Cardiac Neurosis?

Hello,

I am a 38 yo white male with a family history of heart disease (Dad died of CAD at 42, maternal Grandmother had 1st heart attach at 52). I was diagnosed with CAD in June and had angioplasty & 4 stents (Cordis drug eluding type) for 2 blockages each in my LAD & RCA. I suffered a complication, my artery was perforated during the proceedure and a pericardial effussion started, leading to cardiac tamponade and a near death experience. An emergencey Pericardiocentisis followed along with days in the ICU with a drain in my chest, then several months of steroids to shrink the effussion. Follow up echoes show the effussion to be gome and no damage to my heart. I am now on Lipitor80 & Zetia10, and my ldl is down from 160 to 72. I'm also on Plavix, Enalapril, asprin and Atenolol (25mg x2). I have Gerd to add to all this.

I constantly feel chest, gastric pains & palpitaions and these lead to what I believe are panic attacks. I have had 2 thallium stress tests at 2 different facilities in the last 6 weeks, both of which were negetive. My cardiologist assures my that I am fine, I do not have a new blockage or restenosis. He believes that I am suffering from anxiety problems, which I am now forced to agree with. I believe that I am sufferuring from a panic disorder (cardiac neurosis?); I take my pulse and check my BP constantly and I panic at every discomfort I feel in my chest. It is becomming a problem for me.

Do you come across this sort of thing very often? What treatments or therapies do you recommend for your patients who suffer from similiar problem?

[CCF-M.D.-MJM]

Hello,
I am sorry to hear about heart disease and the complication of you stenting.  Cardiac tamponade is a rare complication of stenting, but it does happen and can be devastating.  Fortunately everything turned out well for you.  

I see anxiety about heart disease every day.  In fact, we probably see more people worried about heart disease or fearing problems they don

[Paule]

This site is loaded with people with Cardiac Neurosis...and you, by the way, have something to actually worry about.  Can't say the same for some of the other daily visitors.

Try to listen to your doctor and not so much your body right now...its just wasted worry.  You've been through a lot and are doing all the right things.  Stay on top of your condition but also enjoy life.  "Live everyday likes its your last for one day you'll be right."

[hankstar]

It is common for persons with heartdisease , open heart surgery, and other cardiac procedures to develop these symptoms referred to " as cardiac neurosis", when a apparently all thorough testing suggest that it is not related in anyway to their condition, only anxiety because they are aware that they have a true problem that needs to be watched carefully.

Unfortunately some persons their past is the only future they see for others and themselves(not referring to you personally, but I have a long memory), just to add to what paule wrote, Let's not count the years ahead , nor contemplate the past, but live today and everyday as though it were last.

Just one more thought, let us all here that visit and comment on this forum not be too hard on all our vistors that suffer with "cardiac neurosis", it is an awful problem that can make one become a "cardiac cripple" despite the complete lack of evidence for a true cardiac problem.

Kindest regards.

[va_tony]

Beerhoch,

There's a saying (source unknown): "Sure I'm paranoid..... but am I paranoid enough?". In your case, having had an angioplasty, 4 stents and a family history of early cardiac death, I would say you are DEFINITELY NOT A CARDIAC NEUROTIC.  And you may not even be paranoid enough. However, this is not to say that don't have (justifiable) anxiety which is actually making your situation worse than it need be. You certainly do. You need, as CCF-M.D.-MJM points out, to treat the anxiety as well as his heart condition. An anti-anxiety med (SSRI)like paxil is a great suggestion. As usual, the CCF doctor's advise is right on.

To Everyone Else, especially cardiac neurotics:

Concerning paule's comment and the subject of cardiac neurosis.  I too agree that there are (too)many "cardiac neurotics" frequenting this Forum.  This is not to belittle them because I think they have a serious illness and need the support that they receive here. As CCF CARDIO MD - DLB wrote a few years ago:

"Cardiac neurosis is just a fancy way of saying someone is overly anxious about having heart disease, when in fact they do not. This would apply to many people who are disabled by benign PVCs." [CCF - MD - DLB]

The fact is many true cardiac neurotics regularly experience PVCs and tachycardias which are caused not by any underlying heart problems but by ANXIETY.  The anxiety causes the PVCs and tachy, which in turn further feed the anxiety.  Remove the aniety and the PVCs and tachy will disappear. Some allow this condition to totally disrupt their lives - - - to the point where they fail to enjoy their family and hobbies, can't do their jobs, are afraid to travel, to exercise, .... to do most anything but worry about their (non-existant) heart conditon. It's a viscious cycle which is hard to break.

