Panic and tachycardia

  Lately I have increased problems with panic attacks. I'am 21 years old and I'am very scared that I'm going to fall over
  dead from a heart problem. When I went to the doctor last week my pulse was 140 and my BP was 134/86 laying down and 126/96when I stood up.
  My EKG was normal except for some abnormal T-waves that my doctor said was nothing to worry about. However my heart beat has been so annoying that they put me on Tenorim.
  This medicine helps. Can this medication make you feel tired at first? CAn anxiety cause such rapid pulse and blood pressure? I just wore a heart monitor for 24 hrs. I get the results next week.
  Is there anything else I should be doing. How high is too high for a pulse and when should I got to the hospital?
  Thanks A lot!!
  JAMIE
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Dear Jamie:
Many things can cause a fast heart rate.  The first step is to determine whether it is a regular but fast heart rate, or an irregular and fast heart rate.  A Holter monitor is the usual way to make this assessment.  If the heart rate is irregular, that requires further cardiac workup and treatment.  If the heart rate is regular, but fast, the underlying reason should be sought; possibilities include anemia, dehydration, an overactive thyroid, and anxiety, among a very long list.  Only after a thorough medical workup should fast heart rates be attributed to anxiety.
It is difficult to state when you should seek emergency medical help.  You have to use your own judgment.  If you are experiencing severe symptoms, then you should get emergency help.  It is unlikely that a heart rate of 140 would cause any problem to a young person, as long as you are healthy and have no underlying heart disease.  In fact, exercise would probably raise your heart rate above that range.
Panic disorder and panic attacks can cause a fast heart rate.  In addition to psychiatric treatment, and psychiatric medications, one possible therapy is the use of beta-blockers.  Tenormin (atenolol) is a beta-blocker.  It slows down fast heart rates.  One of its side effects is fatigue.  In some people it can also cause or worsen depression.  Some people with panic disorder have an underlying depression which needs to be treated.  Thus using beta-blockers in this situation can get tricky.  You should discuss the entire issue with your primary doctor.
If you wish to be evaluated here at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist who specializes in fast heart rates at desk F15.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your doctor.