Anxiety

Hi,Im 27 years old woman, I suffer from panic attacks, what causes me tachycardia.All my tests(EKG'S, blood ..) are fine, so my doctor told me not to worry about, because it's harmless, but recently I found some medical researchs in Internet linking anxiety with sudden cardiac death because people with anxiety disorder and depression have a decreased heart rate variability which is linked with a higher risk of ventricular arrythmias.So, am I in a higher risk of sudden death?.I am concerned about this.
Thanks

[Cleveland Clinic]

Triana,

Thanks for the post.

To put it short, you are not.  There is no evidence linking these conditions, even more so in someone with a completely normal cardiac evaluation and no history of arrythmias.

You have made this an unhealthy focus of your anxiety, which in turn has led to further worry.

Good luck

[tickertock]

This is a great question, even though I personally think a person with anxiety has to have some underlying condition that would trigger such an event. I could be totally wrong though. I have read the same research also.

[jwinst]

This is a good question! I have been dealing with panic attacks with tachycardia and PVCs for the past year or so. I am also concerned with the long term effects. I have had all the tests done as well, and have been told there is nothing to worry about..yea right! I would like to think that one would have to have some other problem that is worsened or aggravated by anxiety/panic attacks. I am anxiously awaiting the doc's answer, but not too anxiously!

[woodruff]

I have had episodic panic attacks for probably twenty years now, and can say that this is something--cardiac problems or not (I have a floppy aortic valve)--that you don't have to live with.  I've tried cognitive therapy and drugs, and for me, drugs, specifically SSRIs, are definitely the answer.  Oh sure, the short-acting benzos like lorazepam are useful, but if you're in a stage of your life that includes frequent panic attacks, a long-term strategy is a good one.  As my shrink says, "You have to give the alarm system time to quiet down."  

Over the years, I've tried a good number of different SSRIs, and I know which ones are best for me, so when I enter a panicky phase, I go on a low dose of my favorite SSRI for a few months.  Usually, in 2-3 months, I can feel that things are back to normal, and can taper off the drug--until the next time it's needed.  Some people may find they need continuous therapy, but this works for me.  And believe me, it's a lot better than lurching in and out of panic.

[fearfactor]

Hi, I think you are right - in most people with severe anxiety disorders there IS an underlying condition.  From what I have learned through research it is a chemical imbalance in the brain that causes hair-trigger anxiety reflexes, so to speak.  I have severe anxiety, have had panic attacks since the age of 12 - so do many, many members of my family.  Even some folks who have never had a heart palpitation in my family have severe anxiety.  So, I don't think it's a physical condition (at least not as they are commonly thought of) with most people, but an imbalance of brain chemicals.  That's why SSRIs seem to work so well for so many of us, they balance the brain chemistry.

[tickertock]

That is absolutely correct, anxiety  from chemical imbalances manifest itself with a broad variety of physical symptoms, though heart related symptoms are by far the most common.

[CollegeGirl143]

people with anxiety tend to reach for something tangible to blame their anxiety on, rather than just accept the fact that it really is usually in your head. Celexa completely cured my anxiety... searching for conditions on the internet to further your anxiety is only going to hurt you... As for the arrythmia part of that question, i only know about SVT because its the only one i had, but i know that i was born with it and anxiety doesnt cause it.. it triggers it.. the extra pathway i was born with caused it.. im assuming its the same with VT..Maybe the article you read was trying to convey the fact that if you already have VT, anxiety is a likely trigger, and its a known fact that people with VT are at a higher risk for SCD. if you are still very concerned see a cardiologist but be willing to accept his answers. Then see a psychiatrist if you need to.. anxiety is more common than people think.

