk after having food instead of taking a rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Include lots of green leafy vegetables and fruits in your diet. Elevate the head end of the bed or use pillows during rest or sleep. You should get prescribed an antacid like Pantoprazole 40 mg before breakfast once a day for two weeks. Regarding your anxiety, you should take some antianxiety medicine like the tablet Clonazepam for two weeks till your reflux symptoms resolve. Regarding, Propranolol, it can certainly decrease heart rate but not stop your heart from beating at this dose. Mostly it will not cause many harmful effects, because a sleeping pulse goes even upto 40 BPM (beats per minute), which is ok. But better to avoid it since we are seeing a low pulse rate, and we have other alternatives. I hope this helps. Thank you and take care. Regards.
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Cardiology
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