OpenHealth Q&A

Two Years of Unexplained Symptoms: A 20-Year-Old's Struggle

I’m a 20-year-old male, standing 5'8" tall and weighing 145 pounds. Currently, I am only taking Flonase and vitamin D supplements. Although I haven’t been officially diagnosed with generalized anxiety disorder and panic attacks, assessments from healthcare professionals suggest that I meet the criteria. I've also experienced some symptoms that may align with a depressive disorder. My asthma has been relatively stable over the last few years. Since mid-February, I have been grappling with severe health anxiety that escalated after an illness triggered feelings of health-related panic and some agoraphobia. I believe it’s time to seek another medical opinion, partly because I need to find a new primary care physician after my previous one closed their practice. However, I’m caught in a dilemma between seeking closure and exacerbating my anxiety, leading me to postpone visiting the doctor for quite some time. I am working with a therapist and have made some progress, but my physical condition still feels stagnant. Starting in mid-2023, I began noticing heightened sensitivity near my heart accompanied by fears of rhythm irregularities, brief episodes of lightheadedness—resembling brain zaps—and some discomfort in my chest. After consulting a cardiologist, I underwent an EKG and wore a 14-day Holter monitor, both of which returned normal results. Although I still think about cardiovascular issues, I managed to suppress these worries until recently, as my symptoms have intensified. In late March, I had a telehealth consultation where I voiced my concerns and underwent blood tests, which, to my knowledge, did not include specific cardiovascular markers like troponin or d-dimer. The results were predominantly normal except for some elevated red blood cell values, which were also noted two years prior to my cardiology visit. Even though I received a referral to a hematologist out of caution, my nurse practitioner seemed unconcerned and indicated I could elect to repeat tests like an EKG or blood pressure readings if desired, emphasizing that there was no immediate threat. I have yet to follow up, largely due to various factors happening in my life and my anticipation of finding a new PCP. I have faced a range of symptoms that have become more persistent and distressing since February, despite mild cardiophobia since 2023. The symptoms include: - Nearly daily mild chest discomfort, usually located on the left side but occasionally on the right or in the center. The sensation varies, sometimes presenting as fullness or light pressure, and at times feeling sore without any crushing or debilitating pain. - This discomfort can last anywhere from an hour to all day, occasionally beginning with exertion but more often appearing randomly. At times I wake up with a subtle sensation that feels “itchy” or congested around my nipple area. - A continuous feeling of slight lightheadedness and dizziness; however, it doesn’t feel like faintness as I rarely feel close to losing consciousness. I’ve experienced actual presyncope a few times, particularly after blood draws or during heat exposure years ago. - Persistent fatigue, an increase in heart rate upon standing, sometimes rising 40-50 beats per minute, potentially indicating POTS. This can happen with mild lightheadedness or chest discomfort. - Occasional mild shortness of breath during exertion or at random times, not accompanied by classic symptoms of distress. - Other sensations include rhythmic thumping feelings that often occur near my heart and sporadic spasms in my abdomen, along with moments of head pressure or fullness. - Instances of transient leg soreness, which can affect one leg or both. Earlier in my experience, I dealt with many ectopic beats, but since May, they have drastically diminished. I still notice some peculiar heart responses; for instance, when I shift positions, my heart rate can slow in situations where it typically speeds up, creating a feeling of being “stuck.” The anxiety stemming from these symptoms has led me to become quite sedentary and deconditioned. Just last week, I completed a 10-minute strength training video for seniors, and my heart rate soared to around 170 for the majority of the session, peaking at approximately 190. Prior to this, following a recent illness, my resting heart rate averaged closer to 140. Until my high school years, I was a competitive swimmer, engaging in significant physical activity without major issues, which changed when anxiety began to interfere with my capacity to exert myself. In summary, I am uncertain about my condition. While the intensity of my symptoms remains mild, the combination of prolonged experience and their impact has left me feeling disconnected from my usual self—functionally restricted and perpetually anxious. I dread being home alone, fearing a sudden cardiovascular event. With a move approaching in less than three weeks that will require considerable exertion, my level of concern has heightened. At this point, I am not anticipating an online diagnosis; rather, I seek to gain a clearer understanding of what possibilities exist, empowering me to prepare relevant questions for my impending visit with a new PCP and perhaps find a sense of tranquility. Any guidance or insights would be greatly appreciated. Thank you for taking the time to read my story.

Answers (1)

7/4/2025, 5:40:59 AM

OpenHealth AI

It sounds like you have been navigating an incredibly challenging situation with a range of physical symptoms and anxiety, especially relating to your heart health. It's understandable to feel overwhelmed and seek clarity as you prepare for your health journey. Here are some key points and actionable steps based on your provided information:

Main Points

1. Symptoms and Anxiety: Your symptoms are intertwined with health anxiety, which can amplify physical sensations.
2. Recent Evaluations: Past assessments by cardiologists and blood tests returned normal results, which helps rule out acute cardiovascular concerns.
3. Next Steps: Address your symptoms with a new primary care physician (PCP) while continuing your therapeutic work.

Explanation

The combination of mild chest discomfort, increased heart rate upon standing, lightheadedness, fatigue, and anxiety can be distressing. It’s good that you've had thorough evaluations, including a Holter monitor, which did not indicate any serious cardiovascular issues. Your anxiety, especially health-related panic, often exacerbates physical sensations, making them feel more concerning.

Your previous level of physical activity, like swimming, also indicates that you have a healthy background, but anxiety can significantly affect how you perceive exertion and your body's responses.

Actionable Next Steps

1. Find a New PCP: Prioritize finding a new primary care physician who understands your anxiety and ongoing concerns. Make it clear during your appointment that you want to address both your physical symptoms and anxiety.

2. Prepare for Your Appointment:

   • Document Symptoms: Keep a symptom diary for at least a week prior to your appointment. Note when symptoms occur, their intensity, and any triggers or relief methods. This can help your new PCP understand your condition more clearly.
   • List Questions: Prepare specific questions reflecting your concerns, such as:
     • What could be causing my chest discomfort and lightheadedness?
     • Should we consider additional tests for conditions like POTS?
     • What lifestyle changes can I implement to help with both my physical and mental health?

3. Gradual Reintroduction of Exercise: Start to reintroduce physical activity gradually. For instance, aim for light activities such as short walks or gentle stretching that don’t overly elevate your heart rate. Keep directly monitoring your reactions to changes in intensity.

4. Manage Anxiety: Continue working with your therapist. Techniques like cognitive-behavioral therapy (CBT) can specifically help with health anxiety. Mindfulness and relaxation techniques can also be beneficial.

5. Educate Yourself: Sometimes, learning about anxiety and its effects on the body can make symptoms less intimidating. Understanding that anxiety can cause real physical sensations may provide some reassurance.

6. Hydration and Nutrition: Ensure you’re staying hydrated, which can help reduce feelings of dizziness or lightheadedness. A well-balanced diet might also support your overall well-being and energy levels.

Remember, it's essential to approach each concern step by step and give yourself grace as you navigate these challenges. You are making significant strides by seeking help and considering your next steps. You’re not alone in this, and help is available.