Health problem of a 26 yr old which docs can't identify!?

Question

My friend who is 26yr old is suffering from a health problem for about 6-7 months. The symptoms are : heavy feeling in the heart, heart feels very weak, squeezing type of pain. He feels tired all the time even though he's not working or studying. He can't really sleep at night. Therefore he sleeps for very long hours during the day. He went to a cardiologist & did several tests including an echo cardiogram. Doc said everything is fine & referred him to a nuerologist. That doc examined him & then referred him to a psychiatrist. That doc gave xanax & other med to help him. But none are working for him. he's still having all the symptoms. He & I are both very worried for his health. My friend thinks he doesn't suffer from mental disorder but also there's is nothing wrong with the heart yet the pain is there. He's very worried.What should we do ???

Answer 1

Very complex question i like it first i don't think it is anxiety related but there are two things that stick out.
First the pain is only on one side.
It is in the area of the heart.
I bet they ruled out Mitral valve prolapse and
Intercostal neuralgia ?
But here are two disorders that both the doctors. Would miss it is not in the area they both study.
Acid reflux is one.
A good way to find out without seeing a g.i. doctor would be going to the store and buying prilosec and wait 7 days .
See if that helps
What are the symptoms of acid reflux?
The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

Also a less common problem is costochondritis
History: The key to the diagnosis of costochondritis amid the differential diagnoses, which include cardiac and pulmonary disease, is a thorough history and physical examination.

Presenting characteristics of chest pain associated with costochondritis
Onset - Typically insidious, occurring over several days or weeks; may be acute
Nature - Sharp and stabbing
Location - Anterior chest; pain usually unilateral, but may be bilateral
Radiation - Chest, upper abdomen, or back
Exacerbating factors - Coughing, sneezing, deep inspirations, movement of the upper torso and upper extremities
Relieving factors - Rest, application of ice, or use of heat
Preceding conditions - Upper respiratory tract infection or exercise (common in the preceding 3 months)
Physical: Vital signs should be assessed. Careful and complete pulmonary, cardiac, and abdominal examinations eliminate the possibility of an underlying disease process.

Inspection focuses on symmetry of the chest wall. Asymmetry may indicate trauma as a cause of chest pain.
Swelling is uncommon. Patients with Tietze syndrome, however, may have swelling over an upper costochondral junction.
Ecchymosis would be expected only in trauma.
Respiratory effort is normal.
Palpation that reveals tenderness over the costochondral junction is diagnostic. The tenderness should be localized and is most common at the sternocostal cartilage of the second through the seventh ribs.
Examination may be performed with firm, single-digit palpation of the area.
Crepitus is uncommon and may indicate a fracture.
Auscultation of the lungs, heart, and abdomen are normal.
Causes: Most cases of costochondritis are idiopathic. The remaining cases may be the result of costochondral irritation caused by the following:

Direct trauma
Aggressive exercise resulting in a strain (eg, repeated twisting of the upper torso, stretching-pulling activities of the upper extremities)
Preceding upper respiratory tract infection with cough (which can cause repeated stretching and strain at the costochondral junction)

Here is a list of other problems that could be the issue.

Anxiety Disorder: Panic Disorder - He is on the right meds. No help
Asthma - Doctor would of heard it
Cardiomyopathy, Hypertrophic - Heart tests are normal
Child Abuse & Neglect: Physical Abuse -are you beating him?
Esophagitis - This is acid reflux
Fibromyalgia - This disease does not fit a male 26
Gastroesophageal Reflux
Mitral Valve Prolapse - Heart tests are normal
Myocardial Infarction in Childhood - Heart tests are normal
Myocarditis, Viral - I would ask for a cbc
Pericarditis, Viral - I would ask for a cbc
Pneumonia - would not last 6 months
Pneumothorax - Collapsed lung
Pulmonary Infarction - Heart test normal
Sickle Cell Anemia - Is he black ?
Somatoform Disorder: Pain-This is a mental condition




Other Problems to be Considered:

Aneurysm - He is not dead
Arrhythmia- Heart test normal
Gynecomastia
Muscle strain- Would of recoverd
Neurofibroma of an intercostal nerve
Psychogenic chest pain- Again in the head
Rib fracture- Would of healed
Slipping rib syndrome- It may be
Stress fracture- Would of healed

Tests i would ask for .
c.b.c.
c.r.p.
sed rate.
Endoscopy

I would see a Pulmonologist
Also a Gastrointestinal Doctor
Also i would try :
Ibuprofen 800mg Three times a day for a week. If he has a G.I. issue it could make it worse.
Prilosec i would double the dose it is safe

Xanax- This drug would of fixed any anxiety issues.

A Homopatic doctor who uses herbs only may help.

