Can the anxiety (cardiophobia + panic disorder and agoraphobia) lead to high variation of my blood pressure and my pulse rate?

Hi Everyone,
                         Just wondering if it’s possible that my heart focus (cardiophobia) can lead to the very low blood pressure or high blood pressure I have daily? Same for the pulse rate, sometimes it’s so low that I think I will faint and sometimes I entering into superventricular tachycardia who last 2-3 hours in a row with a pulse of 160 and more…

I ask this cause last week I had a holter monitor 24 hours to record my heart and the pulse rate cause I have superventricular tachycardia almost everyday since 1 month and strangely, the 24 hours I wear the holter monitor, I was able to do a lot of physical tasks and had NO chest pain at all, had no tachycardia (only in the morning but was around 110 for 1 hour or less) and when I return to the hospital to have the holter monitor remove, as soon as I return in the car, my heart start going crazy again, in the eveniing the chest pain was back, the morning after I had a very fast pulse rate of 160-180 for 3 hours in a row, had the same fast pulse rate at the end of the afternoon after I take a normal bath…

Same for the blood pressure… It was high for the whole month, especially the diastolic number ( around 150/95-110), and now it’s seem to be low ( around 110/55-60)… I’m quite worried about all of this and also confuse… Why suddenly my blood pressure return to the low side while I had it higher for the whole february month??? IS it me who monitoring too much my blood pressure and pulse rate or I pay to much attention to it???

When my blood pressure is too high I feel bad and think that I will have a heart attack or a stroke… and when my blood pressure is slow, I feel like I will faint, my pulse rate is higher and I feel bad also… it’s seem that I feel all the time bad cause of my heart…

I’m a little bit frustrated cause the holter monitor will give normal results and my Cardiologist will call me and say I have nothing wrong BUT in fact I have a lot of weirds things who happen with my heart since a while… the chest pain, the back pain, numbness of my left arm and hand, headache with pulsating veins on the temple of my head all the time, eyes pain, dizziness, intolerance to physical exercise, emotionnal stress will trigger superventricular tachycardia, things like that…

Of course, my family Doc do some test at his clinic when I saw him last week and find out that my blood pressure and pulse rate are weird, he took my pulse rate when I was standing and ask me to do some exercise in his office and take my pulse rate again 1 minute after and my pulse rate who was at 70 before jump to 168 with only minimal physical exercise… same when i’m sit and when I stand, I have a big difference in my pulse rate as well as my blood pressure… it tend to be lower for the blood pressure while i’m standing than when i’m sit…  Sometimes I wonder if the Klonopin and the Xanax can lead to those weird symptoms?

I’m now so anxious about all of this that I link some foods to the fact that my blood pressure or my pulse rate is high or low… that’s like an obsession… I barely eat now cause I fear to have a bad reaction to food that I eat!!! I also loose 21 pounds in less than 2 months… no wonder why….
For example,  everything with calcium increase my blood pressure and reduce my pulse rate… fruits and vegetables tend to make me sick (intestine pain and bloating, chest pain) and decrease my blood pressure, bread, pasta, rice tend to increase my blood pressure BUT can also lower it… I now fear to take my vitamins that I need daily cause of my gastric by-pass surgery I had to loose weight years ago… the Iron pills will increase my blood pressure, the Vitamin D will decrease it, the Calcium pills increase it OR lower it, the  Vitamin A tend to increase it…

I now give up on the beta-blocker, I try the Acebutolol 3 times and had bad reaction to it… I had some Inderal pills and since one month I was used to take 2.5-5 mg of Inderal when I had the superventricular tachycardia and it was reducing a little bit my pulse rate but was making me a lot anxious cause of the low blood pressure I had with it (low systolic number but , I don’T know why… and mno difference for the diastolic number), my Family Doc RX another beta-blocker last week, it’s call Atenolol  and I try it 2 times and felt very bad on it also, worse than on the Inderal…  It’s like my adrenal glands are all ****** up… can’t tolerate low dose of beta-blocker…

