DD (19) constant palpitations and tight chest but no GP appointments - advice, please

[Thelonelygiraffe]

Hi all, I'm posting in Chat for traffic, rather than Health. Sorry about that.

I'm very worried about dd (19). She has had heart palpitations for about the last two years or so. She has had ECGs and BP monitors. At first the doc thought she might have SVT as her heart was doing uneven/out-of-time beats, but this seems to have been resolved and they are happy with her latest ECG and have said there is nothing wrong with her heart, but she still feels like she's having palpitations. Also, when she feels like this her chest is very tight and she feels like she can't get a deep full breath in or out.

She has a heart monitor app and her heart is never beating too fast or racing witb these episopdes - it just feels like it is. And I gave her a peak flow monitor yesterday and she blew 550 on it, which is well into the healthy range.

She has suffered on and off with anxiety for years - could all these be anxiety symptoms? That's what the GP and hospital docs have suggested, but she says she's having these symptoms almost constantly at the moment and she is not worried about anything. She is not under stress at all, so why is her body reacting like this?

And could it be anything physical?

She's had a few other things too over the past months: low iron, low-level UTIs often, terrible periods that make her faint/vomit most months; tonsilitis... I just don't understand why as she eats well, drinks plenty of water, has a pretty healthy lifestyle for a 19yo.

She doesn't smoke or vape. Social drinking (no change in symptoms after alcohol). Has cut right down on caffeine. Is fit - can run for 45 mins on a treadmill.

She's just rung up for a GP appt as her chest is feeling really tight again, to be told that there are none left to book but she can have a phone consultation in 11 days... our GP practioce is useless.

Can anyone advise or make any suggestions for what this might be?

I agree that even if the anxiety isn't the root cause it is now a very real condition which can end up in a vicious cycle. The body feels tension which the mind interprets as a threat, feedback loop to the body is to be on alert.

As well as anti-anxiety meds, good things to do (they really work)
Yoga, (not fast or hot)
Breath work and meditation - calm and Headspace are good for this.
30 mins minimum of daylight
Enough sleep?

If her iron is low is she getting enough b12 in her diet (eaten with the iron source)? This is important for iron absorption. You can be taking supplements but not getting the benefit. Other will know better than me the best remedy for the low iron.

Rather than meds etc has she tried anything such as CBT?
I am currently receiving CBT as I'm going through a really shitty time and having terrible anxiety due to it. I don't feel like I need medication as my situation is very specific due to my husband's poor health and I need techniques to manage it. As he had unpredictable seizures.

I have found some of the grounding techniques and distraction techniques have really helped with 'someone sitting on my chest' and me going into 'catastrophe mode' which sounds like your daughter re going on holiday etc

@Whataretheodds - I think that's it exactly.

Can't think of any event that started it off. She's never had Covid - that we know of. She had two Covid vaccines, I think, but none for ages.

She uses the roll-on essential oils for calming, she has the Headspace app, she's seeing a therapist at uni...

CBT - I wonder if that would help?

I'm sorry to hear abotu your husband, @MoserRothOrangeandAlmond

I was severely anaemic and had palpitations and was breathless - you don't have enough red blood cells carrying oxygen around your body so your heart is working harder to get it round, and you feel tired and breathless. Get her to check when the next blood test is as (depending on how heavy her periods are) iron supplements take time to work so she could be losing more than the she is getting.

Are they doing anything about her periods? Sorting that is the only thing that will really help

Some beta blockers are contra indicated with asthma. I was on bisoprolol and it definitely made my asthma worse. Disappeared once put on a different one.

Sorry to say the type of periods you describe are a huge red flag for endometriosis. She should really be referred to a specialist endometriosis clinic to have this assessed (not all general gynaecologists are good at spotting it). Look up the BSGE's list of accredited centres and try to get a referral to the closest.
It really is worth getting it checked out, because it can unfortunately cause all sorts of problems later on.

Her blood test for iron is on Friday, so that's good.

I agree that sorting out her periods would help enormously. All the GP has suggested is Tranexamic acid. I also wondered about endo.

GERD can cause tightness of the chest. Unfortunately it's self perpetuating if the patient is also prone to anxiety. There are some theories linking GERD to palpitations as well, either through stress hormones or a vagus nerve response.

Acid reflux? I ended up in A&E with heart palpitations and my chest hurt (felt like it was burning when breathing in and out)

With the blood tests seek specialist advice if ferritin is low or anything is out of the center of normal. GPs tend to dismiss all as fine as long as they are inside the parameters, but some combinations still need support.

She does have acid reflex.

My anxiety symptoms are physical, including palpitations and feeling like I can't take a full breath. I then feel anxious about the physical symptoms, which makes them worse.

I don't have a cause/reason for my anxiety, it's just like my body was in constant fight or flight mode, and the physical symptoms of this were awful.

Medication has made a huge difference to me. I really recommend that she tries it. I take sertraline.

I’m low in Vitamin B12 which made me anemic. I had a lot of those symptoms and was in no way stressed. It was a purely physical reaction. Might be worth testing along with the iron levels next time she gets her bloods done

Ok so I have all these symptoms but with extremely high blood pressure. I'm in my 50s. Just to go through some stuff posted here

1. Peri menopause caused very heavy periods and taking iron tablets made the flow less heavy. I was very anaemic from my 1st pregnancy until menopause

1. I don't have anything to be anxious about but I do think my symptoms are caused by anxiety and low iron

1. Lack of sleep makes me worse

1. The hot weather makes me worse

1. Transemic acid can cause stomach bleeding like aspirin. My friends daughter had an ulcer age 17 due to taking it.

1. I have low thyroid

My advice would be - no more transemic acid or aspirin. Drink spa tone iron supplements ( gentle on the stomach). Get plenty of sleep. Do some kind of relaxation - meditation, tai chi etc

Sounds exactly like anxiety to be honest, symptoms can go on for as long as her nervous system is in overdrive. Has she got cardiophobia?

But she gets these symptoms when she's not feeling anxious at all! Why would she?

Also, when she feels like this her chest is very tight and she feels like she can't get a deep full breath in or out.

This is a classic anxiety symptom for me. I find that breathing in as far as I can, holding it for at least five seconds, then breathing out slowly helps, but it can take a while to resolve itself properly.

I would throughly look into POTs.

It should not just be dismissed as anxiety. As a female who was treated by a cardiologist, I met several others who had months or years of their problems dismissed as anxiety, putting them at risk as treatment was delayed.

An update: first, thank you all for responding and making so many helpful suggestions.

Dd saw the GP today. The GP has done full bloods again and has booked a chest X ray for dd for Monday. Sounds like she was helpful, listened, and didn't dismiss dd.

The GP said she would discuss results after the X ray, and also discuss poss conditions then, eg POTS, anaemia, etc.

An update and another request for help.

DD's chest is very tight again, she feels like she can't take a deep breath, and she's getting shooting pains across her chest. She's had chest pain every day for a week and a half and she's fed up with it being so sore and uncomfortable, and she's worried.

Wwyd? Ring 111, go to A&E? She's having a shower now to take her mind off it.

Any advice?

A and E and ask for troponin to be tested, in addition to whatever else they look at.