Most of the heart related disorders he would be young to have. Unless he is over weight. And that could be a sign of Hypothyroidism
Signs and symptoms


Thyroid
The signs and symptoms of hypothyroidism vary widely, depending on the severity of the hormone deficiency. But in general, any problems you do have tend to develop slowly, often over a number of years.

At first, you may barely notice symptoms such as fatigue and sluggishness, or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more obvious signs and symptoms, including:

Increased sensitivity to cold
Constipation
Pale, dry skin
A puffy face
Hoarse voice
An elevated blood cholesterol level
Unexplained weight gain
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Muscle weakness
Heavier than normal menstrual periods
Depression
When hypothyroidism isn't treated, signs and symptoms can gradually become more severe. Constant stimulation of your thyroid to release more hormones may lead to an enlarged thyroid (goiter). In addition, you may become more forgetful, your thought processes may slow or you may feel depressed.

Advanced hypothyroidism, known as myxedema, is rare, but when it occurs it can be life-threatening. Signs and symptoms include low blood pressure, decreased breathing, decreased body temperature, unresponsiveness and even coma. In some cases, myxedema can be fatal.

Hyperthyroididsm would cause him to be thin and have anxiety

A simple test is a t-2, t-3, t-4 test.

For all the people who think this is a anxiety disorder here are the drugs.
Most SSRI.'S will treat anxiety and help pain.
The t.c.a.'s Example Amiltriptyline will help pain and anxiety.
Also buspar will help just anxiety.
Some of the maoi's may help but dangerous.
Hell so will Neurontin for nerve pain
Why not topamax it helps pain and bi-polar
Just so he gets plenty of drugs no tests Trileptial helps pain and the crazy head bugs

She stated that xanax does not fix the pain. If he had anxiety related pain it would of abated untill the effective dose was lost.

Also a good test for aniety realted chest pain would be bike riding or running. This is due to the fact that anxiety related chest pain is hyperventilation syndrome.
In psychiatry, hyperventilation syndrome ('''HVS''') is an episodic disorder that often presents with chest pain and a tingling sensation of the fingertips (paresthesia) and around the mouth, as well as deep and labored breathing (causing hyperventilation), although chronic but subtle hyperventilation can cause these symptoms too.

HVS can be part of a panic attack but, despite all the stigma, most patients are not putting on a show but are in true distress. The hyperventilation is self-promulgating as carbon dioxide () levels fall and respiratory alkalosis (high blood pH) develop. The respiratory alkalosis leads to changes in the way the nervous system fires and leads to the paresthesiae, dizziness and perceptual changes that often accompany this condition.

A rapid traditional intervention is to make the patient breathe into a paper bag, causing rebreathing and restoration of levels. The same benefits can be obtained from deliberately slowing down the breathing rate by counting or looking at a watch.

Ok did i miss any reasons he could be in pain

Here is why chronic fatigue syndrome and fibromyalgia would not fit. First he is a male. 80-90 percent of cases are women.
Second. He is only 26 these are disorders that happen in your 40's So his chances of these disoders is remote. 1 in about 10 million.

Answer 2

I hope he has done all the tests including Tread Mill Test, excluded the possibility of other physiological problems.

It might be Chronic Fatigue Syndrome or Somatoform disorder.

Pain disorder is when a patient experiences chronic and constant pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. It can last as short as a few days, to as long as many years.

Somatization disorder (or Briquet's disorder) is a type of mental illness in which a patient manifests a psychiatric condition as a physical complaint. One prevalent general etiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs.

No one treatment has been found to cure Somatization disorder. However setting up a physician that screens complaints the patient has before the person is allowed to see a specialist heavily cuts down on cost of the disorder. Antidepressants and Cognitive Behavioral therapy have been shown to help treat the disorder.

He may get benefit from using Bupropion XL (Zyban) or Venlafaxine (Effexor).
Xanax or any other type of benzodiazapine drugs are not recommend for long term use. It has a high abuse potential.

Learn relaxation techniques or yoga.

Answer 3

Well, to start with does he suffer from obesity? Does your friend wake up and have to eat antacids like Tums, Rolaids. He might be suffering from heartburn or possibly a Hiatel hernia, which in turn sometimes can feel like an angina attack. How about a cholesterol and lipid profile test? It sounds like to me he might suffer from sleep apnea. Does he waken sweating, headache, dry mouth, snoring, breath pauses in his sleep? Maybe a sleep evaluation at one of the local sleep clinics would be another area you might go if everything else doesn't seem right. I see many patients with this disorder. Depression could be or anxiety or panic attacks can possibly cause these heavy feelings in a persons heart. Is there anything happening lately with his mental state? Any changes: death in the family, arguments with friends, love life,feelings of loneliness,hostility,anger?
Xanax is a benzodiazepine mild tranquilizer, and it helps with anxiety and panic attacks. You mentioned another medication that was given to your friend. There are many different meds available for depression and anxiety. Why can't he sleep at night? Take the Xanax on a empty stomach with a full glass of water about 1 hour before bedtime. I don't know what his current dosage is, but follow your doctors orders. I do hope the best for your friend. Get the sleep evaluation and ask about the possibility of awakening with heartburn. Good luck!