Anyway… i’m tired of this situation… I now fear to get out of my bed in the morning cause my heart always race… at daytime my pulse rate increase and decrease all the time, who is normal when you have normal pulse rate but on me it’s not normal cause it’s always too high or too low…. , I can’t fall asleep at night or nap at daytime even if I feel completly exhausted, who is strange cause in december and january I was sleeping more than 8 hours in a row and was doing long nap at daytime without any problem… I now have to take some Remeron at very low dose (3 mg maximum before bedtime to be able to fall asleep… under 3 mg the Remeron don’t affect the adrenaline release…  but it’s now begin to be not effective and don’t want to increase the dosage to more than 3 mg cause I don’t want the adrenaline receptor to be touch…

What to do with all of this? My Therapist don’t seem to know what to do right now…

Thanks for you support!

[greenlydia]

Your question "What to do with all this?" Short and to the point, get a second opinion, the sooner the better!
If I read this correctly, the only tests you mention are wearing the Holter for 24 hours and doing a few jumping jacks in your GPs office. This is NOT a thorough cardiac work up and that is what you definitely need. (In MY humble and non-medical opinion) But speaking as someone with heart issues myself, I would NEVER accept the slip-shod treatment you've received so far.
When you tell us that the evening after they removed the Holter, for three hours your heart rate was between 160-180 bpm, that is NOT good. Normal heart rates are between 60-100 bpm, so you were substantialy above normal. Personally, I would have gone to the ER.
As for your blood pressure, your high readings of 150/95-110 are are worrisome for the diastolic. Your low reading of 110/50-60 is actually quite good. 120/80 is considered to be the "gold" standard..........give or take.
When you have a rapid increase or decrease in blood prssure when you sit and then stand, that is called orthostatic hypotension and can lead to fainting. If your GP tested you for this, the dx is easily made. And yes, some medications can cause this. Your doctor should have investigated this.
As for food affecting your blood pressure or heart rate, I can say I've honestly never heard of that being a problem. Obviously caffiene can cause our heart rates to go up, but I am not sure if it also raises our blood pressure.
That you have been losing weight due to this concern about food is something that needs to be addressed. While I can understand it to a certain point, it's a bit irrational if you don't have medical eveidence that specific foods are the cause. But since you had gastric by-pass surgery, there may be a connection.......once again, I don't enough about that procedure or it's after effects to comment.

You have so many issues happening at once, you truly need medical help to sort through them all. But I firmly stand by my suggestion that you need a second opinion. I think the care you've gotten so far is horrible.
And as for your therapist not knowing what to do right now, he/she should have recommended a second opinion right off the bat. And a therapist who tells you they don't know what to do should be replaced with one who does.
I wish you the help you need and the peace you deserve
Greenlydia

[txQC]

Hi ;-)
       To be honnest, my Family Doc do his best, he said often to me that i'm the hardest person he had to treat in his whole career...

I have a cardiologist, in fact had 2 different ones in 2010, the first one rx a holter 24 h with a stress test with an ecography of my heart... BUT at the time I didn't had all of those cardiovascular problems, my blood pressure wasn't my problem and I had only a low pulse rate all the time... But in the summer 2010 things change and I start having chest pain and weird blood pressure and I ask to see another Cardiologist... That one don't even RX tests for my heart and just say to add more salt to my diet cause he was thinking that my blood pressure was weak and that I had chest pain cause my blood volume was too low...

I saw him in october 2010 and he said to call him back 6 months later to see what happen with the more salt diet... but I call him back in the begining of January cause my blood pressure was all the time low and the chest pain was more and more present... He return my phone call only 2 weeks after, refuse to listen to my complaints about my heart on the phone saying that he didn't had the time to listen to me and he RX a 24 hours test with a machine who take the blood pressure... I wear that machine for the blood pressure for 24 hours in the begining of February and the results was normal... I think my blood pressure average was around 130/85... in the Canada, if it's under 140/90 it's normal... they don't put you on the pre-hypertension category like in the USA...