The first step in breaking the cycle is to realize what you are suffering from (assuming the shoe fits). So, please don't take my (or paule's) statements as a put-down. If you a true cardiac neurotic, it does you absolutely no good to haunt Forums like this and become walking encyclopedias of heart and arrhythmia knowledge. Rather, you should attempt to understand your true underlying problem, anxiety, and have it treated appropriately. You don't need Rythmol or other anti-arrhthymics (or even beta blockers).  You need appropriate anti-anxiety meds, stress reduction or bio-feedback training or even psychoanalysis.

Anyway, these are just my thoughts, meant to be helpful.  I'm not a medical professional.

Best wishes to all,

Tony

[pms_barbie]

ok what about those of us that have other problems along with the pvcs?  I have moderate to severe mitral valve prolapse with mild to moderate leakage.  I am suppose to get an echo every 6  months.  If I am neurotic sorry I cant help it.  I mean I hear that I may never need a valve replacement I just take that as dont worry about it right now but come back every six months because the eneviatable is just around the corner. They say my pvcs are benign because my heart hasnt stretched out yet...what happens when it does?  They become more than just benign then?

[Marilyn (runner)]

Hi,  In my non-expert opinion - the only thing that is important is 'what' you think as a cardiac patient and not what anyone else thinks..  

As a cardiac patient myself I personally would not let any cardiologist or PCP diagnose my symptoms as anxiety...  and if they were telling me it was anxiety - I would politely ask if THEY were an expert in this field of medicine.   IF not, then I would get a referral to seek the expert opinion of a psychiatrist with an MD Degree - as I think they would be the best expert to know the symptoms of 'anxiety' and they should be able to treat your anxiety or panic attacks - if indeed thats what it is.. and if it is - then your getting the proper care from an expert.  You may actually be experiencing "both" cardiac issues and psychiatric issues.  Heart disease in my opinion is 50% mental and 50% physical and some of these cardiac meds are playing havoc on some cardiac patients..  Which could be a case of just adjusting your meds.    

Good Luck
Marilyn (runner)

[Ianna]

Yes, it is a real nasty thing -- "anxiety".
I feel the same things you do, so I know.

May I ask you after your Near-Death-Experience?
I am terribly interested in NDE's.
What did you 'see and feel' while nearly 'over there'?
Thanks in advance.
Have a lovely week-end.

-Ianna-

[Erik36]

I have Cardiac Neurosis. It started with isolated PVC's when I was 18. I developed panic attacks and non-cardiac chest pains at that time. No matter how many times I was reassured by Doctors and Emergency room Doctors I was conivinced I was going to die everytime I had an epsiode. I was started on Xanax and Prozac and Metoprolol when I was 23 years old and went into remission from my Cardiac Neurosis. When I was 26 I started having frequent PVC's every day. I went to a cardiologist who told me my PVC's were benign so I suffered through them every day for over a year. Then one day they just stopped. Since then I get them occasionally, some days more than others. They don't worry me any more.

In 2001 I had a lipid panel done and found my total cholesterol to be 175, LDL 90 and HDL 27 and Triglycerides 212. I went on low fat diet and exercised and all my numbers dropped including my HDL which fell to 24. Once I read about the significance of low HDL this became my new obsession. Through alcohol, diet, exercise and Zocor I have managed to get my HDL up to 42 and now back down to 32. My total is 102 LDL 54 HDL 32 and Tri 81. My doctor doesn't seemed concerned about this low HDL because of my low total and LDL. I am still obsessed, though. And the beat goes on. (no pun intended)

Erik

[Erik36]

I forgot to mention I was diagnosed with PAF (Paroxsysmal Atrial Fibrillation) in 2001 also. I had to be anticoagulated. I've only had one sustained episode whith lots of little ones. I take Toprol and Cardizem CD for this. I can't believe I left this out.


Erik

[hankstar]

"Cardiac Neurosis" I guess this forum would have very few vistors if it wasn't for this "cardiac neurosis". Yes and it feeds off anxiety, but the fact remains "cardiac neurosis" is a label given to many who have a real disruption have the nervous system, usually some form of dysautonomia or PSVT for which there is no other explanation for their symptoms and leaves both patients and doctors baffled.

