1) Stop the testing loop. You have had ECG, three troponins, thyroid, HbA1c, ESR, B12 and kidney tests - repeating them each time you feel the surge only feeds the fear. Two things remain worth doing once: an ultrasound of the abdomen for fatty liver, and a 2D echo plus a Holter (24-hour ECG) so a cardiologist can sign you off definitively. After that, no more cardiac tests unless a doctor examines you and asks for them. 2) Cut caffeine completely for 6 weeks - you have already noticed stimulants trigger it; also cut energy drinks, nicotine and pre-workout supplements. 3) Learn slow breathing and use it at the first sign of a surge: breathe in for 4 seconds, out for 6-8 seconds, for 5 minutes. Exhaling longer than you inhale switches the autonomic surge off - it works better than any tablet in the moment. 4) Book proper treatment for panic disorder: CBT with a clinical psychologist is first-line and works well at your age. Medication (an SSRI) helps if attacks are frequent - it is not addictive and is not a sign of weakness, but it must be started and monitored by a doctor. 5) Attack the metabolic problem: aim to lose 8-10 kg over 6 months, 45 minutes of brisk walking or cycling 5 days a week, cut sugar, refined carbs, alcohol and fried food. This alone will bring down triglycerides 231 and SGPT 88 and raise your HDL. Recheck lipids and LFT in 3 months. 6) Take folic acid with B6/B12 for the homocysteine of 15.2 after your doctor confirms the dose. 7) Keep a simple diary - time, trigger, duration, pulse - and bring it to the consultation; the pattern usually makes the diagnosis obvious. If you would like me to review all your reports together and plan this properly, you can book a consult with me here on Practo or meet me at Synergy Multispeciality Hospital, Miraj.

Panic is the likely diagnosis, but do not self-label every symptom: get seen the same day if chest pain lasts more than 15-20 minutes at rest, spreads to the jaw or left arm with sweating, if you actually lose consciousness, or if your pulse stays above 120 for a long time when you are calm. Also avoid self-medicating with sedatives bought over the counter - they give short relief and worsen panic on withdrawal.

book your consultation,  i would be happy to help

don't go for unnecessary reports by urself

Need further evaluation

Book consultation

do consult me

I will tell you what to do

For This You Must Consult A Physician or A Psychiatrist .

The Treatment Process Is A Little Bit Longer Naturally.The Medication Take To Show Its Effect For Atleast A Month.Do Not Loose Hope And Stop Medicine Abruptly At Your Own. Thank You

Must consult a psychiatrist

Consider testing for secondary hypertension - plasma renin, aldosterone and PAC ratio, urine for metanephrines (24 hr collection)

Avoid excessive caffeine like coffee or soda.

Psychiatric consultation

You're welcome for consultations for management of the latter .