The day I return the blood pressure machine to the hospital, I had a superventricular tachycardia episode who last 6 hours around 130-140 and 241 when I was at the hospital... so I was already at the hospital and the nurse do a ECG on me and send me to the emergency with the ECG results... I was keep at the emergency under Doc supervision for 6 hours, they run blood work, RX of my lungs... and all my results was perfect, nothing wrong in my blood, no lungs problems, my pulse rate decrease to 70 after 20 minutes at the emergency... They say that I have only superventricular tachycardia, who can be linked to my anxiety level and the Doc at the emergency RX a holter monitor 24 hours test to see if I have superventricular tachycardia often at daytime and when I do physical tasks or things like that...

So that's it, I wear the holter monitor 24 hours friday and saturday and nothing happen, even if the whole week before I had tachycardia every morning and also often in the afternoon and in the evening... and now it's returning again...

So that's why I wonder if it's just my anxiety who make my heart beat so fast and also if it's only the anxiety who decrease and increase my blood pressure all the time...

For my therapist, I can't have another one, I don't pay and don't work, so I have to see the one they give to me!!! It's the joice of a public health system!!!

One thing is sure... I feel weird all the time... and it's all linked to my heart... My PDoc say it's only a cardiophobia problem, that I need to stop monitoring my pulse rate and my blood pressure... but that's hard when your chest hurt and when you feel all the time your heart race or beating hard in your chest...

I see again my Family Doc in 2 weeks... will ask for another heart test, not a stress test with the regular treadmill and the ecography, maybe I will ask for a nuclear test, to see my artheries... Maybe I have some artheries blockage??? The chest pain worry me a lot, if it's angina pain, it have to be unstable angina cause it happen all the time at rest and last a long time... and unstable angina is not good!!!

I'm not in a good shape to be honnest, I was fat for almost 26 years, I smoke (try to quit often since 1 year but not easy when you are very anxious), and now im homebound so I don't walk a lot like I was used to do in the past and I don't exercise cause that's trigger panic attack... I don't even take a shower cause my heart beat so fast that I almost faint each time... even taking a bath make me feel very tired and my heart beat fast... Really weird...

Anyway, will also ask to see an endocrinologist... I completly forget the last time... maybe a simple X-ray of my adrenal glands will be helpfull to see if i'm having an adrenal glands problem... or any other kind of hormone problems...

Well, thanks for your answer!

[nursegirl6572]

There's so much information in your post...and while some of it could easily be attributed to anxiety, panic and you overdoing the monitoring of your vitals (causing an increase in your pulse and BP), I agree with lydia that this needs to be explored more thoroughly.  You've already had some testing done, but it seems you are getting mixed messages about the results, which is why if you can...seek out the opinion of a new cardio, and yes, requesting a referral to an endocrinologist isn't a bad idea either.  A panic attack absolutely can affect our pulse and BP..a panic attack is basically our bodies throwing us into "fight or flight" mode, which is the activation of the sympathetic nervous system...normally a reaction to a life threatening situation (ie someone holding a gun to your head, car accident. etc)...it is a self preservation mode that would allow our bodies to "kick it up a notch" and be able to more efficiently flee a dangerous situation.  The adrenaline dump that occurs during this definitely will increase pulse and BP, as again, it is giving our bodies more fuel for fleeing, increasing circulation to the extremities to allow for faster running, etc.  In a PA situation, the problem is...there IS no gun or car accident...the "trigger' is basically our minds, hence why they are so scary!

