18 yrs old boy c/o pain chest on and off since 2 years. No sweating anxiety ghabrahat. All vitals stable. Pain relievs itself after 2-3 hrs. Occurs usually after 1-2 weeks or sometimes in a month? What could be the cause,diagnosis and treatment?

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Take detailed history of the patient esp.psychosocial history, his family history, financial condition, his present working condition to find out the cause of anxiety. ECG is normal. Prescribe him some anxiolytic plus paracetamol with local analgesic cream for local application.

Anxiety neurosis. Give tab Clonazepam one tab hs.one tab multivitamin daily. Morning brisk walking and yoga. Cause may be increased sympathetic activity. Can do autonomic function test and HRV. HRV is part of autonomic function test.

ECG -BER. Anxiety Neurosis. Reassurance regarding ECG which might be the cause of anxiety.

ECG-Normal sinus rhythm, early repolarization. Needed TFT,srcal. CXR PA view , For chest pain may be due to anxiety, gastritis, APD,

avf , lead 3 st elevation , all leads tall t waves hyperkalemia due to vomiting or electrolyte disturbances.

ECG is normal. Adv. 2-D echo for further findings . Prov. D anxiety disorder

Normal ECG.

ECG WNL.ANXIETY NEUROSIS.

ECG WNL. Only reassurance.

ECG- WNL (Early repolarisation is seen which is benign).

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