Are my chest pain and shortness of breath cause by stress?

January 3, 2007 3:24 AM

Could a recurring pain in my chest and recent shortness of breath be caused by stress, or something more serious?

I'm 24 years old, stand 75 inches and weigh in at 228lbs. My BMI is about 20% I lead a semi-physical lifestyle and eat pretty well. I'm able to run a mile and a half in about 12 minutes and regularly play racquetball and such.

About 9 months ago I started noticing a slight sharp pain in my chest, around the area of the heart. I didn't think much of it because it was very random and might happen once every two weeks. I didn't really notice a pattern, so I just figured I had some kind of cramp or something. Within the past two months it's been getting more frequent, and seems to happen more commonly after physical exercise. It's always in the same spot and while dull, the pain might increase a little when I take an initial breath. It usually lasts for a few minutes after that as the slightly sharp pain.

On top of that I've been having shortness of breath for the past month. It's as if I'm not able to inhale fully and get a deep satisfying breath. Instead, I'm only able to take shallow breaths until I'm forced to yawn and get the air I'm not able to get on my own. Strangely, it's not as bad when I'm running a mile or so, as it is when I'm just walking up some stairs or to my apartment. I'll find myself trying to take in a deep breath, but not being able to fully expand my lungs. I start to kind of panic, so I'll do these exaggerated breaths, like I'm trying to take weight off my diaphragm, but again I have to wait for the yawn. It's even gotten to the point where I pretty much have to have my mouth open all the time to breath.

I went to the doctor who had me do some chest x-rays, but said he saw nothing. My vitals were good, and the blood test checking my cholesterol and stuff was good. He gave me an inhaler for the shortness of breath, which is doing absolutely nothing. He basically said it was due to my high level of stress at work and gave me some contacts for stress management classes.

What the hell is wrong with me? Am I doomed or just doing it to myself?

posted by jimdanger to health & fitness (22 comments total)

Regarding your breating - since this has been going on for at least a month, you will probably want to talk to someone (a therapist), and start correcting your breathing. Basically, it sounds like you are not fully exhaling, so your lungs are not empty when you attempt to take a nice full breath. The yawn is a correction.

Try this:
1. relax, take a slow deep (as deep as you can) breath through your nose
2. hold for a few seconds
3. now breath out, *slowly*, through pursed lips.

repeat

I find that step #2 is the most difficult at first, but make sure you don't skip it.
Experiment a bit, or check out links like this: pursed lip breathing.

By the way - I went through a very similar experience, although the breathing came first, then the chest pain. Once I relaxed my chest muscles, got my breathing under control, and stopped the anxiety/panic, my chest pain disappeared.
posted by tom_g at 4:07 AM on January 3, 2007

Oh, and I forgot to mention - this is more common then you think and very treatable.
posted by tom_g at 4:09 AM on January 3, 2007

Could be heartburn. Does antacid help?
posted by smackfu at 6:24 AM on January 3, 2007

Two things in my own experience come to mind. The first is a pinched nerve. I had this happen because I would get a pinched nerve in the side of my ribcage and it would result in sudden sharp pains, almost like someone zapped me with an electric shock. Basicly, my doctor said it just would get better on it's own (which is always lovely news)
The other thing that comes to mind is anxiety and stress. I have a mild anxiety problem and when it first occured and I knew nothing about what it was, I thought something terrible was happening. I would have the exact same thing, pain and shortness of breath. Sometimes the pain gets tight, like a BIG air pocket that expands (sorry, best way I can describe it) The suggestion there are two things: if you take a medication solution, talk to your doctor about maybe a small dose of Xanax, which you can take only when you feel that way, or perhaps a once a day antidepressant with a very small dose. If you are uncomfortable with medication, then the two things are one, exactly what tom_g said, breathing and two RELAX. You have to keep your mind clear of any rapid thoughts, perhaps read, watch a show, call a family member of friend, or do something else you enjoy. I sure hope this helps you.
posted by ForeverDcember at 6:37 AM on January 3, 2007

Had similar symptoms as a teenager, doc put me on an inhaler as well, and it also had no noticeable benefits for me over a few months. Then I saw a younger resident in my doc's office who didn't prescribe anything but just told me his point of view on how closely physical ailments can be related to mental anxiety / stress, and very often the key to curing the former lies in relieving the latter.

I had a fairly stressful adolescence / teenage experience as these things normally go, and two things that helped me immensely in getting back to normal were a) Don't Sweat the Small Stuff..., and b) learning about meditation and practiced relaxation at my local traditional Tae Kwon Do gym. Find what works for you but in the meantime, get thee to the stress mgmt classes to at least give them a shot.
posted by allkindsoftime at 6:49 AM on January 3, 2007

seconding the heartburn suggestion... could it be a hiatus hernia maybe?
posted by chrissyboy at 6:52 AM on January 3, 2007

PLEASE keep pursuing this with your doctor, or get another doctor if you don't feel like this one is taking enough interest in your problem.
posted by kmel at 6:56 AM on January 3, 2007

Next time this happens, take a Tums and see if it gets better. Also, pay attention to what you're eating. It's possible that this is food related.


