Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Heart Disease (Expert Forum)
Cardiac Neurosis?
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Cardiac Neurosis?
by beerhoch, Nov 12, 2004 12:00AM
Hello,
I am a 38 yo white male with a family history of heart disease (Dad died of CAD at 42, maternal Grandmother had 1st heart attach at 52). I was diagnosed with CAD in June and had angioplasty & 4 stents (Cordis drug eluding type) for 2 blockages each in my LAD & RCA. I suffered a complication, my artery was perforated during the proceedure and a pericardial effussion started, leading to cardiac tamponade and a near death experience. An emergencey Pericardiocentisis followed along with days in the ICU with a drain in my chest, then several months of steroids to shrink the effussion. Follow up echoes show the effussion to be gome and no damage to my heart. I am now on Lipitor80 & Zetia10, and my ldl is down from 160 to 72. I'm also on Plavix, Enalapril, asprin and Atenolol (25mg x2). I have Gerd to add to all this.
I constantly feel chest, gastric pains & palpitaions and these lead to what I believe are panic attacks. I have had 2 thallium stress tests at 2 different facilities in the last 6 weeks, both of which were negetive. My cardiologist assures my that I am fine, I do not have a new blockage or restenosis. He believes that I am suffering from anxiety problems, which I am now forced to agree with. I believe that I am sufferuring from a panic disorder (cardiac neurosis?); I take my pulse and check my BP constantly and I panic at every discomfort I feel in my chest. It is becomming a problem for me.
Do you come across this sort of thing very often? What treatments or therapies do you recommend for your patients who suffer from similiar problem?
I am a 38 yo white male with a family history of heart disease (Dad died of CAD at 42, maternal Grandmother had 1st heart attach at 52). I was diagnosed with CAD in June and had angioplasty & 4 stents (Cordis drug eluding type) for 2 blockages each in my LAD & RCA. I suffered a complication, my artery was perforated during the proceedure and a pericardial effussion started, leading to cardiac tamponade and a near death experience. An emergencey Pericardiocentisis followed along with days in the ICU with a drain in my chest, then several months of steroids to shrink the effussion. Follow up echoes show the effussion to be gome and no damage to my heart. I am now on Lipitor80 & Zetia10, and my ldl is down from 160 to 72. I'm also on Plavix, Enalapril, asprin and Atenolol (25mg x2). I have Gerd to add to all this.
I constantly feel chest, gastric pains & palpitaions and these lead to what I believe are panic attacks. I have had 2 thallium stress tests at 2 different facilities in the last 6 weeks, both of which were negetive. My cardiologist assures my that I am fine, I do not have a new blockage or restenosis. He believes that I am suffering from anxiety problems, which I am now forced to agree with. I believe that I am sufferuring from a panic disorder (cardiac neurosis?); I take my pulse and check my BP constantly and I panic at every discomfort I feel in my chest. It is becomming a problem for me.
Do you come across this sort of thing very often? What treatments or therapies do you recommend for your patients who suffer from similiar problem?
Doctor's Answer
by CCF-M.D.-MJM, Nov 12, 2004 12:00AM
Hello,
I am sorry to hear about heart disease and the complication of you stenting. Cardiac tamponade is a rare complication of stenting, but it does happen and can be devastating. Fortunately everything turned out well for you.
I see anxiety about heart disease every day. In fact, we probably see more people worried about heart disease or fearing problems they don’t have, than we do patients that actually have those problems. Feel assured that you are not alone and are probably in the majority. You have taken a big step, however, in realizing and accepting that your pain is not cardiac. It takes people a long time and lots of worrying before they arrive at that point of accepting that is anxiety.
I usually start patients on Paxil for anxiety and use Zoloft if Paxil does not appear to work. Paxil is a selective seritonin uptake inhibitor (SSRI). SSRIs have side effects that physicians need to be aware of and use to their advantage. For example, Paxil can sometimes be sedating. I use this for patients that are anxious to help keep them calm.
Your cardiologist my not be the right person to dose and adjust your SSRI. Cardiologists do not prescribe SSRIs often because there are new drugs coming out that we just don’t have exposure to. Your internist might be a better person to approach unless you have a close relationship with your cardiologist and trust his judgment outside his specialty.
I hope this helps and you feel better soon.
I am sorry to hear about heart disease and the complication of you stenting. Cardiac tamponade is a rare complication of stenting, but it does happen and can be devastating. Fortunately everything turned out well for you.
I see anxiety about heart disease every day. In fact, we probably see more people worried about heart disease or fearing problems they don’t have, than we do patients that actually have those problems. Feel assured that you are not alone and are probably in the majority. You have taken a big step, however, in realizing and accepting that your pain is not cardiac. It takes people a long time and lots of worrying before they arrive at that point of accepting that is anxiety.