The thing with PA's is while the BP and pulse may be elevated during an attack and even a short while after, once our parasympathetic nervous system kicks in to restore order (which, incidentally, it always will...it's how our bodies are made..so even if we feel we cannot control it...our bodies eventually do it for us, despite feeling like it takes forever)....the pulse, BP, etc returns to normal.  That's the part of your situation that is a bit more perplexing.  It seems that the times your pulse and BP are high aren't always related to anxiety.  I think anxiety is a huge contributor here, but it is hard to say is it if the sole culprit!  Having cardiophobia surely isn't helping, as it is leading to irrational thoughts and behaviors (eating, bathing)...so that needs to be addressed as well.

What you have to keep in mind is even IF there is a physical/medical cause for your symptoms...it is way more likely that it is a common or benign condition, rather than to horrible things I'm sure you are worried about...heart atacks, strokes, etc.  There are thousands of cardiac and non cardiac treatable, non-harmful conditions that can cause these symptoms.  What you need to do is find out more of what is going on and demand a VERY thorough cardiac work-up that would either rule it out for good, or find the problem.  Like lydia also said, the increased diastolic BP number (bottom #) is concerning and can lead to chronic health concerns, which is why you need to keep pursuing answers.  There are so many diagnostic tests that can be done.  For one, there are Holter Monitors you can wear for longer periods, which are useful in situations like yours, where your typical symptoms don't "act up" during the 24 hr period of wearing the monitor.  Cardiac caths, Echocardiograms, tilt table tests (for the orthostatic hypotension lydia mentioned) are just a few examples...not to mention ruling out anything endocrine related wouldn't hurt also.

The beta blockers would be a great Rx option for your situation, due to the nature of your symptoms, but they can be a hard class of meds for some to tolerate with side effects like a drop in BP..a lot of people adjust well to them, but again, this all needs to be more thoroughly explored.

Lastly, I cannot stress enough that while you continue to work with your docs, you need to stay on top of your anxiety issues with your therapist...to deal with the phobias you have, and are developing as a result of this (food phobias, etc).  While it may end up being that anxiety isn't the primary CAUSE for your symptoms, it is definitely a contributing factor that needs to be controlled as much as possible as to not muddy the waters while you are in the diagnostic process.

You're in a tough situation for sure, and I know it is frustrating...but hang in there and keep working with the doctors until you have more concrete answers.  One thing that is hopefully a bit reassuring for you is if you were having a major cardiac event (like a heart attack), it would have already been discovered by now.  I know you fear dropping over dead...that's the cardiophobia talking.  To be honest, while you may indeed have something medical going on..statistics have it that you would have already dropped by now..if that makes sense.  There is no nice way to say that, but it is true.

The very best to you, please let us know what's going on!  Try to manage that stress and anxiety as best as you can!  Start with trying as hard as you can to limit yourself to once or twice a day taking your pulse and BP.  The simple act of measuring those things can cause a spike in the #'s and may even act as a trigger for spikes in the #'s.  This is why so many people have a noticeable increase in #'s at the doctor's office or hospital...it's called the "white coat syndrome".

[txQC]

Thanks for your answer ;-)

Yeah, I put a lot of informations in my post cause I have a lot of issue that CAN be related to anxiety BUT also to many other disease... and that's a very frustrating situation cause  a lot of Doc and Cardiologist will say it's only anxiety related and will trivialize the situation
and put you into the category of peoples who are very anxious and hypochondriac category and will not want to run more tests on you... that's what happen to me... Even if I ask for more tests for my heart, my Doc and the Cardiologist will say no cause I had a lot of tests for my heart run last year and everything was ok with my heart, even if my symptoms get worse over the last year!!!

Right now, what I can say about my blood pressure is that it's now returning to the low side at home, that's really weird cause it was high for one month... For me, I feel worse when my blood pressure is lower than 110/60... right now it's around 105/65... and the more it's low and the more I have numbness in my chest and left arm and that dull pain in my chest... I feel better when my blood pressure is normal like 135/80... who is my normal blood pressure that I had for several years until last year... When I have to get out of the house, cause I can't be in a car without having a panic attack, my blood pressure, especially the diastolic number is higher, but that's normal and I don't freak about that, since it's not like i'm having high blood pressure all the time... I know that at home it will lowering...

