Panic during stress test...

[parsons1]

Is it normal to have a panic attack during a stress test?
I'm a 38 yr old male in general good health, I started have panic attacks in Sep. My dr. put me on propranalol and it works great, the problem is when I don't take it I have an attack. He did blood work and everything came back good except for minor lipids, he said I could work it out with diet and exercise then scheduled me for a nuclear stress test just to be safe.

Triglycerides       284
Total Chol.         192
HDL                 32
LDL                 103
Chol/Hdlc ratio     6.0

I hadn't taken the propranolol for 48 hrs for the upcoming test
And yesterday during the test I had a panic attack.
I had a couple of PVC's that worsened my already high anxiety
This concerned the tech because my heart rate went to 173 bpm

The Dr. asked a few questions, told me my EKG was normal and that the panic would explain the rapid heart rate.
then told the tech to go ahead a get the images of my heart.

I did the scan process and had another attack during the scan.
I was freaking out because I couldn't move while getting scanned!

I'm still waiting for the nuclear results but the EKG was ok despite the attacks.
Anyway, has this happened to other people, is this common?

The tech asked if I exercise any at all,
I’m not that out of shape, I’m 6’ tall 185 lbs, don’t smoke or drink,
I walk 4 miles a night at a pace of 4 mile an hour.

I'm so embarrassed, worried and feel like an idiot!

[Cleveland Clinic]

parsons,

Sorry to hear of your events. The medical system can be an unnerving experience, even in those not prone to anxiety. Ive seen alway kinds of responses, and dont think anything negative because of it.


Hope your results come back ok.


good luck

[woodruff]

Parsons, I also have panic attacks.  Over the years, I have learned that mine tend to come in phases when, for some reason, I'm prone to them.  In between these periods (usually a spell of three or four months), I'm fine.  Sometimes, there's a year or two between bouts.  Anyhow, I have learned that, during the time that they're likely to be a problem, one of the SSRIs will give better control of them than "as-needed" drugs like ativan or propranolol.

Just a thought.

Curious, isn't it, that we feel embarrassment about having panic attacks?  We wouldn't feel embarrassed to have stomach ulcers, and yet, this is no less a medical condition.

[andie3330]

I had a echo stress test a few months ago and I was so nervous that my heart rate was 120 before I ever stepped onto the treadmill. The tech was sort of annoyed with me and kept telling me to calm down because she couldn't get a true "resting" echo image. Obviously, she didn't have much experience with anxious people because telling me I needed to "calm down" only made me more anxious. Anyway, during the treadmill part of the test my HR got up to 185 (slightly over 100% predicted max.) and the cardiologist said the ekg looked normal. The echo immediatly after exercise was normal too, so overall, the test was very reassuring for me - after I had the results, that is.

FYI, even with a normal stress test, a "second opinion" cardiologist recommended I have an angiogram due to some symptoms I was having (jaw and abdominal pain) that seemed to be related to exertion. But, since I'm only 39, female and no risk factors for CAD, I asked about a CT angiogram. The cardiologist agree it would be a good test for me, so that's what I did. My CT angiogram was normal, and was worth every penny (that insurance didn't want to pay - but later did end up paying in part) for the peace of mind it gave me.

[ljd]

What is a ct angiogram?  I had many of your symptoms and my cardiologist didn't want to do an angiogram.  I had an echo,stress test, and holter monitor all came back normal.  They are telling me it is stress.  But I really don't beleive it.

[andie3330]

A CT angiogram is a new, non-invasive test that looks at the coronary arteries to check for calcium buildup as well as hard and soft plaque that could be causing blockages. Ideally, it shows the doctor the same thing, more or less, as a angiogram. But, it is a new technology and may only be available at major medical centers. Also, it may only be appropriate for certain patients, depending on your risk factors. For example, if someone's stress test strongly suggests CAD or someone has a lot of risk factors, a doctor would probably recommend a traditional angiogram. For one thing, with a traditional angiogram, other corrective procedures can be done at the same time, ex. stents, etc. Also, because it is new, it is very important to have a cardiologist or radiologist that knows how to accurately read the results. The upside is that it is no more complicated than having a regular CT scan with contrast media (which some people are allergic to). The only prep is to take a single dose of a beta-blocker because your heart rate needs to be under 65-70 beats/min. to get clear images. This is the one thing I worried about because I have panic/anxiety disorder and thought that my heart rate would be too high. But I also took a low dose of Xanax (for which I already had a Rx to use as needed) and I was just fine. I think my HR during the test was about 60. For me, the CT was a godsend because I wasn't willing to risk the complications of a cath angiogram given my very low risk profile. Best wishes, Andie

Also, insurance may not cover this new test.

