Anxiety Attack or Heart Attack?

[Jenifer-Murphy]

  Bear with me...I must explain from the start:
  Over the past two weeks, I have had some major stressors added to my life, which already includes working full time with two young children (age 4 and 1 1/2). During these two weeks, I started having chest pains. Previous to this, I tended to have shortness of breath but only occasionally. My doc was sending me to have some basic cardio tests (blood, chest x-ray, and ECG). I had those tests done last Friday afternoon. Then on Friday night, my heart just started racing. I went to bed, but woke up an hour later with an even higher pulse rate (around 130/min). I called the doc who said I better go to emerg and have it checked just in case. In emerg, they hooked me up to the ECG machine, as well as the finger oxygen monitor. They did some blood work and took an x-ray. They also gave me an Adavan which made me sleep for the 2 1/2 hours while I awaited results. The results were all fine, as was the oxygen and cardio readings.
  Probably stress/anxiety related they said but I could see my doc next week and have some additional tests done just in case (thyroid, stress test, etc.). Numerous times over the weekend I had tachycardia....along with the mild chest pains. I was also out of breath each time I did the slightest chore. I called the doc who said I was making it worse each time by worrying - therefore causing anxiety - therefore causing my heart rate to go up.
  On Monday morning, I awoke after a long deep sleep (around 9 hours) to a totally numb left arm, palpitations, splitting headache, sweaty-clammy hands and (mild) chest pain. I got up and went downstairs to try to calm myself. Then I added nausea to the list of symptoms. After about one hour, I finally began to calm down and the symptoms went away one by one. When I took my son to school and went to see my doc, I felt completely fine. My BP was fine as well as my pulse rate at the docs. He gave me 10mg twice a day of Thioridazine to calm me. He has also set up a halter monitor for next week. I have never had any heart trouble in the past.
  I am afraid that something else is wrong with my heart. I am afraid to go to sleep at night, thinking that I am going to have a heart attack and die. My questions are:
  1. Can an anxiety attack occur during sleep and awaken you to this  scenario?
  2. Is it true that only anxiety could be calmed down and go away, whereas a heart problem would have continued on no matter what I did?
  3. Would the ECG machine in emerg have picked up on an existing heart condition?
  4. Is there some condition that could be affecting me when I am asleep and not as much while I am awake?
  I know this is a lot to ask, but I just want a second opinion. I am very afraid now and this will be making my condition worse if it is anxiety. I have to wait for a week to get the halter monitor and in the meantime, I just want to know what you think. I am about 90% believing that my problem is stress/anxiety related, but that 10% of me is still wondering....
  Please feel free to eMail me direct if this is too long to answer on the site.
  Thanx, Jennifer

[CCF Cardio MD - MTR]

Dear Jennifer, thank you for your questions.  I agree with the information provided in T.Wright's response to your question, but I'll respond to each of your questions individually.
  1. Can an anxiety attack occur during sleep and awaken you to this  scenario?
Yes, anxiety attacks can occur during sleep and can awaken you.   There is no specific time course by which anxiety attacks occur.
  2. Is it true that only anxiety could be calmed down and go away, whereas a heart problem would have continued on no matter what I did?
Yes, if you had a true underlying heart condition, it would not go away with resolution of an anxiety attack.  The ativan that you received in the ER was given to relax you and to terminate your anxiety attack.  As a result, your "cardiac" symptoms went away and you felt fine afterwards.
  3. Would the ECG machine in emerg have picked up on an existing heart condition?
Yes, if you had a serious heart condition, it may have been identified by the ECG machine.  
  4. Is there some condition that could be affecting me when I am asleep and not as much while I am awake?
That's doubtful.
Overall, I doubt that you have any serious cardiac condition and I think that an underlying anxiety disorder may be the cause of your problems.  Thus, I suggest that you seek treatment for such a problem (biofeedback, anti-anxiety medications, stress reduction classes).  I understand your concern and frustrations, but hopefully, your physician can reassure you that your heart is fine.  Good luck!

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.