I usually start patients on Paxil for anxiety and use Zoloft if Paxil does not appear to work. Paxil is a selective seritonin uptake inhibitor (SSRI). SSRIs have side effects that physicians need to be aware of and use to their advantage. For example, Paxil can sometimes be sedating. I use this for patients that are anxious to help keep them calm.
Your cardiologist my not be the right person to dose and adjust your SSRI. Cardiologists do not prescribe SSRIs often because there are new drugs coming out that we just don’t have exposure to. Your internist might be a better person to approach unless you have a close relationship with your cardiologist and trust his judgment outside his specialty.
I hope this helps and you feel better soon.
Try to listen to your doctor and not so much your body right now...its just wasted worry. You've been through a lot and are doing all the right things. Stay on top of your condition but also enjoy life. "Live everyday likes its your last for one day you'll be right."
It is common for persons with heartdisease , open heart surgery, and other cardiac procedures to develop these symptoms referred to " as cardiac neurosis", when a apparently all thorough testing suggest that it is not related in anyway to their condition, only anxiety because they are aware that they have a true problem that needs to be watched carefully.
Unfortunately some persons their past is the only future they see for others and themselves(not referring to you personally, but I have a long memory), just to add to what paule wrote, Let's not count the years ahead , nor contemplate the past, but live today and everyday as though it were last.
Just one more thought, let us all here that visit and comment on this forum not be too hard on all our vistors that suffer with "cardiac neurosis", it is an awful problem that can make one become a "cardiac cripple" despite the complete lack of evidence for a true cardiac problem.
Kindest regards.
There's a saying (source unknown): "Sure I'm paranoid..... but am I paranoid enough?". In your case, having had an angioplasty, 4 stents and a family history of early cardiac death, I would say you are DEFINITELY NOT A CARDIAC NEUROTIC. And you may not even be paranoid enough. However, this is not to say that don't have (justifiable) anxiety which is actually making your situation worse than it need be. You certainly do. You need, as CCF-M.D.-MJM points out, to treat the anxiety as well as his heart condition. An anti-anxiety med (SSRI)like paxil is a great suggestion. As usual, the CCF doctor's advise is right on.
To Everyone Else, especially cardiac neurotics:
Concerning paule's comment and the subject of cardiac neurosis. I too agree that there are (too)many "cardiac neurotics" frequenting this Forum. This is not to belittle them because I think they have a serious illness and need the support that they receive here. As CCF CARDIO MD - DLB wrote a few years ago:
"Cardiac neurosis is just a fancy way of saying someone is overly anxious about having heart disease, when in fact they do not. This would apply to many people who are disabled by benign PVCs." [CCF - MD - DLB]
The fact is many true cardiac neurotics regularly experience PVCs and tachycardias which are caused not by any underlying heart problems but by ANXIETY. The anxiety causes the PVCs and tachy, which in turn further feed the anxiety. Remove the aniety and the PVCs and tachy will disappear. Some allow this condition to totally disrupt their lives - - - to the point where they fail to enjoy their family and hobbies, can't do their jobs, are afraid to travel, to exercise, .... to do most anything but worry about their (non-existant) heart conditon. It's a viscious cycle which is hard to break.
The first step in breaking the cycle is to realize what you are suffering from (assuming the shoe fits). So, please don't take my (or paule's) statements as a put-down. If you a true cardiac neurotic, it does you absolutely no good to haunt Forums like this and become walking encyclopedias of heart and arrhythmia knowledge. Rather, you should attempt to understand your true underlying problem, anxiety, and have it treated appropriately. You don't need Rythmol or other anti-arrhthymics (or even beta blockers). You need appropriate anti-anxiety meds, stress reduction or bio-feedback training or even psychoanalysis.
Anyway, these are just my thoughts, meant to be helpful. I'm not a medical professional.
Best wishes to all,
Tony
As a cardiac patient myself I personally would not let any cardiologist or PCP diagnose my symptoms as anxiety... and if they were telling me it was anxiety - I would politely ask if THEY were an expert in this field of medicine. IF not, then I would get a referral to seek the expert opinion of a psychiatrist with an MD Degree - as I think they would be the best expert to know the symptoms of 'anxiety' and they should be able to treat your anxiety or panic attacks - if indeed thats what it is.. and if it is - then your getting the proper care from an expert. You may actually be experiencing "both" cardiac issues and psychiatric issues. Heart disease in my opinion is 50% mental and 50% physical and some of these cardiac meds are playing havoc on some cardiac patients.. Which could be a case of just adjusting your meds.
Good Luck
Marilyn (runner)