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Angina or not?
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Angina or not?

Hi Everyone,
                  I'm having a severe panic disorder with a cardiophobia, that's mean that almost all my anxiety is linked to me heart. To do a short story, more than 1 year ago I start having a very low pulse rate but no chest pain. I had an appointment with one Cardiologist and he RX some tests (stress test with echography of the heart, ECG and also a Holter 24 hours monitoring). The results for all those test was negative, the Cardiologist said that I had not coronary disease or anything else, he just say that my pulse rate was above 50, but that it was not dangerous. Also, at the time, my blood pressure was bordeline (around 140/90 all the time).

3 months after all those tests, I start having new cardiovascular symptoms. After a very bad panic attack while I was driving my car, I faint because of the very fast pulse rate of more than 200 BPM and I start having chest pain once in a while. Strangely, the low pulse rate stop for 2 months and I had to deal with fast pulse rate most of the time (above 100 at rest and more if I had something physical to do like taking my shower). Strangely, my blood pressure start being low ( around 100/60, who is for me very low...i'm 6 foot tail and my weight was at the time 215 pounds).

So last november I meet another Cardiologist and told him that I faint and also that I had a lot of chest pain not relieve by rest. He told me that I had to eat more salty foods and he said that the chest pain was cause by the very fast pulse rate and my anxiety. He said to eat more salt and that he will call me back 6 months later to see what happen...

I had to call him in the begining of January cause the chest pain is now 24 hours ON...  My symptoms are worse between 8 PM and 10 AM... I have neck pain all the time, jaw pain all the time also, teeth pain, pulsating veins on my head (weird headache), eyes pain, numb left arm and numb left hand, I have pain all the time in my left arm pit, I have pain in my back on the left side, lower legs pain especially at night, my hands are most of the time cover by sweat, same for my feet, I wake up all the time in the middle of the night cover of sweat and my heart beat is very fast and irregular and I can't sleep again, my blood pressure is all the time weak (very low or too high), I have long episode of fast pulse rate (above 180 BPM) and those episode can last more than 10 hours in a row and are not relieve by my anxiolytic meds, I also have a lot of skipped heart beats, the chest pain is now very strong ( on the left side of my chest) and I can feel 5 to 10 times each evening a weird feeling in my chest, like something inside my chest is releasing a liquid who intensify the pain, like an adrenaline rush and of course my heart beat fast, always more than 100 BPM and is A LOT IRREGULAR, mean that it can beat very fast for 5 heart beat and stop for 2 seconds and restart very fast.

The chest pain is worse when I cough and I have some difficulty to breath as well...

Anyway, is it usual for someone with unstable angina, to have chest pain who can last all day long for more than 2-3 weeks??? I mean that if it was really a heart disease or blockage of some major arteries, I will already had a heart attack no???

The Cardiologist RX another test, I will have a 24 hours monitoring of my blood pressure... and he send me see a nutritionist because he really think I don't have enought salt in my diet... but I add salt all the time in my food since 3 months and see no difference, i'm worse than before...

He also RX a beta-blocker call "Acebutolol" but can't tolerate it, each time I take it I faint, even if I reduce the dose...

Of course, I don't want to run to the emergency cause they will told me it's all anxiety related!!!

So I need some advices...

