Can A Panic Attack Act As A 'Sort-Of' Exercise Stress Test?

[jerry78]

I know, sounds weird; however, I have had both: A treadmill Stress Test and too many panic attacks that I care to remember.

I worked up to over 90 % of my MHR and 10.1 METS on the Treadmill, and all was fine (back in 2001).

Now, with my Panic and anxiety (currently under control w/ Klonopin and Zoloft), there were times that I reached 90 % of my MHR during a full-blown attack, for at least 5 to 7 minutes straight.  If there were blockages, is it OK to assume that a full-blown Panic Attack would indeed cause angina, such as with a Treadmill Test or snow shoveling?

[CCF-M.D.-RCJ]

jerry78,

Interesting question.

Q:"If there were blockages, is it OK to assume that a full-blown Panic Attack would indeed cause angina, such as with a Treadmill Test or snow shoveling?"

Not necessarily.  Although different activities may lead to the same peak heart rate, they may not have the same ischemia-producing potential.  As an example, some people only develop angina with upper body movement or with eating, but have no problem with walking.  At least some of the disparity may be accounted for by the blood pressure response to different types of exercise, but other factors may also be at work.

If a person had angina in the past with panic attacks and then had a stent placed in a blockage, and now did not develop angina, then it would be a reasonable assumption that the stent was still open.  If that person later on began to develop angina again, then that might warrant further evaluation of the stent's patency.  The point is that an activity can serve as its own control.  But I can't claim that an activity can serve as a control for another activity.

Hope that helps.

[Carolina03]

Heir Doktor:

I know I'm breaking the rules by posting this question, but rules were meant to be broken!

I've been told that I'm having microvascular spasms; I'm also 6 months postpartum and have aortic and tricuspid insufficiency, as well as "marked" sinus bradycardia.

My cardio theorizes that the spasms are due to a chemical imbalance vs. heart disease. (Aren't we made of chems?)

If a patient w/ microvascular spasms is given nitro and it works, does that indicate a lesser form of CAD? (I've ruled out GI spasms). Can recurrent or prolonged microvascular angina cause cardiomyopathy or lead to a heart attack?

And what is the recommended diagnosis of and treatment for Cardiac Syndrome X, if that's indeed what I have?

Thanks,

Carolina

[CCF-M.D.-RCJ]

Carolina,

The pathology of Cardiac Syndrome X (CSX), or microvascular spams, or whatever you want to call it, is largely unknown.

Nitrates and calcium channel blockers are often used, but no one can tell you that they are the drugs of choice.

As far as whether or not CSX is a lesser form of CAD is largely philosophical.  We don't know the natural history of this disease, but most of us assume a more benign prognosis.

MRI has been used to diagnose CSX at some centers, but this should still be considered research.

Good luck.

[Carolina03]

Interesting. I like philosophical debates.

I'll have to live with the unknown I guess. My instincts are that a year from now I'll either be cracked-open, still under monitoring or living a carefree life in the Caribbean. (Care to join me?)

Thank you kindly for your informative response.

Best regards,

Carolina

[zinky]

Can someone explain the procedure TRANSMYOCARDIAL REVASCULARIZATION?? orTMR

[LynnSB]

I can tell you about Transmyocardial Laser Revascularization (TMR).  Cardiothoracic surgeons are using it  to help folks with angina who have run out of traditional options ( angioplasty with stenting, bypass surgery, meds) for relieving angina.

Using a Yag or , the most recent development, I believe, the CO2 laser, cardiothoracic surgeons create tiny channels through the wall of the heart (myocardium) with the  laser and this can help angina. The exact mechanism of how this works hasn't been figured out yet but studies have shown that TMR has a positive benefit and improves the quality of life. There's no evidence it prolongs life but one cardiothoracic surgeon told me it might well do that -- people feel better, can exercise more, they feel like eating better, taking care of themselves better.. seems only logical they might have better overall health and longer lives. Studies have showned improvement in symptoms and fewer hospital stays for recurring chest pain.

The procedure is most frequently applied as an adjunct to bypass surgery -- TMR is applied to the areas  of the heart where  blood vessels are no longer present that would permit standard bypass surgery or angioplasty.

hope this helps..

Lynn