[andie3330]

I've had pretty severe anxiety issues - mostly health related - for over ten years now, I'm 39, female. Cognitive behavior therapy and Paxil had been helping quite a bit until the last few years. Since my daughter was born, it seems like my anxiety has really intensified.  For those of you who have had success with SSRIs, which one have you found to be most helpful in treating anxiety without increasing tachycardia/arrythmia issues? Since I've been off and on Paxil several times over the last ten years, I think, and my doctor agrees, that it has lost its effectiveness for me. My doc suggested adding Welbutin, but I didn't want to do that because I've heard it can aggrevate heart issues. I think I'm going to wean off Paxil (which in and of itself is a difficult process for me)and then try Luvox - which I've heard is good for reducing obsessive thinking without being stimulating. My doc said this would be fine - he couldn't really say that one SSRI would be better than another. Since I don't really have depression, I just need to figure out which of the SSRIs would be my best bet to try next.

Fearfactor, since you've had success in recovering from health anxiety, do you have any thoughts? Was there a particular part of your treatment that seemed especially valuable for you? Have you had any luck with SSRIs? I hope you don't mind the directness of my questions. I would just really appreciate your insight since I know you've "been there". Thanks so much.

[mrbh]

At times, my anxiety is disabling, leaving me feeling morbid as well as sick. So I can appreciate what everyone is talking about.

Over the years, I have refused ALL of the SSRI meds after reading the literature on them. Heart issues of one kind or another are a considerable risk with all of them. Already suffering with sinus tach, PVC's and other vague palps, the last thing to be looking at is medication that will aggravate those conditions.

SSRI meds can also be very difficult to stop taking.

Seems to me that the downside of these meds far exceeds any benefit they might have.

[Erik36]

For me, Prozac seemed to be the most effective in stopping my panic attacks. It was the first of the SSRI's to hit the market back in the late 80's. Its safety profile is similar to all the other SSRI's. And it's a very easy drug to taper off of because it is very long acting unlike Paxil, which is why it is so hard to taper off from. Best of luck to you.


Erik

[momto3girls]

Hi Triana,

I too have suffered from panic attacks over the last few years.  Mine were brought on after my 3rd baby was born, my body went wacky and I kept thinking the worst (tumor, cancer, heart) until they could find the problem.  Sadly, it was incapacitating which was very difficult as I had 3 small children at home.  I think it's very hard to decide which came first (you know the old chicken and the egg thing) because for me I never had a panic attack until I started worrying that something was wrong. I refused to go on anxiety meds and have dealt with it on my own.  My advice would be to try to relax and realize (like the other commentors said) that they are most likely benign especially in light of the fact that you've had a cardiac work-up.  I truly know what you mean though, my heart skips, flutters, pauses and races.  I've had numerous work-ups and all the cardio doctors say the same thing, totally benign but obviously annoying!  They can be hard to ignore especially when they feel the way they do!  Good luck to you though and try to gain reassurance from the tests you've already had done (:

[woodruff]

I have used Paxil, Lexapro, Celexa, and Zoloft, and for me, the best of the SSRIs for panic has proved to be Zoloft (although Celexa has worked fairly well in the past).  As I calm down on the stuff, the intensity both of panic and the co-existing pvcs diminishes greatly, and I do have the impression that the frequency of my pvcs actually tends to decline.  I haven't checked it compulsively, because after I feel better--well, frankly, I'm not really interested in listening to my heart anymore!  However, I can say that on followup visits with the doc, neither of these drugs has increased my rhythm irregularities or adversely affected my BP, quite the opposite, in fact.

As for tapering off, I have found Zoloft and Celexa to be very, very easy to do.  Piece of cake, with no dramatic horror stories to report.

[dmbe70]

Can anyone explain the difference between the two for me?  I have had the whole cardio workup done, and come back with no problems except PVC's and PAC's (although I was told at one point I have supra ventricular tachycardia. not sure what that means), but all has been deemed "not worrisome".  
What I tend to feel is the sinking feeling (PVC, PAC, that I know) but there are times (the cardiologist calles it sustained) when it goes on and on and instead of the initial hit or skip, I feel a sensation where I can't catch my breath, and I continue getting the skips.  Almost as though my heart does not reset it's rythym.  The doctor caught it on the 30 day monitor, but not a really bad one, yet she still says it's not worrisome.  
Any chance this is perpetuated by the anxiety that you are all talking about here?  How can it not be worrisome??  I have never even had 'anxiety" mentioned to me.
Any thoughts?  Or can anyone tell me what their "episodes" feel like.  Cardiac OR anxiety.
Thanks!