Thanks everyone!!!
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1137980 tn?1281289046
I am so sorry that you are going thru all of this worry txQC.....i totally understand your worries on this but i think one of the first things you need to do is to settle down, step back a little bit and look at alot of this logically and it may help you somewhat.  I am not only a community member here but have been in the medical field quite some time now (over thirty years) and you may want to read my profile to give you just a little background.  But.....first things first lets approach each worry you have bit by bit ......
Anxiety for most people in relation to the heart is super common trust me....that includes me as well and i do not suffer from panic attacks and never have.  We all worry when strange feelings pop up and its the unknown that gets all of us until we get confirmation from a heart doc that all is fine but even after that it still nags us in the back of our mind mostly because the heart and the brain are the two organs that we don't ever want anything to happen to because they sustain life.  So that is understandable what you are going thru.  The great news is that after all of your tests as you stated in the first paragraph you got the green light that all is well so thats fantastic and your vital signs were within normal limits.  As to the second paragraph, it would seem to me that you fainted or experienced what is called syncopy more due to the panic attack and hyperventilating then the increased heart rate.  In the medical field we all do a little trick when a patient or ourselves find ourselves getting a little panic y or shocky...its call smell the roses blow out the candles....what we do is breathe in slowly thru our nose with our mouths closed and blow out slowly thru our mouths until the air is gone and we repeat this ten times....medically speaking what it does is to balance out our 02 levels in our brain so that we get the full benefit of oxygen or we go the old fashioned way of breathing into a paper bag to regulate the 02 levels which increased our 0-2 from 28% as we are doing as we sit here to the upper 90's trust me it works and calms anyone down.   Something you may want to try, its safe for anyone. The other thing to remember is that when our pulse rate increases its common for the blood pressure to drop, its the bodies normal way of compensating for the increased heart rate and it is considered within normal limits if your heart beats anywhere between the upper 60's and 120 beats per minute.  People who are conditioned well say like Lance Armstrong has a resting pulse rate of 38 beats per minute continually and most people that are super active in exercise and sports can have a normal pulse rate of the 40's to 50's and its fine.  In your third paragraph you stated that the next heart doc told you to eat more salt...the reason for that is that he wants to no doubt increase your electrolyte balance naturally which calms the heart and also increases the blood pressure a little.  I think that was probably a good call for you or anyone w. the same issues.  In your next paragraph which seems to be what is upsetting you the  most you need to realize that all symptoms may not appear to be what you think that they are and thats why we have doctors to supervise looks to me like you are worried about having a possible heart attack but from what you have described it seems like its more like a reaction to the worry then the physical.  Try to remember that the earmarks for most people in the risk groups are if you have had anyone in your family have a heart attack at age 50 or younger that you would be in a higher risk does not mean that you will just that you are in a higher risk group and at age 35 as you are you would be in that group if someone in your family had had a heart attack at such a young age which is improbable but not impossible so you should definately relax there a little.  Try to put it into perspective that the human heart beats over 100,000 times in a 24 hour period so its normal to feel all kinds of little weird things.  Its the main pump of the body.  The majority of the symptoms you have listed are more anxiety related and getting upset will definately cause many many of those...remember my friend,,,,,, smell the roses blow out the candle theory.  With the tests you have had done if you had suffered a heart attack the docs would know it and it looks like you chose some great pro active docs and now its up to you to take your life back and power thru this.  Angina would have been confirmed no doubt thru the stress tests and a heart attack thru labs.  Angina is caused from blockages of 02 and blood flow in and out of the heart and issues with the muscles of the heart and have super specific symptoms....and what you are describing again doesn't quite fit the bill.  If you are having issues with the beta blocker it no doubt is lowering your blood pressure way too much and the dosage needs to be adjusted.  Its  a great beta blocker and one of the most common given however if taken in too large of a dose it causes people to faint because the blood pressure drops too low a simple adjustment will fix that...what you never want to do is to stop taking it can be very very have to be weaned off of any beta blocker because if you don't you'll experience something called re bound and the fast pulse, irregular pulse will come charging back at you times 3 so be very careful and let the doc make that decision.  It is not for you to play around with the could do alot more harm then good to yourself.  The doc may want to take you to a completely different beta blocker that is more compatable with your body.  The main thing txQC is that you are steps ahead of the game here if you recognize that you are prone to panic attacks and anxiety issues.  So that is a plus...somehow you have to find a safe place in your mind with the heart worries my friend...if it were me i would try my best to put them to rest and take back control of your life.  You have to realize that here on earth we are not the navigators but the passengers and have no control over what may or may not happen to us medically speaking but can only exercise preventitive measures to try to avoid most things.  At age 35 as you are and as intelligent as you seem to be maybe the lack of total information is what is causing this.  Unless one of your heart docs told you something different you really aren't in a high risk group because of your age, your physical description, your vital signs.  Maybe what you need is what alot of us have done...find a diversion to take your mind off of these issues,,,,,volunteer at a humane society to walk the docs or feed the cats, sign up to visit senior citizens at a convalescent hospital who are lonely, volunteer to help clean up the beaches in your area, try anything to divert yourself where you think of others and not yourself because sometimes it really helps.  Also understand that Medhelp has a wonderful anxiety site and many members have the same issues of worry as you do and they are super active with one another and toss out some pretty great ideas to one another.  Good luck with this txQC and know that we are out here for you....and remember SMELL THE ROSES AND BLOW OUT THE CANDLES you'll be surprised how easily it works and if you feel faint remember to sit down, put your heart between your knees until the moment passes.......Godspeed to you.
Avatar m tn
Thanks for your answer cindy707! I really appreciate it, trust me!!!

