Chest heaviness brain fog. Should i do?

The reassuring part is that both your 2D echo and TMT were normal. That significantly lowers the likelihood of major structural heart disease or severe coronary artery disease at your age. It could be 2 probabilities: *Intermittent arrhythmia (palpitations/tachycardia) such as SVT, inappropriate sinus tachycardia, panic-triggered tachycardia, etc. * Anxiety/panic cycle after the first episode, where the fear of another event keeps the body in a hyper-alert state causing chest heaviness, brain fog, facial tingling/sensations, and constant worry.

1. Get rhythm monitoring done This is the most important investigation now. Ask a cardiologist for: * 24–48 hour Holter monitor if symptoms are frequent OR * 7–14 day event monitor / loop recorder if episodes are occasional This can identify: * SVT * sinus tachycardia * ectopic beats * atrial arrhythmias * anxiety-related sinus rhythm Without capturing the rhythm during symptoms, diagnosis remains incomplete. 2. Basic blood tests Some reversible causes can trigger palpitations and brain fog: * CBC (anemia) * Thyroid profile (TSH, FT4) * Vitamin B12 * Vitamin D * Electrolytes (K, Mg, Ca) * Fasting glucose/HbA1c Since you already have hypothyroidism treatment in your own history, thyroid imbalance is especially important to rule out because both low and excessive thyroid hormone can contribute to palpitations and cognitive symptoms. 3. Watch for anxiety/panic features This line is very suggestive: “feeling what will I do if I am alone and something happened to me” That pattern often occurs after a frightening first tachycardia episode. Then the body becomes hyper-aware of every heartbeat and sensation. Symptoms commonly caused by anxiety/panic/hyperventilation: * chest heaviness * facial tingling * shifting sensations left/right * brain fog * dizziness * fear of dying * symptoms worsening when alone This does not mean symptoms are “imaginary.” The symptoms are real, but the driver may be autonomic/anxiety related rather than dangerous heart disease. A consultation with: * a physician/cardiologist first * then possibly a psychiatrist or psychologist if cardiac causes are excluded can help greatly. 4. Lifestyle measures For the next 6–8 weeks: Avoid: * excess caffeine/energy drinks * nicotine/smoking * pre-workout stimulants * sleep deprivation * dehydration Do: * regular sleep * walking/exercise gradually * hydration * breathing exercises during episodes * reduce repeated pulse checking/googling symptoms 5. When to seek urgent care immediately Go to emergency urgently if you get: * fainting/syncope * severe chest pain * breathlessness * persistent HR >150 that doesn’t settle * weakness of one side * speech difficulty * oxygen drop * blackouts

Based on your age and normal echo + TMT, the probability of a dangerous heart condition is relatively low. The most useful next step is documenting the rhythm during symptoms with Holter/event monitoring and checking thyroid/B12/electrolytes.