[PikaPika88]

Cardio said I didn't have any PAC & PVC.  All my palps is due to anxiety.  Even I have a pacemaker, mildly enlarge left ventricle and wpw.  The palps are belong to nothing. JUST ANXIETY!  So....  Cope with that.  

I wonder anxiety kind of tachy is hard coping than the PAC, PVC or not?  My palps come in after eating.  Anyone with anxiety after each meal?  What a food cause me so anxious!  

Pika.

[LukeL]

I believe when you say heart rate variability  you are refering to a webpage which indicated that when an EKG or telemetry shows the same pattern over a period of time without a change in any of the wave forms or duration it is an indicator of a fatal arrhthymia occuring shortly there after. (You can tell I am in the same boat as you).

From what I got that only is true for those people with damage to there natural pacemaker and AV node and other conduction problems which would show up on an EKG. In short this is nothing to worry about.

I probably spend 1-3 hours a day studying all kinds of medical research and have never seen a studying linking SCD to anxiety in an otherwise healhy person. It is true that in a person which severe CAD or other heart problems a panic attack can be deadly but for you this is not the case. I would try to tell you to move on and try to focus on something more positive in your life.

Of course I am not a doctor and the above is just my opinion.

[fearfactor]

Hi, I don't mind questions at all!  In fact, I like to talk about my anxiety because it helps me overcome it.  I can't take an SSRI right now because I'm pregnant so that makes it tough, but Lexapro did work well for me with very few side effects.  I think you do just have to experiment to see what works best for you - I"ve tried lots of others but Lexapro seems to be the one for me.  As to the therapy, what has really helped me is the "reality check" aspect of it - my therapist has me write down all my scary thoughts and then see if they're really realistic and write down responses to them.  That has helped me to see that a lot of what I was thinking was just exaggeration and wasn't rooted in reality.  She also has told me I have to let go of what if's - well, what if this time it is v-tach, what if I drop dead, etc.  Well, what if it is, which it likely isn't!  I can't sit in my house and wait for that feared occurrence - I have to go out and live and not let this cripple me.  I've decided living life is more important to me than sitting inside worrying about health (at one point I couldn't be home alone and was scared to go anywhere).  It's taken a while, but it has really helped.  I had severe anxiety after the birth of my 1st child so I know it can be tough.  I'm going back on Lexapro a couple weeks before my next delivery so I can be prepared!  I hope you can find some relief from your health anxiety, it is so tough.  Feel free to ask me any more questions!  :)

[Triana2]

Thanks to the doctor and everyone for the replies, maybe I am exaggerating too much, but it is so confusing all the information about anxiety and cardiac mortality..
LukeL, I dont know, but the research I found about heart rate variability, linked anxiety with sudden cardiac death, not sure if they refer to people with an underlying heart disease or arrythmias already, but it is scary for me,I am quite concerned and confused..Take a look if you want, maybe I misunderstood them:

http://spitswww.uvt.nl/web/fsw/psychologie/emotions2003/2/h4.pdf

http://www.med.wayne.edu/wayne%20medicine/wm2001/yeragani-anxiety.htm

[jwinst]

I do have some problems with palps after eating. Sometimes when I eat a large meal I get palps with a rapid heart beat. I think the fast pulse is due to the fact that I get the palps and I get nervous. Going out to eat is not always a pleasant experience! I have not narrowed to down to a certain type of food, just the amount. It is very odd.