  In the past few years a much better understanding of this has evolved, for example a majority of panic attacks blamed on anxiety, about 50-60 % of these cases , PSVT was actually the trigger and not anxiety, after ablation about 85% of all panic attacks/disorder disappeared.

  While no doubt they are many that have no true heart problems and are true "cardiac neurotics", just to label everyone that has anxiety because of symptoms related to the heart a "cardiac neurotic" is unjustified because the heart symptoms are usually found to be the manifestation of some other medical condition that has not been diagnosed properly.

[Erik36]

Thanks for the kind words of wisdom.

Erik

[va_tony]

pms_barbie

I don't know how accurate CCF - MD - DLB's simplified definition quoted above is, but it is pretty straightforward to interpret.  The key features are being "overly anxious", "benign" and "disabled". Sure everyone has some degree of heart problems as they age (valve regurgitation, arterial plaque buildup, stiffening/thickening of the ventricles, etc.). Many even have arrhythmias not related whatsoever to anxiety (except, as Hank says, anxiety likes to feed off them). Even if not strictly benign, the arrhythmia at least doesn't present a near term death threat. The proper way to handle these, I would think, is by visiting the cardiologist regularly, taking prescribed meds, educating oneself on one's condition and following a heart healthy lifestyle (maintaining BP, proper diet, etc.). Then living life to the fullest. But if one overreacts to these arrhythmias to the point of disabling oneself, being afraid to live a normal life, then that's cardiac neurosis IMO.  In particular, if you are so anxious that everytime you think you feel you are having a palp you go into a panic and the resulting adrenaline rush causes/worsens your episode, then I would say you are suffering from a form of cardiac neurosis. On the other hand, concern over a real heart condition is natural. C. Neurosis all comes down to whether or not anxiety has reached a counterproductive stage that now needs to be treated.

The case of over-reaction to PVCs is one that I think naturally suggests C. Neurosis. First because PVCs are so common in the general population and second, because they are usually benign. It should not be having a disabling effect on one's life.

Best wishes,

Tony

[lmroswell]

Does anyone have an experience with CAD, which resulted in a  bypass and aortic valve replacement, and since has gone on to have carotid artery blockage?  I am interested in experiences and treatments for such a scenario, as my Mother is now dealing with this situation.  It has been recommeded to her, by her oncologist/internist that she treat this medicinally and not surgically, due to her cardiac history.  She also has had breast cancer.  Her cardiologist has referred her to a neurologist.  Why a neuro, I am not sure.  But, so far, everything I have read suggests that surgery, though risky, is her best bet.  Any thoughts?  Thanks...

[suki1724]

Let's see, I had an ablation six weeks ago for pvc's, (20,000+ per 24hours verified by CCF), I was very symptomatic, and my wonderful, well-respected EP DR. at CCF told me that my symptoms were CAUSED BY MY PVC's.  The fact is that some people don't feel them, (lucky devils), some people can ignore them, and some people actually feel sick from them.  I am living proof of this.  Now that they're gone, I'm not having any shortness of breath, light-headedness or nausea.  Could it be possible that I had a REAL problem that was fixed?????  

[hankstar]

Some can have a-fib with heartrate of 160+ and not feel a thing, while others are totally disabled!!!

Some persons can tolerate a common cold better than others, some are coughing and sniffling and feel terrible, while others barely have stuffy nose and it barely bothers them, yet it is the same cold virus if tested!!

Bottomline you might not have had a life threatening problem, but for you , you had a REAL symptomatic problem with PVCs that impaired your quality of life, Thankfully sounds like it was fixed and hope it keeps that way!!!

No doubt some over react to symptoms and anxiety contributes to more symptoms, nevertheless, it is not justified to label every person with severe symptomatic palpitations as"true cardiac neurotics" that is just not so!

[suki1724]

Hankstar, what a wonderful post!  Thank you, Susan

[va_tony]

"it is not justified to label every person with severe symptomatic palpitations as "true cardiac neurotics" that is just not so!"