[Barbarella]

Yes, it is normal to have a panic attack during a stress test.  Normally exercise should cause certain endorphines (hope I spelled that right) in your brain, but sometimes exercise can cause the opposite, something in your blood caused by strenous exercise, and it can give you a panic attack.  I used to suffer from severe panic attacks, and sometimes got them while exercising, and my doctor explained to me what I said above "why" this can happen.

[momto3girls]

I am scheduled for a nuclear stress test next week. My symptoms have been on and off chest pain, squeezing in the center of chest and just recently burning in my chest while exercising at the gym. (I'm female, 33 and have a slight family history of my grandfather and uncle having heart attacks in their later 30's). I a little freaked.  I've had numerous ekg, echos, stress test and even stress echos. I'm on beta blockers for suspected SVT.  Any thoughts from those of you who've already gone through this?  I'm kind of nervous especially since my cardiologist actually said she's looking for blockages in my arteries.  Thanks!

[bama jane]

I have svt and also have chest pressure in my chest every day and have had numerous stress tests over the years that all came back ok.  I also have had heart palpitations every day for over 6 years.  Does any one else have them every day all day long? I am going through a time where they are really bad and I have a lot of symptoms like sob. Does anyone know why bending over or reaching above your head will cause them?..   Also eating or lieing on my left side.  I even get them when my stomach churns. I just wondered if anyone knows why certain movements cause them. Some times I have to sleep in a sitting position to keep them at bay so I can sleep. I think most people get nervous when they are having heart tests done and no one should feel embarrased by that. I know I always am even though I have had numerous tests and been in cardia rehab for arrhythmia 2 times.

[CollegeGirl143]

I had svt that was so easily triggered just standing up would sometimes trigger it.. im not sure why these seemingly harmless things like bending down or laughing too hard can cause an episode, but they do!... Eating was the big thing for me, everytime i ate i had an episode. it got so bad i refused to eat except one small meal once a day because i was so scared of bringing on the svt. I finally saw a doctor who realized i needed some serious help and he gave me a cathater ablation a couple weeks ago that cured it.. Have you thought of this option???? if not, you should depending on what kind of SVT you have.

[Fran71]

When I had my echo a few weeks ago I arrived at the appointment with no tachy, no PVC. As soon as the doc turned on the echographer I started having tachy and lots of PVCs. When the echo was over and the doctor told me he saw nothing abnormal, the tachy and PVCs disappeared.

I know these are not panic attacks, but I don't suffer from panic attacks so I guess I'd be unlikely to have one just during a medical test. However I think in a person who is prone to have panic attacks medical tests can certainly increase the probability of having one, if they can cause such nervousness in a person who does not suffer from panic attacks.

[bama jane]

thanks for the input.  I tried an ablation 6 years ago and it failed.  I don't have the tach as much as I used to.  Mine is actually pat and a few other things as well so I really have more than one arrhythmia.  The fast sustained rates ( 3o minutes or more) are somewhat controlled for now on atenenol but I do get short bursts sometimes every day and then sometimes less frequently.  I had one last week brought on by changing positions while watching a movie at the theater. Was yours cured?  Do you still have extra beats every day?  What kind of svt was yours?

[parsons1]

Hey everyone,
Got my results yesterday and was told that
The test came back abnormal. I couldn't get ant info from any one with out going back in for a consult.
Couldn't sleep at all last night thinking the worst,
Even having pain from the anxiety!

Went in today and the Cardio doc said the
Stress tests, EKG, were normal despite the panic attacks :)
The images show no sigh of CAD, and the reason the test
came back abnormal was, they couldn't see past my diaphragm.

He told me with no family history and no risk factors
I wouldn't have to do a cath and they would do an echo in the morning to look at the lower bottom of my heart.

Thanks to everyone who posted, my stress level
Just went down 100%

Health and happiness to all!!
Bryan

[andie3330]

Talk about panic ... I just posted on the NSVT thread asking for your help, but I think that thread might be closed to new comments. Here it is:

Help! Now I'm scared because I just listened to my heart with a stethoscope and I hear a lot of the triple sounds "lub dub dub" or maybe - I'm hoping - "lub lub dub". In other words, I'm hoping that what I'm hearing is a lot of PACs rather than a lot of PVCs. I know that when I have a PVC while I'm taking my wrist pulse there is a definite pause between beats. But during the "triple sounds" or "lub lub dub" beats my wrist pulse feels steady and regular. Does this make sense? I don't think they could all be PVCs if my pulse is steady, right? Also, I can generally feel PVC's but I wouldn't know I was having these "lub lub dub" sounds (hopefully PACs)if I hadn't used the stethescope. Why did I feel compelled to listen with a stethescope? I almost wish I hadn't because until I know for sure these are PACs and not all PVCs I'm really scared. Please help if you can. Thank you!

