Discussions By Condition: I cannot get a diagnosis.

chest pain, tachycardia in young male

Posted In: I cannot get a diagnosis. 0 Replies
  • Posted By: fredflinstone
  • February 26, 2008
  • 04:26 PM

I am a 25 y/o male. Smoked cigarettes between ages of 17 and 22. Regular exerciser. Normal body weight - light drinker. Healthy lifestyle. Drink ~1 cup of coffee a days and do no other recreational drugs. I saw a doctor for depression four months ago and have been taking Wellbutrin 100mg three times daily since. I take no other medications.
My metabolic panel is nearly perfect although my cholesterol is a little high. My Alkaline phosphatase is usually a little elevated and runs between 140 and 165. My thyroid panel is normal.

Family history: father was an avid runner but died of a sudden heart attack at age 45.
For the last four years I have had occasional chest pain. I am a little nervous/anxious by nature but it does not seem to be correlated with my emotional states. For several weeks I will not experience any chest discomfort and then I will have a few days to a week where I have feel a lot of chest pressure/pain. This usually happens when I have not exercised in a week or so, but sometimes seems to come on the day after I exercise after having taken a week or so off.
On a scale of 1/10, I would put the pain between a 0.5 to 1. It is subtle but undeniably present. I would describe it as a dull aching that sometimes radiates into my left shoulder and down my arm. Usually a feel it for about two to five seconds at a time but sometimes it lasts longer. It does not get worse when I take a deep breath. It is not tender to palpate my chest. It is not positional. This is usually associated with tachycardia. My resting heart rate over 24 hours averages 88 beats per minute, but during these several-day episodes of chest pain my resting pulse will often be around 110. When I exercise, I rarely feel chest discomfort although a few times I have felt jaw pain when bicycling hard.

This is where things get difficult:
I work in EMS. Yes, I know what you're all thinking: "Oh, he's just nuts." Let me say I've seen so many young health care professional hypochondriacs that I cringe whenever I hear a new nurse mention they're having chest pain or anything of the sort. I know no doctor will take me seriously if they find out what I do.
I told my family practice doctor two years ago (when I hadn't felt chest pain for a few weeks), he did an EKG which showed a normal sinus rhythm and then blew me off as yes, a hypochondriac. I felt humiliated and do not want to repeat this.

About six months later during a day I was feeling intermittent chest discomfort I gave myself a 12 lead EKG (I've done thousands, and my lead placement was perfect). It showed sinus tachycardia, left ventricular hypertrophy (by voltage), and borderline right atrial enlargement. A week later I was not feeling any chest discomfort (nor had I for several days) so I repeated the EKG. It was a normal sinus rhythm with LVH (by voltage) but no right atrial enlargement. I am thin so I am not sure how seriously to take the LVH.

I keep ignoring these episodes but they happen again and again.
I know I should be talking to a doctor but I do not want to be offered an SSRI prescription and a box of tissue. I know chest pain is related to anxiety/depression but I have considered my symptoms carefully for several years now and I'm pretty ***n sure it has nothing to do with my emotional states.

I am not really sure of any underlying causes for my symptoms.

Any ideas?

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