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Welcome to Am I Dying, a column that hopes to save you from your late-night WebMD spiraling. You can email us your hypochondriac questions at firstname.lastname@example.org.
The question I always come back to is: is there something wrong with my heart? I have asked my general practitioner and my therapist, and they both tell me I’m fine, and that there’s a 99 percent chance it’s anxiety. But there is REAL pain there. Sometimes it’s stabby. Sometimes it feels like heartburn. Sometimes it feels like my heart is racing. Sometimes it’s tied to my left arm (which feels troubling.) Sometimes it just feels like random dull pain. It always goes away (and tends to sneak up more when I’m thinking about it) but it still worries me a lot. Any thoughts on the topic would be much appreciated!
Before I get to the part where we talk about how frustrating it is when a doctor ascribes every last one of your symptoms to anxiety, because believe me, I’ve been there more times than I can count, let’s talk about your symptoms, and whether or not to worry. Maryann McLaughlin, a cardiologist and Medical Director of the Cardiac Health Program at Mount Sinai Hospital in New York, says some heart and chest pains are a cause for concern — but there are others that you really can (try to!) ignore.
When I described your symptoms to McLaughlin, she told me she thinks it’d be worthwhile for you to see a cardiologist (NOT because she’s worried, so don’t panic!). Mostly, this would be for your own peace of mind. “If you’ve had these types of symptoms, it’s worth seeing a cardiologist at least once to get checked out, even though the chances of a heart attack are very low,” she says. “And if you’ve already been examined by their GP, it would be worth a one-time consultation with a cardiologist just to make sure that structurally everything is fine.” A cardiologist would likely perform an echocardiogram, a test that uses sound waves to create pictures of your heart’s chambers, valves, walls, and blood vessels, would reveal whether or not you have any underlying issues that might require treatment or monitoring.
One such condition is called a “mitral valve prolapse disorder,” which isn’t as scary as it sounds. This condition is usually associated with the sort of “stabby” pain you describe, particularly beneath the breast area, says McLaughlin, though it can also be accompanied by palpitations and/or a racing heart. A mitral valve prolapse is when the “leaflets” at the top of the mitral valve sort of overlap or bend backward — McLaughlin describes it as similar in appearance to double-jointedness. Sometimes a mitral valve prolapse can lead to a heart murmur, but often it doesn’t. “Even in patients without significant prolapse [showing] on the echocardiogram, patients can have this similar kind of sensation,” she says. “If there [are signs of] mitrovalve prolapse syndrome, then it’s to be followed periodically, but it’s not serious, it’s a common entity on an echocardiogram, and it’s not particularly worrisome.”
Another possibility is that your chest pain coincides with progesterone changes caused by your period. If you think that might be the case, McLaughlin recommends keeping a chest-pain journal, making special note of your menstruation start and end dates.
Finally, your chest pain might be a sign that you need more aerobic exercise. “A lot of people in my office come in with near-fainting feelings and palpitations,” which can be caused by a nervous-system imbalance, says McLaughlin. “Interestingly, the best treatment for that is actually aerobic exercise, because it helps to re-balance the nervous system a little bit.” And if you’re in the middle of what feels like a panic attack, or experiencing heart palpitations, McLaughlin recommends drinking a cold glass of water, which “helps to stimulate the vagus nerve to slow the heart rate.”
But okay. As to the anxiety-as-red-herring piece. In some of my more hypochondriacal episodes, I’ve gotten this line a lot. And it’s always frustrating, because my anxiety is something I bring up, almost apologetically, and when the doctor I’m seeing inevitably accepts it as the sole explanation, it feels like I’ve done their work for them. I know I have anxiety. But I am also mortal, and I can (and do!) get sick. McLaughlin agrees. “I get referrals all the time from people who’ve been dismissed by other doctors, and to be honest, I’ve found things in some of those patients,” she says. “People with anxiety get heart attacks too. It’s important to treat the underlying anxiety but also to make sure the heart is okay.” This is not to say that a heart condition is likely, but rather to make you feel like your symptoms aren’t your fault, or imaginary. Anxiety could be the root of it, but there are other (non life-threatening!) possibilities, too. It’s okay (and smart!) to ask for a second opinion. Doctors are more qualified than we are, but they’re also imperfect humans who sometimes get it wrong. You’re not crazy or wrong to doubt yours from time to time.