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Constant sternum/chest pain/pressure; what is it?

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I'm a 26 year old female who is inactive (based on fibromyalgia pain, and recovery from a Breast Reduction in April, 2011), and overweight; I do not smoke at all, and consume maybe 2-3 drinks per year. I'm on 1-2mg of Clonazepam nightly, as well as a spray of Afrin, and 2-4 generic Ibuprofens for sinus pain. Take as needed, I use Vicodin (5/325) or Percocet (10/325) for pain. Lastly, I have been on Mirtazapine (generic Remeron) for insomnia at 35mg nightly for the last three years. However, have been tapering the Mirtazapine since December 1st, 2011, taking 15mg a night.

I have been experiencing constant pain, pressure, and tightness in my sternum/chest for the last 4+ months. It radiates down under my breasts, on the left side mainly but also on the right, and around to my shoulder, neck, arm, back, and jaw. There is rarely a moment that it doesn't hurt, and painkillers don't really make it go away. Also, the more it hurts, the more anxious I get, and the faster my heart beats, making the pain more pronounced with palpitations. I haven't had true shortness of breath, however I sometimes feel, while breathing, as is if I'm not getting enough oxygen, and sometimes I wake up feeling like I haven't been breathing. I've had two sleep studies, and know I don't have sleep apnea, so this is strange. Between the constant pain, the radiating pain, the feeling of lack of oxygen, and the other pains, I'm confused and concerned at what it could be. I have further information to try and help figure out what it is. I've seen multiple doctors, and am at a loss.

My long winded backstory starts in April; 3 days after my Breast Reduction, while in the hospital, I felt a fluttering in my chest, and as if someone had sucked the air out of my body; my pulse jumped to 180bps. It happened once, and didn't happen again; the nurses told me that it was simply a panic attack. I was fine throughout April and May as I recovered. However, come June, I was having regular and constant chest pain in my sternum, above the surgery site, seemingly unrelated. The pain grew worse over time, and remained around the clock; sometimes it got worse, sometimes it got a little better, but it was always there. Then I started to have fluttering sensations now and then, and started to develop anxiety attacks based on the sensation. On August 2nd, 2011 everything progressed to the point that I had all the symptoms of a heart attack; chest pain, tightness, pressure along with jaw pain, left arm pain, arm tingling and a feeling of impending doom, feeling truly as though I was having a heart attack and about to die. I went to the ER, where they promptly did an EKG, chest xray, and blood enzyme test; all came back normal, including Troponin levels. They administered nitro as I was told I had an esophageal spasm. After doing research on them, it fit the symptoms; I was at ease, and figured the constant pain was my throat. I scheduled to see an ENT in September, but when I saw him, he denied to treat me until I saw a Cardiologist to rule out cardiac problems; I had to wait 3 weeks for my first visit. In that 3 weeks, the pain remained, and my anxiety grew worse. I ended up back in the ER on mid October with the same symptoms of heart attack; yet again, I had an EKG, chest xray; I had to demand the doctor do a blood enzyme test. All came back normal again. I was told this time that I was panicking, and needed to relax; they administered Ativan, and I had a serious reaction to it, yet was discharged anyway. I finally got into the cardiologist, and my BP was 170/100; I was panicked at the time, he didn't seem concerned. He looked over all my blood work and tests, and said he wasn't all that worried, but would do a holter monitor anyway, and then a stress echo to double check. The holter monitor was done for 24 hours, and the results were given after the stress echo, which was done a week later; the holter monitor came back with minor PAC/PVC (the fluttering explained with PVC), and the stress echo test came back clean; I had a panic attack that had my pulse at 146, and then the exercise itself shot it up to 170+, and I had no extreme pain or illness, and no issue on the ultrasound that was visible. He didn't think anything was wrong with me, and said to relax and look for a psychiatrist for the panic. He did say, though, that he could give me beta-blockers for the PAC/PVC if it was annoying, but didn't want to yet. Weeks went by, and in mid November, the pain, tightness, and fluttering was driving me nuts so I returned to see him again. Bp was 170/100 again (thinking their small/old cuff has issues, as it barely fits); he said he couldn't reassure me anymore that I wasn't going to have a heart attack. He prescribed me Metoprolol 25mg. But to date, I have not been able to start taking it as I've been tapering Mirtazapine, and my neurologist said to wait at least a month before getting on the betablocker.

