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Mental Health  (Expert Forum)
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Anxiety? Arrythmia?
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Anxiety? Arrythmia?

by njrob, Jan 29, 2004 12:00AM
I am 40 y.o. old male, exercise regularly, no history or family history of heart disease.  Last August I woke from sleep with the sensation of an adrenaline rush, numbness in both my hands, lightheadedness, and racing heart (150 bpm).  I had never had any similar symptoms before, became quite worried and went to the ER.  After 35 minutes my hr came back to normal. All blood tests came back normal.  After a cardiac exam (stress test, echo) that came back normal a holter monitor captured a second episode (146 bpm) while relaxing on the couch.  The cardiologist told me it was sinus tachycardia- possibly due to stress.  My internist diagnosed GAD and prescribed first xanax and then Zoloft 50mg (I stopped the xanax). I also stopped all caffeine and alcohol (never excessive to begin with). I have been feeling much better, however sometimes as I am doing cardiovascular exercise, after approx 15 minutes I am feel some PVCs followed by heart racing (approx 140-150) that lasts approx 5-10 minutes (with no pain or tightness) then goes back down to normal.  Also, certain nights I experience the numbness in the hands, jitteriness, racing and pounding heart, and insomnia.  I have tried relaxation breathing but seems difficult for me  to break the sensation or to feel calm.  When I am sleep deprived the symptoms come back more often and stronger.  The internist has told me that he attributes these problems to the anxiety.  I am worried that the underlying problem is an arrythmia or heart condition, and the anxiety has arisen from this.  My questions are:

1) Do my continued problems while exercise sound consistent with symptoms of GAD? Can anxiety cause episodes of sinus tachycardia?

2) Should I avoid the exercise right now or fight through it?

3) If this is the anxiety triggering the tachycardias how do I determine if the medication needs to be increased or changed.

4) Should I ask my internist to refer me to a mental health physician or do I continue under his care?

5) Do The nocturnal problems I'm having point more to anxiety than arrythmia?

6) What is the prognosis for improvement with this problem.

    

Thank you
Doctor's Answer

by Roger Gould, M.D., Jan 29, 2004 12:00AM
First of all, the prognosis is very good, and that is most important. Yes, anxiety can cause a tachycardia and arrhythmias, so if your internist does not have any other physiologic reason for the tachycardia, that is the best bet.  Regarding sleep, yes, it can definetly wake you up, just like a scary nightmare can wake you up with a tachycardia, here you have the effect without any memory of the image that caused it.  I think your doctor, or a psychiatrist, can find a more effective medication to control the anxiety.
Member Comments (12)

by susans, Jan 29, 2004 12:00AM
To: NJrob
Don't be afraid of Xanax. My psychiatrist has told me that people with GAD are so afraid of being addicted they rarely abuse it. I've been taking it for a number of years for severe GAD and panic disorder. I rarely experience panic attacks. I do not take the full dose that I'm permitted to, and my doctors have told me that if I need it it's OK to take an extra one. I'm also on Lexapro but I haven't found the SSRI's very effective on anxiety in my case. The Xanax brings immediate relief, no need to suffer - you'd take insulin if you were diabetic. I never find that it makes me feel that good or "happpy" that I would abuse it - when you have such a high anxiety level it doesn't work the way it does in non-anxious people. What it does do is take the edge off and restore me to a functioning human being. Hope you feel better.

by pandora9048, Jan 29, 2004 12:00AM
To: njrob
hi,

I also take xanax, and while I agree that it helps a great deal for anxiety, it is addicting.  Ive been taking them every day for about 7 months and i now i feel like i cant get thru the day w/out them.  if i dont take them, i literally feel like im jumping out of my skin, and i wish i had never started taking them.  I wouldnt be afraid to take them on an as-needed basis, but if i could go back, i would never have started taking them every day, but thats just me.

hope u feel better,

Pan

by kennyd, Jan 30, 2004 12:00AM
To: njrob
Your experiences are very similar to mine.  I highly recommend that you find a good therapist.  Remember that medication is not a magic thing -- it treats symptoms but does not cure.  Therapy is essential.  I have been seeing a therapist for 8 months after I started having panic attacks, followed by bad anxiety and chest pains.  I chose to do it without medication, but admittedly it is probably the more difficult route.  Depending on how badly your symptoms affect your ability to function normally, a combination of therapy and medication might be the answer...a psychiatrist could help you determine what has to be done.  If you are like me, you're probably thinking about this all the time, and you are acutely aware of every feeling in your body.  It takes some time to get yourself away from that, and this is where therapy is really helpful.



I had a really hard time getting back to exercising after my difficulties started...probably in part because as I ran on the treadmill I would be worrying about elevating my heart rate and collapsing.  This of course is the cycle that creates the anxiety symptoms like dizziness, chest pain, palpitations, etc.  I am now able to exercise without worrying about that, but I still get chest pain and it is sometimes still hard to accept that it's "all in my head".  But at least walking down the aisle of a supermarket doesn't make me dizzy anymore!

by Honeybear's mom, Jan 31, 2004 12:00AM
I have had similar experiences - I had a run of PVCs in a row one day 5 years ago, which threw me into a full-blown "panic attack," including tachycardia, sweating, hyperventilation, thinking I was dying, etc.  The problem was I didn't know it was panic, and I thought my heart was killing me!  I didn't know there was such a thing as a "panic attack," a true, physiologic response that could be that powerful.  For me, realizing that they wouldn't kill me helped, but I still need to distract myself if I feel them coming on.  Because even though I knew they were related to my heart, now that I knew I could have these attacks, I was waiting for them.  My cardiologist told me that people with mitral valve prolapse and/or PVCs have a higher sympathetic nervous system tone (adrenaline - fight or flight), and are more prone to anxiety.  I recommend that you keep exercising!  It's a great stress reliever, and actually you will have decreased PVCs at a higher intensity.  Stay off the caffeine, too.  And before getting onto Xanax or any other tranquilizer, I would suggest using beta blockers (atenolol, propranolol) only before an event that you know will make you nervous (i.e. plane ride, presentation, etc.).  Xanax can be addictive, and if you can deal with it on your own, great.  However, taking Xanax is a helluva lot better than spiraling into depression about it (which I did, at one point).  If you can afford therapy, it always helps.  So bottom line - PVCs are considered normal in healthy individuals, and it sounds like you've had the tests to confirm that.  The anxiety is most likely related, but can be controlled.  During an "attack," breathe from your abdomen, not your chest, and distract yourself, if possible.  Sometimes I'll just move, or eat something.  I hope this helps!  Best wishes!

by anacyde, Feb 01, 2004 12:00AM
I've been suffering from panic attacks ever since I went to see a counselor for my anorexia