My BMI is about 20%

Uh, your BMI is about 25.7, it's not measured in percentages. You're just barely overweight by US government standards, which hold 24.9 the top of the "not overweight" scale. Your height and athleticism may make you look overweight on the BMI scale even if you're a healthy weight for your own body, however.
posted by croutonsupafreak at 7:00 AM on January 3, 2007

If you can have a chiropractor look at your back, could be something needs adjusted.
posted by imjosh at 8:00 AM on January 3, 2007

Seconding kmel. Go get a second opinion from a reputable doctor rather than chasing suggestions from random strangers here.

And relaxation does help just about everything...
posted by Burhanistan at 8:07 AM on January 3, 2007

I'm a regular ask.metafilter reader, and I've often considered registering an account, but what made me do it was my urge to respond to this topic.

I have had a similar problem for a number of years. I'm 23 years old, 71 inches tall and 175 pounds. My chest pains probably started about two years ago (I weighed about 140 lb. at the time, and I was composed of considerably less muscle) - it's a dull ache around the area of my heart, accompanied by the feeling of shortness of breath. I actually have experienced all of the symptoms that jimdanger described, except for the yawning (which I've never noticed).

After about six months of this, I saw my physician, who sent me for x-rays and the whole nine yards. He told me the same thing - nothing wrong, it must be stress. The problem is that I could swear I've never been under undue amounts of stress. At least not to the point where it has haunted me mentally in any way.

In any case, my chest pains have calmed considerably in the last few years. I only get them every now and then, and they are even more dull then they originally were, but I've never found out what is wrong with me. To the best of my knowledge, my only physical problems are a dislocated vertebra in my middle back (which does not cause me any pain unless I do something crazy, like lift weights five days a week) and *possibly* a mild asthma. I was also born premature with a collapsed right lung. My doctor knew all of this and tried to convince me that I was suffering from physical manifestations of stress, but I don't really believe it. However, I'll not discount it.

The only difference that I can think of which might account for the decrease in my symptoms is that in the past few years is that I now do far less heavy cardiovascular exercise - but that is really a shot in the dark, because I've never felt any pain while exercising or immediately afterwards. It seems to come at random times - like when sitting in front of the computer or driving my car. I can't say that I've ever been thinking of anything "stressful" during those times either.

For what it's worth, I've learned to live with my dull aches, but I would certainly love to figure out what's going on. The pain used to be so bad that I considered going to the emergency room on a few occasions, but I've not experienced anything close to that in at least two years, and I had in fact largely forgotten about it until I saw this post.

Sorry for the long reply. I thought it might be helpful.

(I love ask.metafilter, by the way).

-Mark
posted by gaiamark at 8:37 AM on January 3, 2007

Please see a doctor.

That said - I was having recurring pain in my chest, pretty much dead center, a bit above and kinda between my breasts (I'm female). It would come on at night, start as a dull pain, then get worse and worse and I'd try stretching, Tums, everything, it just killed. It was coming on about 4-5 times a month.

I got worried and went to see my doc, who (rather quickly) diagnosed costochondritis, which she explained was an inflammation of the cartilage in the rib cage. She told me to prophylactically start taking like 600 mg of Aleve every 8 hours and call back in 2 weeks.

I did not take the Aleve, it happened once more, and I haven't had it since.
posted by tristeza at 8:46 AM on January 3, 2007

Doctor. Now.
posted by Ironmouth at 9:33 AM on January 3, 2007

Let me be more specific. Heart Doctor. Now. My brother just got diagnosed with a congenital defect a few weeks ago he knew nothing about for 37 years. He has a bicuspid aortic valve. Now I have to go in. You should do the same.
posted by Ironmouth at 9:35 AM on January 3, 2007

Ok, again, as everyone else mentions: keep pestering your doctor until he figures out what the deal is. Now my story:

About 3 years ago, I decided to quit smoking. It took my a few tries to finally do it, but I had some interesting stuff happen.

After about 2 months of not smoking, I started getting strange chest pains and random times, and usually centering around my heart. The first time they started, my doctor sort of wrote it off after first thnking it was a virus, and then a Cardiolyte stress test showed everything as normal. Eventually, the pains went away after I started smoking again. This happened twice.

The last time I quit (will be 2 years in Feb) this all happened again. I had a new doctor this time, and an EKG showed my heart doing something strange, so I ended up having to wear a 24-hour heart monitor. Heart monitor showed a little strange activity, but nothing that my doctor said should be worried about. Then I asked about anxiety/stress. After a long discussion, we decided on Lexapro for anxiety/mild depression. It still took me about a month 1/2 to decide on trying the medication, as I was terribly reluctant. Eventually I decided to try it, as nothing was working and my life was being terribly effected by this problem.