Hank

Perhaps you would please point out where I said (or implied) that "every person" with severe symptomatic palpatations were "true cardiac neurotics"?  I think you guys are reading far more into my words than was intended.  It wasn't a blanket indictment, just a call towards self-examination as appropriate. If what I said doesn't apply to you, then great. I put in quite a few disclaimers in my posts ("if the shoe fits", "experience PVCs and tachycardias which are caused not by any underlying heart problems but by ANXIETY", "concern over a real heart condition is natural", "this is not to say that you don't have justifiable anxiety which is actually making your situation worse than it need be", etc., etc.)

Seems to me I'm seeing some gut level defensive reactions here and denial rather than appropriate recognition that cardiac neurosis/anxiety is a real problem for some. If you guys don't believe me, then believe CCF-M.D.-MJM, who wrote (see above): "we probably see more people worried about heart disease or fearing problems they don

[hankstar]

Look, I am not referring directly to you or your comments, I am writing my personal opinion on the subject regarding cardiac neurosis in general, I am not ashamed to admit that I would fall into the category of being a cardiac neurotic myself, in fact an EP cardiologist affiliated with CCF in Florida back in 1987 once labelled me a " cardiac cripple" despite the complete lack of evidence of heart disease after a stress test and holter monitor for severe symptomatic palpitations and anxiety caused by them.

Needless to say I was offended by label because I went about my everyday life despite the symptoms and was able to function normally and able to do alot more than others that had no symptoms at all. It was the words "cardiac cripple " that offended me , if he had labelled it as neurosis I would have not been offended at all.

  Please read my comments carefully as i have already received a warning from medhelp to ban me from posting on the forum if any more more flaming was to erupt because of my comments. I only started posting again because I personally never once initiated an attack on this forum so I felt I had nothing to stop posting for.

   I admire the way you and Erik set aside your differences the other day and acted like gentlemen, I hope it can be seem for us,not that we had differences to start with. You appear to be too much of an intelligent person to become involved in such childish and inconsiderate exhanges.

   I agree with Dr MJM reply completely also.

Have a nice day.

[va_tony]

Perhaps I too was being defensive.  I just naturally assumed that you were referring to my comments because you put quotes around "true cardiac neurotics", a term I had used above.

I recall the flamming incident you speak of a few months back and personally thought at that time that medhelp's threat to ban you was unfair.

In the current discussion, I gave my views and you gave yours very civilly.  There was no animosity on anyone's part as near as I could tell.  

I also chose my words carefully and frankly felt that some of the later respondants might have been reading more into what was said than intended. Sorry if I was wrong.

Best wishes,

Tony

[hankstar]

I can understand a person emotions and how they react, it is human nature sometimes to feel offended by coincidental quotes that was never meant to include or refer to them in anyway.

If you look back at Comment 3 by me you will find that I put quotes around "cardiac neurosis" and "cardiac cripple" from my very first comment on this thread.

Don't worry I understand exactly where you are coming from and how you feel.

Also thanks for your support in thinking I was treated unfair also, that in itself says alot!

Take care and keep posting your very interesting comments.

  Hank.

[uptowngirl]

Hi, I appreciated everyone's comments on this thread.  It really opened my eyes. I had never heard the term "cardiac neurosis" before.
  I do want to say that specifically I seem to recieve alot from the comments/wisdom of "Hankstar" and "ErikwithouttheDr." They seem like very balanced and encouraging individuals. I hope there isn't anyone banned from posting.
All the Best,
Uptown

[Paule]

Ask yourself "what type of person am I?  If you could choose the date of your death, would you?  And if not, why do you worry now? Are your affairs in order? How many of you have a will?  A living will?  

What if you were told that you would live to 78?  Would you spend time on this site worring or would you now make an effort to do as much as you can (exhaust yourself so to speak) until then?

My father had MVP all his life...he is 78 and walks 4 miles per day on the treadmill on the most vertical setting at 4 mph! He was biking 40 mpday in his 60's until a fall left him a little shook up.  He recently told me, "I'm living." In contrast, a 48 y/o male neighbor of mine, who worked long hours, was obese, smoked and on 7 meds for a variety of aliments (diabetes, high cholesterol, high bp etc.) told me once, "I'm not living, I don't feel alive."  He decided to retire early, used medifast under a doc's supervision, walked 6 miles per day (walked), lost 1 almost 100 lbs and is now on ZERO meds.  He developed a fib and is on aspirin only (no coumadin).  He now tells me he is alive, again.  