[momto3girls]

I agree, you cannot sit at home terrified of what might happen.  I am speaking from experience here too!  It can be very disabling and the mind is a powerful thing!  You can convince yourself that the worst will happen (v-tach, scd, heart attack) and then be so afraid to go anywhere.  I understand it completely but I think the solutions you gave are great!  Writing down your fears and then read it to see if they're realistic and how you respond to them.  It is hard to deal with especially being pregnant I assume.  The what-if's are definitely easy to get into the pattern of doing.  Life is hard sometimes isn't it?  We all have our issues to deal with in life and anxiety sure as heck doesn't help at all!!  The most important thing is to go out and live your life, like you said, instead of anticipating the worst.  I know for me, traveling to to other places alone with my kids was the worst.  It's a serious problem that needs to be dealt with directly in the face, look at it and analyze why you feel the way you do.  Don't let it plague your life!!!!  Great advice fearfactor, it brightened my day!  Take care everyone (:

[fearfactor]

I'm glad that what I wrote brightened your day!  One more thing I've realized about my anxiety about arrhythmia is the CONTROL issue.  I don't fear CAD, b/c I feel I have a lot of control over it - eat healthy, exercise, keep weight down, etc. and you should be OK.  Same with other "preventable" type diseases.  Arrhythmia scares me so much because of it's seeming uncontrollability - you either have it or you don't and you can't really stop it if you do.  I am a "control freak" and I think my anxiety is rooted in this.  That is one thing that has REALLY helped me to see that!

[MHL]

Gosh, I feel like I'm home.  What a great forum!  I only wish I could join a local group like this in person.

I am a 33 year old female.  I've been having SVT episodes (about once per year) since I was in high school but it wasn't until 2 years ago when I called paramedics during one that I was able to take an EKG to my cardiologist.  She diagnosed it immediately and said it was nothing to worry about, just an annoyance.  They did a work-up and concluded my heart is healthy.  Now, it must be said that I'm a highly anxious person.  My heart rate has probably never seen less than 75, and is generally between 80-100.  I should also mention that I occasionally experienced panic attacks.

Two weeks ago, I had a freaky episode while eating lunch with friends.  I could feel my heart start beating fast and hard (but NOT like an SVT episode) for no apparent reason, which then probably increased my HR from the sheer anxiety.  When I called paramedics, my HR was 156.  They arrived, checked my vitals, HR slowly decreased to 120.  BP was of course high.  They chalked it up to a panic attack or a "preemptive SVT" attack.  I've since forwarded the EKG and info to my cardiologist, but I really think it was probably a panic attack of some sort.  It's happened several times since that episode 2 weeks ago, probably because I'm hyper-sensitive now.  Is there a drug that can be taken at the onset of an episode, rather than ongoing treatment?

Okay, maybe I should see a psych.  I can see myself becoming more obsessed with my heart health and the possibility of dying from something related.  Life's too short.  I'll take any and all suggestions.  Thanks, everybody.  Really a great forum.

[Triana2]

So, What do you mean? Anxiety is dangerous as well for people without any cardiac issue?,this scares me a lot....

[andie3330]

Hi Triana,
I totally sympathize with your anxiety, but you worries are unfounded. Think of it this way. If you had serious heart problems - like advanced CAD or serious heart rhythm disorders (not just PVCs or PACs or SVT or whatever) or advanced cardiomyopathy, you would NOT be able to get up and run around your block without putting yourself at risk. You would have to have a closely supervised, doctor approved exercise program.  On the other hand, if you have a healthy heart, vigorous exercise is not only safe but very beneficial. Does this help at all? Because of my anxiety disorder, I have stressed out over many research articles that I have read, but invariably, once I have the whole picture - for example once I have actually discussed it with one of my doctor friends or my own personal doctors, I will find out that there is piece of information that I am missing that makes the research totally irrelavant to my situation and then I can instantly let go of the whole issue. Now I try not to get myself all hyped up over these types of research studies or news stories to begin with.
You have my sincere best wishes. Andie