First of all, using the ER for your doctor isn't going to cut it. They are there for emergencies only, and so they basically triage you and then release you, assuming you will go to your regular doc for a more thorough exam or sent to a specialist for more thorough exam. It's certainly possible something physiological is going on, the only way to find out is to get really thorough exam that would cover as many bases as possible, not just heart problems, which you apparently don't have. But given you do suffer from bad anxiety, it can cause these kinds of symptoms. Did you consider therapy or was it recommended before you were put on medication? As for your symptoms, again, you can have anxiety and still have a physiological problem that is separate from it or causing it. Examples are thyroid problems, blood sugar problems, nutrient deficiencies, etc. A lot of times doctors are quick to attribute problems to anxiety and give you a drug because it's a lot easier than having to explore all the possible things that can go wrong that might cause anxiety or the other problems you might have. Docs often just assume if you have anxiety that's the cause of all your problems. Which it very well might be. I hope the sertraline helps, but because taking any medication is an intrusive modality with possible problems, I'm always surprised when a person is able to live their lives but isn't given the option of therapy first to see if that works, because if it does, you don't need medication and you'll be cured, which medication can't do. But it does take time and it doesn't often work that great, so there is a cost of it taking more time. Peace.