Since I was 14 I had sudden bouts of accelerated heart rates over 200 bpm without passing out or anything...they would go for 10-20 minutes. Sometimes not coming for years sometimes several times a month. What do I do about it?  I rock and ice climb, scuba dive, sky dive, water ski, surf, hike and mountain climb in high altitude.  Do I worry about getting attacks?  no?  do I worry about my heart going out during a climb? Let's just say it's pretty far down the list of things to worry about which is my point.  I'd worry more about not having a will (I have one 11 y/o girl) then dying because of palpitations that I've had for almost 30 years!  Try to worry about the things you can change, even little goals such as getting your will done or hiking a certain trail.  Don't get yourself in such a state of anxiety that causes you to become homebound.

This subconcious worry about one's heart rate is actually causing more harm to your arteries (from release of stress hormones) over time then what a normal pvc/pac will be doing.

Wonder why you have low hdls and a frequent visitor to this site and worrying about your cholesterol levels? Get a 24 hour urine and I'll bet your stress hormones are high, which in turn elevate your trigs which in turn lower your hdls...its not rocket science.

Do yoga, meditation and moderate excercise & you'll see your need for meds and visits to this site lower tremendously. or do as my neighbor did, just live...I'll say it again, doctors approach every patient that presents themselves as having nothing wrong with them "until" proven otherwise. If your doctors have told you nothing is wrong with you why would you think any differently?

[~*CaMeO*~]

Taking something you said out of context:  please explain a 24 hour urine test for stress hormones.  I was told that there is no test to measure stress, excess adrenalin. etc., but apparently I was told wrong???  Yes, I have PVC's and yes, I am an uptight personality and yes, I KNOW that the "adrenalin rush" will trigger the skipped beats as I am a case in point.  Please elaborate and thank you.

[Paule]

For patients that present with anxiety or high bp etc. in what should be an otherwise healthy person, too many doctors like to write a script for xanax or a ssri and say "your suffering from anxiety.." which I'm inclined to say that they are often 95% of the time correct.  However, that is not the appropriate standard of care in my opinion.  A doctor should rule some things out. One is checking stress hormones with a 24 hr. urine.  You avoid certain foods and pee in  a jug for 24 hrs ( a jug provided by the doctors office or lab ) and store in your refrig until you drop off ( warning, don't drink, Ha ) they will see the levels of catecholamines and other stress hormones.  If the test finds that they are spilling into your urine then your releasing too much and need to get them in check.  The test primarily rules out a very very rare condition that causes runaway hypertension (pheochromocytoma) a ususally benign tumor that causes the release of epinephrine and norepinephrine, which in turn causes severe hypertension which may be persistent or intermittent.  Also, this condition may cause the following symptoms:  headache, sweating, palpitation, apprehension, tremor, nausea, pain in the chest etc....see the similarities to anxiety??? HOWEVER, before anyone thinks they have this...THERE ARE ABOUT 800 CASES A YEAR IN THE US!! I'VE SEEN ONE IN 16 YEARS!  ALSO, even if your 24 hour urine is high, to have a PHEO your levels will have to be mutifold out of range, or very very out of range!

Hope this helps.

[~*CaMeO*~]

Thanks so much for the reply - you answered my question completely!  Might be something to request as I have all the above mentioned symptoms and it would be nice to rule out a physical problem and then deal with just plain old anxiety (right!).  My Doc did 'scribe Paxil but I'm just not comfortable taking any meds that I really don't need ------ an occasional Valium works just fine when required.

[beerhoch]

Thanks to everyone for your posts. It helps to know that there are others out there with the same problem. My PCP started me on cymbalta for anxiety last week. He says it is quick acting and that he has had very good results with it. I am hopeful of feeling better soon.