I don't have the time right now to write a long answer... but I want to add some little things about my heart issue and also about the high risk group.

First of all, I smoke and trust me, I know it's bad. I'm 35yo and I smoke since i'm 12yo, so for more than 23 years old now. Since my heart is weak and since the chest pain appear in jun 2010, I smoke less then before, I reduce from 1 pack of 25 cigarrettes a day to 15... byt since 1 week and since the chest pain is on all the time, I smoke maybe 5-6 cigarettes and always when I feel less pain or have a regular heart beat, normally between 10 AM to 5 PM...

Some other things I forget to mention.. I had a gastric by-pass to loose a lot of weight in 2001. I had morbid obesity for 10 years, was at 445 pounds the day I had my surgery...

My sister have high blood pressure and my father have also high blood pressure...

I'm not fit, I was used to walk more than 1 hour a day until 2007... but since the anxiety is back in my life, and since the panic and heart anxiety start last year, I can't exercise at all.

For the fast pulse rate, since you told me you work in the medical field, is it dangerous to have a fast pulse rate of 180-200 BPM, it's also very irregular with a lot of heart skip beat, for more than 10-12 hours in a row? I have those episode 3-4 days by week... especially if I have to get out of the house, I have agoraphobia and can't be sit in a car, or drive, that's making my heart race... OF course, when that's happen, I have more chest pain, i'm a lot dizzy, I need to cought cause I can't breath normally... I try to put in practice the deep breathing technique I learn in one of my older therapy and it's not working to reduce the fast pulse rate, relaxation don't help me also, same for the yoga... So I wonder if having that very fast pulse rate can damage my heart or cause a heart attack?

Also, since 2 months, each morning when I get up, my heart beat is fast, not 180 - 200 but around 140 BPM and it's like this for 2 hours in a row... I was used to smoke cigarettes in the morning but now I can't because if I smoke only 1, it's trigerring powerfull panic attacks, and some of them lead me to fainting episode...

Same thing for the shower, now I have to take my shower in 2 parts... I wash my hairs and my face first and have to get out of the shower and sit and relax cause my heart beat can be above 200 BPM and I Feel a lot dizzy and anxious. I wait 10 minutes and when my heart beat is around 120 BPM I return in the shower and waks the rest of my body, but god I do this really fast trust me... After I take my shower I'm tired for the rest of the day... I Can'T even go out for a walk and just climbing the stairs make me a lot tired and can trigger panic...

So I don't know if everything I just wrote put me in the major risk group or not?

I try all the meds for stomach acid reduction ( Zantaz, pantaloc, Malox, rolaids...) nothing seem to reduce the chest pain and help my stomach... The chest pain is always worse after I eat BUT can also be worse for no real reason, I Can be sit on the couch and start feeling the weird liquid release in my left side chest and the pain increase to the point that it's trigerring panic and I feel like I will die...

Also, the new symptoms I experience since 1 week leave me a lot worried... I never wake up in the middle of the night cover of sweat, with strong chest pain and fast pulse rate... it's new for me...

Well, will write more later... have to go for now... but thanks again for your help !!! Maybe you can explain to me the difference between real cardiovascular disease-angina and the kind of heart problen the anxiety can create???


Vince ;-)
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