Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): Hello expert, please take a look at my symptoms! I am a male, 25 years old, the first month: sudden rapid heartbeat chest tightness, breathing difficulty, like to faint, a sense of near death, and then quickly to the hospital to check the electrocardiogram, the results are normal. And in the following month, the heartbeat accelerated irregularly every day (I usually exercise and my heartbeat is between 60-75) reaching 85-105, but the breathing is still relatively smooth, the head does not hurt, and can be described as a trance. Sometimes the orbital nerve is connected to the headache. Then another attack went to the hospital for another ECG, and the result was a heartbeat at 99 beats, otherwise normal. Blood pressure is sometimes unstable, sometimes 80-120, sometimes 70-110 or 80-125. It is difficult to fall asleep at night, and it is more fragrant after falling asleep. During the day, he is also drowsy. The heart sometimes has a stabbing pain, sometimes a small pain like a muscle strain, but not for a long time, all at once. Sometimes there is a soreness in the upper part of the left chest nipple (somewhat like the tip of the heart) and in the left shoulder. I also have pain in my left back. But it is not very painful and can be tolerated. No constipation, occasional diarrhea. A little impotent. Urination is not frequent, but a little urgent! Eating is normal, the amount of food is reduced, sometimes there is a feeling of abdominal distension, people have lost about 10 pounds a month. Eyelids are blue (like bags under the eyes), and they are not gone yet! No edema. Smoking, alcohol 2-3 times a month (in moderation). Bloodshot whites of the eyes. Second month: now the discomfort in the precordial area is not as strong, but there are still occasional bouts of pain, very small, all at once. Dyspnea is more frequent, easy to breathe out and hard to breathe in, sometimes with chest tightness, always feel like I’m dying and worry about sudden death! Always nasal congestion, but not a cold or fever, taking cold medicine is useless. At night when I go home and sit on the Internet in bed, I will have involuntary back and forth swaying, but the magnitude is not large! (I did not deliberately sway, the posture is like a monk meditation). Sometimes I think about this symptom and I’m afraid it will happen, but the more I think about it, the more the symptoms come instantly! I also have motor restlessness, and I can’t be alone, so I get panicked and scared and the symptoms come on! The spontaneity of the symptoms and my fear go hand in hand! 2 ECG normal, 1 cardiac ultrasound normal, 1 chest X-ray normal, 24 hours motility, blood routine hemoglobin higher than 0.1 Medications: Yixinshu, Betaloc, Heart and Blood, Musk Heart Pill, Compound Danshin Tablets, Shule Valium, Fast-acting Heart Pill. After eating no significant effect now only eat betalac, tianwang tonic heart pill. The effect is not great! The following is the 24-hour kinetic heart rate: Total heart rate: 126,655 Average heart rate: 88 beats/min Slowest heart rate: 51 beats/min Fastest heart rate: 156 beats/min (probably climbing stairs) Ventricular premature (total number of ventricular premature, percentage of heart beats, ventricular tachycardia (bouts), ventricular premature pairs, ventricular duplex) all O Supraventricular premature (total number of supraventricular premature, percentage of heart beats, supraventricular tachycardia (bouts), supraventricular premature pairs) all 0 Heart rate variability SDNN: 164 msec MSD: 23 msec SDANN: 195 msec rMSSD: 43 msec pNN50: 12.58% events (total number of arrests, longest arrest, longest interval, longest longest interval, tachycardia: 35, bradycardia) all 0 except tachycardia Other manual events: 0 Total number of atrial fibrillation: 0 Summary 1: sinus rhythm 2: partial ST-T Can the above information exclude my organic problem? Myocarditis, coronary artery disease, etc. 2. Am I suffering from anxiety or cardiac neurosis? 3. I always worry about myocardial infarction or sudden death when I have an attack, will it happen? 