[Linda123]

Well - I've got to comment on this one!
I was a cardiac cripple, cardiac nutcase, whatever term you want to use - I was scared out of my wits with heart arrythnias for about 5 years.  I found out eventually I had some scar tissue in my atrium which accounted for a lot of my arrythmia - but it took me a long time and a lot of feeling humiliated infront of various doctors before I did find out.  The arrival of menopause sent my palpitations into overdrive, I felt unbalanced in my chest the whole time, and my life became one of continual fear.  Taking HRT helped enormously to bring me back to feeling normal and I have now topped this up with the anti-depressant seroxat and I can honestly say I feel wonderful.  My palpitations have all but vanished and I never stop being grateful.  Perhaps I am in remission - who knows - perhaps they'll be back, but right now I'm really living.
So - the moral of this story to the person that originally wrote in is - anti depressants can really, really, help - I am a living example of that, and I don't see why anyone with our problem should feel ashamed of taking them. I discovered the meaning of the word "fear" when I started experiencing palpitations.
Best Wishes to all, Linda

[~*CaMeO*~]

You GO, Girl!!!  Great comment!!!  Am with you 100%!!!

[Jimmy Joe meeker]

Amen!

[Barbarella]

Can anyone blame us for having cardiac neurosis?  After all the heart is our major organ.  If the ticker stops, thats it.  Can anyone blame us when we constantly read about high BP being "the silent killer".  If our cholesterol is above 200 the docs are to quick with wanting to prescribe statin drugs, and if we don't want to take them we are told that we are "a walking time bomb". It takes decades for our arteries to clog up, not weeks or months.  I'm  talking about people who have yearly checkups and within this year their cholesterol went up, not people who didn't see a doctor in 15-20 yrs.  

Cardiologists told me my PVC's are harmless, and PVCS's in general are harmless only to read in a magazine that PVC's can kill you if you get them while exercising which was written by a doctor btw.  When mentioning the article to the Cardiologist he brushes it off.  

Lots of people over 50 with healthy hearts are told by their docs to take a baby aspirin every day because "at your age" we are told.  

No wonder people get anxiety and neurotic about cardiac stuff.

[MaryRoe]

God Bless those with Cardiac Neurosis...Me included (-:

Hank i just read this whole forum and you do share such great words of Wisdom. You sound more God Like than anything else I have read.  Thank You soo much.  I needed this.

[Barbarella]

Unfortunately lots of people even some doctors don't understand cardiac neurosis or panic attacks.  If for example somebody suffers from depression that is understood by everybody.  People who are afraid of needles or pass out when seing a needle we are expected to understand this, but for people like us there is very little understanding.  I for example have severe white coat hypertension for the last 30 yrs.  All I have to do is look at the BP machine and I feel the anxiety creeping up.  There is still little understanding about this.  I tried to get help about this, but so far nothing has helped i.e. biofeedback, deep breathing exercises, anti anxiety medication etc. The last time I saw a doctor about this he asked me "what's the matter are you afraid that the BP cuff wont deflate?" I felt totally humiliated, and walked out.  A Cardiologist then told me not to have my BP taken at a doctor's office again.  To take it at home and bring my readings to my appointment which I do.  I'm on meds for my BP, no side effects, and I feel fine, but let me tell you there is very little understanding about white coat hypertension even now a days. I know from my own experience.

As for cardiac neurosis, panic attacks, and white coat hypertension:  All I ask for is that people realize that this is a problem for me and people like me.  I do not understand how an adult can be afraid of a needle, but I do understand that it is a problem for these people.

[mosem]

Many cardiologists are diagnosing cardiac neurosis when they are unable to correctly diagnose a patients 'real' medical problem, either because they are medically inadequate, or lazy, or fear potential legal proceedings if anything goes wrong while treating difficult cases, or according to my brilliant neurologist, many just want to 'pass the buck' or responsibility to someone else.
Perhaps this does not happen in America, but my neurologist says that this is unfortunately becoming a standard mode of operating in 'parts' of Australia.
Beerhoch, if anyone has the right to have anxiety though, then you do. You have been through a great deal, and I know it is difficult to stay calm.
There are a few tricks that I use, that 'sometimes' work.
I invent one or two things each day to look forward to. These are treats like setting aside time for walking on the beach, or reading my book, or watching my favorite DVD, or eating a favourite (though healthy) food etc..
I try and meditate, and during this try and concentrate on all the loving and kind things that I see and can influence in the world (sounds a bit corny I know, but it works sometimes).
I should talk to people more, but I have trouble coming out of my reclusiveness. Try and meet with some people for friendly conversation when you are well.
Sleep when you are tired (at any time).
Stay of high anxiety foods (soft drink, coffee, cigarettes, alcohol etc..)
Good Luck
Mark

[AmandaMouse]

A related discussion, Undiagnosed was started.