I agree that I need to less monitoring my blood pressure... I already stop doing it and try to avoid to take it... but for the pulse rate it's hard cause I always feel my heart pounding in my chest or hear it in my ears... I don't need to put my finger on my wrist to take the pulse rate, I can count it and feel it!!!

Like I explain in another message, I can't ask for another Cardiologist, we have a public health system here and I take the Cardiologist they give to me and if i'm not happy I can't do a lot of things... What I can do is to ask to have a new Cardiologist in another hospital, but I will be put on a waiting list for 6 months or more... The Cardiologist I have right now don't care about me and don't run any kind of heart test on me... just the blood pressure monitoring 24 hours and I had it 1 month ago and he never call me back to give to me the result... I had the result from my family Doc only cause I had an appointment with him and ask the hospital where I had the heart test done to send the results to my Cardiologist and also my Family Doc...

I ask my Cardiologist to have other tests, but he say no, tolding me that I had already a holter monitor 24 hours and a stress test with an ecography of my heart... he say that all the other tests are not necessary... so what I can do?

For the panic attack, I have them since i'm 19 yo, so since 16 years... and I know they increase the blood pressure and the pulse rate, i'm used to them... but what I live now is completly different... The very fast heart rate (140 and more) who last several hours, the numbness of my left arm, the chest pain who also last 24 hours now, that's not usual... BUT if it will be a problem like angina OR a heart attack, I think I already had a heart attack... that's not possible to have chest pain and left arm numb for 5-6 days in a row.. it must be only the anxiety who constricts my blood vessels in my chest and my arm... and also give to me that bad headache pain with pulsating veins on my left temple of my head and the eyes pain...

What I think is that my sympathetic nervous system is all the time on the flight or fight mode now and that's why I have more and more anxiety symptoms who last all day long... and since I have cardiophobia, my anxiety probably jump in my chest and heart and affect my head also... I know that normally after a panic attack the sympathetic nervous system return to the normal and the blood pressure decrease and pulse rate also... but I guess that for me it's all the time ON...

In the past, I had minor panic attack... last 5-10 minutes and I was ok after and not anxious at all... now it's like i'm all the time in a panic attack...

That's why I want to ask my Doc to see an Endocronologist, cause I maybe have a problem with my adrenal glands... I had my cortisol level took in the morning and it was very low, and less cortisol often = more anxiety, more panic...

For the beta-blocker, I try a lot of them in the last year... Was on 160 mg of Inderal, 3 years ago for my migraine problem, but it was not working...at the time I didn't had the cardiophobia and never notice a decrease of my blood pressure or a slow pulse rate... I was just tired all the time... But I try last year the Bisoprolol, Lopressor, Inderal (again), Atenolol, Acebutolol... I feel worse on them, they decrease too much my blood pressure, have orthostatic hypotension with them and they don't reduce my pulse rate at all... they tend to make me more anxious... I try in 2009 the Clonidine, who is an agonist of the A2 receptor and it was ok... more tolerable than the beta-blocker... Maybe I will ask my Family Doc to RX it again to me when I will see him in 2 weeks...  The main benefits of the Clonidine is the fact that it's not decreasing too much the blood pressure and reduce more the pulse rate... OK it's more sedating, but at least when I take it I don't feel like my heart will stop...

For the Therapist, I saw her only 6 times for now...  I see her again next week... it's a work in progress... I had a very bad childhood and my anxiety problems are very linked to my very low self esteem... she agree that I don't need an exposure therapy like a regular CBT, I need something different... since exposure therapy don't work on me... It will be a long work that I will have to do with her... For now she can just listening to me and give to me some work to do at home... especially write about my emotions and what I feel everyday... to relieve myself from my a part of my anxiety...

Anyway, thanks for your answer ;-) I will give some news later...