[7deuceman]

Hi Bama Jane and all:

Hopefully I can answer some questions-

RE: Panic.
Let me start by saying having panic during a stress test (and having panic for other reasons is very common) I have had both and saw a doctor to assess my condition and perscribe meds for panic/depression. Ive been on the regimen for six years with gradually better results. I take 25mg zoloft 4 days/33mg, 3 days.

Now to the SVT/tachy.
I had ablation in January to handle PSVT (AVNRT) which was successful. I used to have the full-blown, 'run for your life- panic in the streets' SVT, and, not-sustained SVT (sounded like popcorn in my pillow at night) it was a very unnerving feeling to lie on my right side and hear the rapid 'heartbeat' noise in my pillow. The ablation got it and it's gone. Consider having your SVT treated by ablation and find an experienced EP doctor at a major heart center!

As an aside to the SVT-
Yesterday, I decided to plan to have a tempermental AV nodal 'junction pathway' ablated and I see the EP doctor in May. Having the new procedure done, scares the hell out of me, but we ALL need to press forward and do the right thing. (As some of you might remmember from my other posts, for a long time, I lived in denial and didnt do anything about my health and it almost cost me my life.. Please take appropriate action to protect your health!)

Now to the PVC's-
I have had many PVC's after my VF incident in 97.  I get them almost every day, and some days are really bad where paranoia is 'right around the corner' and panic sets in.  On some occasions, the symptoms are so frequent/upsetting, I stop my activities, do deep breathing exercises and take a quarter/half of .025 Alprazolam (Xanax).  Sometimes I need to take the whole tab to make the palps to go away. They happen when I talk, turn abruptly to reach for something, get startled, you name it. But the med does the trick and stops PVC's most of the time especially when I have a very cold glass of water and sit down to chill.  (This is an addictive med, so use it only if you really need to. Your doctor will tell you about the side effects and caution you to use best judgement in using it.)

Adequate Sleep- lack of sleep might contribute to PVC's...
Getting enough rest is really important especially for those of us with cardiomyopathy.  Make a log of your sleep pattern and MAKE YOUR BEST EFFORT to get 8 hours/night!! I recently had to go back to logging my sleep hours because my schedule was getting out of hand, my sleep habits got worse!  I know some people that have sleep apnea, which can be really bad for heart patients...your doctor can determine if your sleep pattern is a factor and if you need a sleep study...
Hope this helps! Everyone keep your chin up!!
Tom/7deuceman

[woodruff]

Ooooh, bad Andie!  No listening with a stethoscope!  The important thing, and it's hard to come to grips with this, is this:  Can you do all your normal activities, especially if you're not concentrating on your ticker?  Do you forget about your irregular beats if you're busy?

This is a highly emotional issue, I know.

[fearfactor]

Hi, Andie - I am a person who nearly let heart palpitations RUIN my life, literally!  Don't let this happen to you.  I got so bad that my husband nearly left me - I was researching on the internet about 10 hours a day, scared all the time, couldn't be home alone - things got really bad! I know it is hard to stop obsessing about them.  I have been in an intensive therapy program for health related anxiety and it's really helped.  I still obsess about my heart's weird activities from time to time (especially being 20 weeks pregnant right now!) but I try not to let it consume me.  I don't know if you've gone to the cardiologist and gotten all checked out but if you haven't do so for your peace of mind and then try to let it go.  I KNOW it's hard but these things WILL scare you to death if you let them!  Don't let that happen to you.  Good luck!

[tickertock]

Please listen to woodruff and fearfactor no stethescope, you'll drive yourself bunkers,you need a ecg tracing to see exactly whats going on to really know. I've been there, remain calm , while your palps are real and scarey " cardiac neuroses" can cripple you without any real organic evidence of significant heat disease.Take care, don't fret, please.

[CollegeGirl143]

i had AVNRT and ya it was cured.. thank god.. since recovery i had no extra beats... just a few runs of sinus tach from anxiety.. what kind of SVT do u have?

[Fran71]

Hi Connie!
Thanks again to you and Upbeat for trying to make me understand NSVT once more...Thanks for being so patient!
One thing that had confused me a little in the old thread was that you said each PVC in SVT should have a pause. At least, this is what I understood. I assume this is bigeminy - last Feb when I went to the ER I was in bigeminy all night (1 strong beat, 1 pause, 1 beat etc.), and if that was really NSVT it would have lasted for hours and I would have to be dead! But I guess we're saying the same thing. So tell me if I got it right: as I understand it, a simple PVC is lub-dub. A couplet is lub-dub-dub. A run of NSVT with 5 beats would be lub-dub-dub-dub-dub-dub. Correct? I wonder how long the pause would be then with 5 "dubs"! Or maybe it isn't that simple.