I still experience daily chest pain, and sometimes it flares up into jaw/arm/hand pain, as well as back pain, and a sense of unease. I have not had any shortness of breath, however when I breathe normally, it feels as though I'm not getting enough oxygen. My PVCs are worse, and my stress is through the roof. I have GERD as well. I have episodes that feel like heart attacks, just like the ones that put me in the ER twice, however I have not returned to the ER as I was told I was fine, and have chocked them up to panic attacks. As I write this, I'm expercing left arm pain, tight/pain in my sternum, and reflux. The pain has been consant for 24+ hours (I have insomnia and have been up that long). I'm really at a loss and don't know what to do at this point. Is it just panic? Is there something I should put the cardiologist about? He's fixated on me being female and young, as part of the reason he's not worried, besides the tests. I'm concerned something is being missed. It's ruining my life, basically, to feel like this and be panicked at all times.

Thank you for reading my long question. Thanks!
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replied January 9th, 2012
I have dutifully read your long complicated history, and it seems to me that you should pay attention to the opinion expressed and see a qualified psychiatrist. Certainly what you are describing is not the picture of a "heart attack." And you yourself state "my stress is through the roof." Indeed, I would suggest that you need a key medical person to manage the panoply of symptoms you have and to lead you on the road to recovery rather than more pills and persistent discomfort.
Please be aware that I am unable to diagnose medical conditions online.


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replied January 11th, 2012
Thank you for your opinion. I've been thinking of finding an internist to go through the list of symptoms and problems. I'm definitely tired of medications, that's for sure.
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replied November 3rd, 2012
I'm going through the same thing.I been to the ER twice and everything came back find. I was asked was I stressed and I said I dont know. I been having this for almost three months now. I had a reduction in january and this started in august. Im ging to see my doc again to find some kind of solution.
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replied June 26th, 2013
Sternum swelling with fullness in chest/throat
Hello,

I am so relieved that I found this site. I have been feeling so awful since the begining of 2011. Here is my story.... I moved to a new apt the end of 2010 and was fine for a few months but started to have a dry cough for months i figured maybe i developed an allergy being that the apt had lots of mildew on the ceiling in my bedroom. Months later I noticed my sternum well the top of my sternum just in the center below the collarbone had swelled a little.....I thought nothing of it and kept going. Well a childhood friend of mine passed away she was very ill and shortly after I developed skipped beats of the heart it was so annoying it drove me back and forth to the er thinking my heart was giving out on me. Anyway they diagnosed me with anxiety ofcourse they gave me a ekg, checked enzymes, chest xray the whole works all was normal....but I must add I do believe the persistant cough caused the skip beats that I was feeling. As time went on I developed severe back pain that was awful I applied the heating pad to it a few days out the week it finally went away....constant trips to the er thinking I have something wrong with my heart, or lungs and diagnose with anxiety I am now fearful of returning to the er because I seriously think they have me down as crazy. Ok this subsided in 2012 once I got pregnant I did however occasionally get the fast heart beat and flutters and ofcourse I returned to the cardiologist for more work up a echo, holter everything again was fine. during my 7 month of pregnancy I vomit up blood bright red I thought to myself something is wrong with my lungs return to my gyn he didnt think anything was worrisome he said he was not concern I may have strained to much while vomitting...ok after having baby I felt great until oct pain under my left breast more like burning back to the er I went. I once again had the works all was fine including the chest x ray..... Well in November after nursing my baby I had a severe pain in my upper back blade my arm and neck I couldnt move went to the er another chest xray ekg blood work all was ok, they gave me a shot in my bottom to relieve the muscle pain my sternum once again swelled making it hard for me to breathe. After a full month things got better but in January the cough came back with mucous and back pain sternum swelled making my chest tight feeling as if something was on my chest making it hard for me to get air I felt I was being smothered. Finally after all my complaining and 2 more chest xrays I recently got a ct scan with contrast of the chest because my cardiologist wanted to rule out a possible pulmonary embolism since I kept complaining of chest pain and feeling as if I didnt have enough oxygen the heart was fine no pulmonary embolism but small opacities a mild thickness in right lung but he assured me he was not worried. I then went to see the pulomonologist and she explain that I didnt have any tumors, or consolidation and the small opacities were from not taking enough deep breaths but for some reason I am not happy with her answers I think something isnt right I feel awful, when I go for my daily walks I feel upper abdominal bloating, chest fullness/throat pressure and fast heart beat. I do believe this is all coming from my sternum swelling....I constantly cry on a daily basis I no longer feel well and at times I get a weak/shaky sensation like maybe I didnt eat all day when I did. The dr's are just brushing me off as anxiety but I know its more than anxiety I do however have thyroid nodules and cysts on my thyroid gland could this be my problem? also had a ultrasound done on my sternum came back normal I get bad headaches and at times dizzy spells I am so worried something is seriously wrong with my health...any answers would be great! Sad
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