Answer 4

Alprazolam is a short-acting drug in the benzodiazepine class used to treat anxiety disorders and as an adjunctive treatment for depression.

Alprazolam was invented by Pfizer and is marketed under the trade name Xanax. Its patent expired in September 1993.

Side effects

Common side effects of alprazolam can include:

* Somnolence (drowsiness)
* Euphoria
* Confusion

Less common side effects can include:

* Fatigue
* Headache

Rare side effects can include:

* Sleep apnea
* Hypoventilation (Respiratory depression)
* Blurred vision
* Difficulty in depth perception
* Slurred speech or dysarthria
* Changes in personality
* Confusion
* Disorientation
* Amnesia (memory impairment)
* Vivid dreams and/or nightmares
* Jaundice
* Tachycardia
* Bradycardia
* Changes in plasma cortisol and ACTH levels
* Blood dyscrasias
* Decreased salivation
* Increased salivation
* Diarrhea
* Constipation
* Nausea
* Elevated hepatic (liver) enzymes
* Incontinence

Rare paradoxical side effects can include:

* Nervousness
* Anxiety
* Agitation
* Rage
* Insomnia
* Muscle spasms and rigidity

Paradoxical side effects are usually a result of too high a dose (sometimes deliberate) and/or combination with alcohol. Adjusting the dosage usually causes them to cease.

Long-term treatment with alprazolam may lead to physical and/or psychological dependence. Users often develop a tolerance to the drug's sedative effects, though tolerance to its anxiolytic efficacy rarely develops when used at theraputic dosage levels.

There is now a general consensus among many psychiatrists that alprazolam (a so-called 'high-potency' benzodiazepine) poses a particularly high risk for misuse, abuse and dependence. Withdrawal after long-term treatment should be done slowly over a period of weeks (or even months) to avoid serious withdrawal symptoms such as agitation, panic attacks, rebound anxiety, muscle cramps and seizures. Some patients may benefit from a substitution with diazepam or clonazepam as these drugs remain in the bloodstream longer and have a somewhat lower risk of dependency.

I think you have to stop your friend to continue taking xanax. Do body check up with another doctor. I don't know how and what cause your friend get sick, take action now. It may become serious if not take care it well.

Can you bring your friend to my office to have a free body check up? It is free. I hope i can help more people.

I do have some alternative medication (nutritional supplement & therapies) may help to prevention and maintaining good health. I can recommend some if you need it. It's safe and natural. you can email me to know more.

There were people with serious illness get cure after taking the nutritional supplement that i recommended. I hope i can help you and bring good health to everyone. Don't wait until everythings is too late.

[e-mail]

Answer 5

Wait for a week or two, if the symptoms are still there go back to your doctor. If he doesn't have any respiratory problem, most probably it's an anxiety disorder which relaxing exercises like Yoga might help. by the way if you are sure there is nothing wrong with his cardiovascular system, there is not much to be worry about, although i understand it bothers him a lot.

Answer 6

Could be anything, most likely something around the heart causing pressure, have a MRI of the chest done. I hear a lot of the docs around here give out psychiatric medicine like candy, they are the psychos, haha! This does not pertain to all doctors for my brother is a doctor. I would get a second and maybe third opinion.

Answer 7

No one has suggested this so it is a thought.
He may have chronic fatique. Or could be something like glandular fever.
Something is wrong he hasn't got a mental illness, you just need to keep going to the doctor or to another doctor and keep trying to figure it out. Good luck and take care

Answer 8

No X-ray done? Could be a rib micro-fracture that is pressing into his lung cavity and/or onto his heart.

Get a endocrinolgist to do a blood test for the usual hormonal levels. Could be a hypo or hyper active thyroid - hence the lethargy and then the insomia.

Answer 9

If anyone touches you in a naughty place just yell STRANGER DANGER! and call Mommy. I wish I would of known that when I went to my first boy/girl party last month when I was 42

Answer 10

Go back to the doctor, and suggest they do a lung function test, but I suspect he has some psychiatric problem and needs stronger meds than Xanax.

Answer 11

I think id find another cardioligest, go to webmd.com too just throw the symtoms out there to them and see, it sounds like congested heart but I dont know,diet is always a factor check out what hes eating -if push goes ta shove take him to emergency tell them the symtoms and dont add that he has had this for 6 mo. till a Dr comes in God bless you be well.