Anyway, to Andy, I agree with the others that we shouldn't be listening with a stethoscope. We are not doctors, we have no training, and listening to our heartbeat isn't as easy as it may seem. Don't waste time with things you can't fully understand, or they can drive you nuts. Just consult a good cardio and address all your concerns to him/her.

Take care

Fran

[bama jane]

I have several thing going on: Paroxysmal atrial tachycardia pac's, pvc's, wandering pace maker, sinus arrhythmia, accelerated junctional rhythm.  Bigeminy, trigeminy, couplets and I am sure I have forgotten something!  I try not to think about it too much since they say it shouldn't kill me, but it does make life a bit diffiuclt.  I have different kinds of misbeats all day lomg some days and it drives me crazy. I don't usuall have them all at once. Thay have found no reason for them other than just an electrical problem. On a good note I am so glad your siuation was fixed.  I think that is what what everyone hopes for. Good luck! It is always good to hear of positive outcomes.

[Momto3]

First, I agree with the others that listeing with a steth can lead to an unhealthy interest in your heartbeat.  Listen, learn, and pack it away!!  Don't panic : )

Andie,

For me, "lub-dub-dub" is a pvc. Actually, I don't know if you could hear the difference between a pac and a pvc.  I rarely had pacs so I have no idea what they sound or feel like.  I am very familiar with pvcs tho : )

I still get occasional pvcs, but I used to have over 20,000 per day.  PVC's are harmless with a normal cardiac workup.  They're just a glitch in the system.  Think of them as heart hiccups.  Don't worry.  I could "feel" pvcs in my pulse, but it was very regular.  In other words, the beats were in a pattern. The "triple sounds" you describe sound like pvcs to me, but I'm not a doctor.  If you have had a normal cardiac workup, and are still worried, talk to you doctor about wearing an event monitor.  With the event monitor, you push the record button when you FEEL something.  The machine records the event and the doctor can correlate what you feel with a firm DX.

FWIW, I would had twenty some thousand pvcs every day for years, and NO pacs.  One time, I remember seeing a report that said I had about 5600 pvcs and 4 pacs.  I felt a lot of them, but not nearly as many as I was having.  Don't worry.  

Fran,

Lub-dub is the normal sound associated with a heartbeat.

Bigeminy is a pattern of having a pvc every other beat. So, it's lub-dub (normal beat), lub-dub-dub (pvc), lub-dub (normal), lub-dub-dub (pvc), and so on.  Bigeminal episodes can be short and go on and on.  A couplet is two pvcs in a row like, lub-dub-dub (pvc), lub-dub-dub (pvc) and then a normal beat... lub-dub (normal).  

NSVT is a series of at least 3, but not more than 30, pvcs before a normal beat.  It is my understanding that it is not "technically" SVT (sustained VT) unless there are at least 30 pvcs in a row.  So, less than 30 is considered "nsvt."  

There are several website that demonstrate heart sounds.  Type in "heart sounds" or "normal heart sounds" and you'll find examples.  Listen to the NORMAL sounds and do not worry about the other sounds on the websites...Hope this helps : )  

Have a terrific day!!

http://depts.washington.edu/physdx/heart/tech2.html

http://www.oztiryaki.com/heartsound.html

[andie3330]

Thank you so much for taking the time to answer our questions. I guess I was under the impression that if you're taking your wrist pulse (not with a stethoscope) and had a pvc then there would be a definite pause between pulses like: pulse....pulse....(pause)....pulse.... pulse

Along with the flip-flop feeling, thats how I used to feel them, I wonder now if I could be having them a lot more than I think - that is if they can happen with no pause in my wrist pulse. Or maybe I'm having pacs and maybe they don't cause as much of a pause in my wrist pulse.  

I just keep telling myself that it doesn't really matter since both pvcs and pacs are benign, since I'm not having other symptoms and all my cardiac tests have been normal. I just get obsessed with this stuff and want to know exactly what is going on - I know it isn't healthy and probably an impossible pursuit - given we can't know much of anything with 100% confidence.

[Fran71]

Thanks dear! I guess we're saying the same thing then! I'll certainly try the web sites with heart sounds, thanks!

[woodruff]

fearfactor, you did JUST the right thing in getting into a program to deal with your anxiety!

[fearfactor]

I am so glad I did - life is so much better when you're not obsessing about your heart 24/7!  I can actually get stuff done now!  I'd advise anyone else with extreme health worries to get into a therapy that specializes in health anxiety.