4. How can I treat it? Is it medication or psychological? I don’t have any family history, I don’t have high blood pressure, and I used to be in good health! First of all, I would like to thank the doctor for reading such long information, please give some detailed diagnosis and advice, I appreciate it! Dr. Xu: Basically, it can be determined as cardiac neurosis, you can take a look at a recent article I wrote about cardiac neurosis, all your symptoms are more typical of anxiety symptoms. Patient: Hello Dr. Xu these days of recuperation feel much better in chest tightness and dyspnea, only once in a while. But still palpitations! I recently went for a medical checkup, so please take a look! There are handwritten reports and photos of the tests: urine, blood, biochemistry, ECG, etc. Are there any problems with these tests? Do you need any more specific tests? Thank you! Dr. Xu: These reports are perfectly fine, please rest assured. If you are still not sure, you can check the flat panel exercise ECG test and cardiac color ultrasound to make a ruling! Patient: Heart ultrasound has also been done, normal! Dr. Xu: Then do a flat-panel exercise ECG! Patient: Hello, Dr. Xu, I just read your article again, I think I have to symptoms and psychological problems can be said only word, I would like to know, in the clinical characteristics you wrote 《《《《, such as for the disease excessive tension worry (hypertensive patients worried about their cerebral hemorrhage, worry about a stroke bedridden, coronary heart disease patients worried about myocardial infarction attack, with ventricular early fear of sudden death, etc.); too nervous, the Like a bird of prey, easily frightened (the slightest sound, especially the sudden sound will be scared heart beating, even the ringing of cell phones, refrigerator start sound, clock ticking, hear others quarrel, sick, accident, they will be scared shaking); all day long feel afraid (afraid that they will faint heart attack can not be rescued, afraid to go to the closed environment such as supermarkets, elevator room, hotel rooms, and even afraid of one person) (fear of being alone in the street and no one to rescue you, fear of watching intense drama, fear of drug poisoning, etc., even because of fear of drug side effects, just after the medicine home also discarded); or continuous depressed mood, all day long, not happy, do not want to do anything interested, years of old friends and neighbors do not want to contact, like to be alone quiet, afraid of annoyance and fear of family members; often feel a little energy, eat anything is not good, difficult to sleep at night They feel that they can’t see well when they are sick, that there is no point in living, that they are redundant, that their family will be happier and more relaxed after they die; outsiders can find that the patient loses weight rapidly in a short period of time, his face is old, his personality has changed dramatically, and it is difficult to get along with him, and so on. If, furthermore, we spend more time, we can find out some psychosocial events that happened to the patient, and even some events that the patient’s family members are also unaware of, such as the death of a family member, loss of love, loss of job, loss of competition in work and study, receiving legal and administrative sanctions, long-term continuous overload, high work pressure; newly found to have a serious disease, or a long illness, family genetic disease concerns, etc.. Or experienced a stressful and scary event, such as encountering a car accident, accidental injury event, witnessing the unexpected death of a loved one or friend, etc. 》》》》》 These worries and fears don’t really happen, do they? I just think I’m a lot like that , and sometimes I’m so scared that I don’t pass out (probably because I’m physically strong) just need to lie down and rest and I’ll be fine. I also went for an ultrasound the day of the exam and it was normal! The chest x-ray was also normal! Now I’m afraid of the “excessive tension and worry about the disease (hypertensive patients worry about their own cerebral hemorrhage, worry about stroke bedridden, coronary heart disease patients worry about myocardial infarction attack, have a ventricular morning worry about sudden death, etc.) all day long (afraid that they will faint heart attack can not be rescued, afraid to go to the closed environment such as supermarkets, elevator room, hotel rooms, and even afraid of a person alone on the street sick no one to rescue) 》” This particular fear Dr. Xu: This is caused by anxiety, the anxiety is under control, these strange, insecure thoughts will gradually eliminate, so it is recommended that you must come to the hospital to treat anxiety, otherwise the quality of life will be very affected. The reason you are called for treatment is not that these horrible and stressful things will happen, such things will not happen, but what needs to be treated is your apprehension a mental state, which is an unhealthy mental state that will seriously interfere with your normal rhythm of life and will cause you unnecessary painful experiences. Be sure to treat it as a disease, then you can get rid of its interference with your life, study and work.