Anyway: it worked. My chest pains went away. I'll slowly be moving off the meds eventually, but for now they have made such a huge difference both physically and mentally that I wish I would have come to terms with this a lot longer ago.

Note that this post is a major condensed version of my story, and feel free to send me an e-mail if you want. But to answer your question: don't rule out stress and anxiety and at least ask your doctor about it. Also keep pushing your doctor to help you, and by all means seek a second opinion if you must.

I hope everything works out for you!
posted by punkrockrat at 9:45 AM on January 3, 2007

Ugh.. forgot to mention, this is all something that went on between the ages of 30-34 (I'm now 34). I'm a pretty young guy.
posted by punkrockrat at 9:46 AM on January 3, 2007

It could be stress-related, but it could also be a form of angina pectoris.

The American Heart Association encourages anyone with chest pain to see their doctor right away. The AHA also recommends that any episode of chest pain lasting longer than 15 minutes be treated in the emergency department. Call an ambulance.

Obligatory disclaimer: I am not a doctor, and you should always ask your doctor if you have questions about your health.
posted by jesourie at 9:56 AM on January 3, 2007

I've had a similar issue on and off over the past few years, and had lots of blood tests, EKGs, etc. Even went to the emergency room one night (more because it freaked me out, not because of the severity). They've never found even the smallest thing wrong. The best I could get was a "nonspecific chest inflammation".

The only this I could find that seemed similar is this:
Precordial catch syndrome
posted by blue_beetle at 10:10 AM on January 3, 2007

Here, I'll throw another possibility into the mix: pleurisy. I was diagnosed with it a couple years ago after having weird chest pains. They sent me in for a stress test that was perfectly normal, in fact good, and decided that if the pain wasn't anxiety/depression, which it may well have been, since I've had trouble with both on and off my whole life, than it could well be pleurisy. So if you've recently had a cold or virus, you may have pleurisy. Not a damn thing you can do about it except wait for it to go away.

punkrockrat, I quit smoking a month ago & I've been having weird chest pains for the last week! I'm so glad you posted that - I almost took myself in to the ER on Sunday, but decided not to since I had a perfectly normal stress test a couple years ago & have no heart disease risk factors at all except the smoking. I've been on & off lexapro for years & I'm currently in an off stage; maybe I'll go back on for a bit.
posted by mygothlaundry at 10:47 AM on January 3, 2007

Yeah, pretty much what everyone else said. The key is to get an EKG to verify proper heart function. The beauty of that is, if you find out to a fairly high level of certainty your heart is okay, and it is stress/anxiety related, just finding out you're not about to die may help alleviate your stress.

In my case, the chest pain, I'm pretty sure, goes back to an old chest muscle injury when my brother was trying to turn me into a jock and tried to make me bench press more than I was able. I strained the muscle on the left side of my chest and it seems to bother me whenever I do heavy lifting or deep breathing for an extended period. I've also had some acid reflux issues.

BTW, I ran the numbers (6'-3", 228 lb.) through the same BMI calculator as croutonsupafreak and I got 28.5 for your BMI. Still in the overweight (not obese) range, but it wouldn't hurt to drop a few.

In 2005, I dropped my 6'-2" frame from 240 to 170 using the South Beach Diet. It doesn't cost very much as all you have to buy up front is the book and you can prepare all the food yourself. In fact, to *know* you're getting the right stuff, it's a good idea to prepare everything that goes into your mouth for Phase I (two weeks). I think of the first two weeks as diet boot camp.

Sadly, I gained about half that weight back in 2006, but with the New Year I'm back on South Beach and have already dropped a couple pounds.

The point of this whole long post is that a LOT of the symptoms I associated with getting old (I'm 44 now), really had to do with carrying the extra pounds. When I lost the 70 lb., I felt better than I had in years, and got rid of the acid reflux, blood pressure, cholesterol medications, and even stopped snoring. Take care of yourself a little and you'll find it's well worth the investment in terms of your overall quality of life. If you want any further info about how I did it, email me (doohickie AT charter D0T net).
posted by Doohickie at 11:16 AM on January 3, 2007

Thanks for all the replies! I didn't realize my BMI was so high. I recently had a health assesment where I got the 20% number. I've lost some weight and it continues to go down, so I'm working on that.

I'm hoping it's stress related as most people have mentioned. I'm looking into setting something up where I can talk to someone and maybe find some better ways of handling it. I just wanted to see if anyone thought I should do something extreme like go to the ER or anything when I get it.

I'll keep pestering my doc and see if we can get something a little more conclusive. The antidepressant idea might work as well, so I'll bring that up.

Thanks again for your suggestions guys.
posted by jimdanger at 12:14 PM on January 3, 2007

The most likely explanations are acid reflux and anxiety.

Do make an appointment to see your doctor again. It would be a refreshing change for him to see someone who can actually describe his symptoms. And let me add that your doctor doesn't want to try to figure this out over the phone.
posted by neuron at 11:33 PM on January 3, 2007