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Heart racing out of control...
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Heart racing out of control...

Please help.  I am 39 years old and have been diagnosed with 'panic disorder'. However, my heart has really been going out of control, far beyond what I had experienced in the past with an attack.  Over the past few months I have been to the ER and have had a number of EKG's-- my heart rate was always elevated at the time to anywhere from 113bpm to 130some (and this is after having taken about 1mg of xanax) but EKG's were ok.  I went to a cardiologist earlier this year who had done another EKG, stress test, and sonogram...he said I was normal and didn't think i needed a heart monitor. Again, I was dismissed as having panic attacks.
Last night I came back from dinner where I had had one glass of wine, and  my heart was pounding out of my chest.  The rate was so fast it was impossible to count- probably close to 200.   I took 10mg of Inderal and .5 of xanax but in 30 minutes it still had not slowed down.  This terrified me even more. Shouldn't the Inderal have worked more quickly?  And because it didn't, isn't it an indication that something else is seriously wrong?
I called my doctor and got permission to take another 10mg of Inderal and  1mg more of xanax.  It took well over an hour for my heart to slow down to 100bpm-  About 90minutes afterward, it went down to about 80 and i seemed to calm down.  I am afraid I'm being dismissed as someone who has 'panic attacks'  and they are overlooking other things...
What else can I do?  What kind of tests should I be getting?   Last night in no way felt like a normal panic attack. It felt as if there were something seriously wrong with my heart. I have been reading up on Supirventricular tachycardia..could this be it?  I read people who have this have heart rates going up to 200 and beyond as well.
Please advise.  I am so terrified of it happening again.  
I also recently had a Chest CT scan because I've been feeling it difficult to breathe. That came back completely normal if that means anything.  
thank you,
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If I saw you in clinic I would check and echo and a Holter monitor.  If the 24 hour holter monitor didn't capture and event, I would do a thirty day monitor.  the key is seeing how the rhythm starts and how it finishes.  If it gets better slowly it is usually sinus tachycardia and consistent with a panic attack.  If it breaks almost instantly, that is more consistent with an SVT.

Indural should take 30 minutes to 2 hours to work -- it has to be absorbed.

From the history you provide, it sounds like panic attacks but I agree that further testing will help clarify the situation.
Hi. People who have panic attacks sometimes feel better when they feel like they are in control of their situation and are taking action to alleviate the underlying source of anxiety.  

Many things can cause somebody to be prone to panic; and just as many things can cause the heart to race. If you are worried that a heart rythmn issue could be the source of your anxiety problem, my suggestion to you would be to take action!!  Ask your doctor to give you a heart monitor for 2 or 3 weeks and catch this thing on a recorder.  You can definitely find out whether you have an abnormal rythmn like SVT.  The results could help guide you towards a solution.
Sometimes I understand SVT can be confused with panic attacks and vice versa, mostly if you were diagnosed with a panic attack thats probably what is was, as  a lifelong sufferer of similar problems . I have found atenolol (beta blocker) to control my heartrate perfect , buT was still having panic attacks that I developed panic disorder. I have since  seen a psychiatrist and was put on citalopram(celexa) 10mg daily and clonazepam .25mg 3 times daily and feel much better for it,  the side effects of citalopram usually subside after a few weeks and are dose related for example once I take 10mg I have no side effects but with20mg I do, I stopped for 6 days recently when I went up 20mg and the side effects went away within 48-72 hours, now I'm back on 10mg daily again and feel fine. The psychiatrist explained to me that persons with panic disorder are not weak or crazy, they sufferer from usually from a chemical imbalance in the brain that makes prone to these symptoms, I advise anyone that sufferer from anxiety and panic disorder to get appropriate treatment from a doctor that specializes in this disorder, once the anxiety is treated the vast majority of symptoms disappears and its like you have a whole new life ahead you, the key is to rule any physical causes that might might mimic panic symptoms, though as I was explained panic disorder itself is usually a physical/medical condition that can be treated with the right medication and counseling. Good luck.
Hi, adviceseeker777,

Like you, I have a panic problem.  I would go back to your cardiologist, explain how distressing it is for you to not know what is going on, and ask to have a heart monitor for a long enough period of time so that it is likely to catch one of these attacks.

I think it is very reassuring that your stress test, etc. were okay.  If anything other than panic is wrong, then as a layperson I would think it is a simple electrical problem that causes the increase in heart rate.  They have meds for those.

It takes longer than 30 minutes for a beta blocker like inderol to kick in.  I now take a dose every day of my beta blocker so it is always in my system.  When I was previously on the take when needed method, it would take hours for my heart rate to drop.

Shortness of breath, you maybe know, can also be a panic symptom (aren't we lucky :-)

I am just a layperson, as I said, but I think you have had the tests that rule out serious physical stuff.  If you cardio won't do a holter monitor, your family physician can probably arrange for one.
By the way, I'll second tickertock.  I can remember panic attacks in grade school, so panic really is a physical problem, not some moral deficiency.

I just wish I could find a med that works for me for panic.  I have problems with all of them.
Did the doctors comment make sense to you?  To clarify, if you have SVT, your heart rate will jump from, say 220 or (whatever your rate is in SVT) back down to 120 (or whatever a normal heart rate for you would be when you're anxious) in just two heart beats. Like this: 00000000000000    0    0    0    0    0    0    0    0. On the other hand, if your high heart rate is due only to panic, your recovery to a more normal rate will be gradual over time.  For example, your rate might be 200  then 196 then 181 then 172 then 167 then 158 etc. gradually slowing down.  My experience with SVT is either that you are in the very fast rhythm or you are not - its like flipping a switch when you convert back to normal sinus rhythm.  Please know that, even if you do have SVT, it doesn't even HAVE to be treated - many people can just manage their symptoms with vagal manuvers when they have an episode.  Other people choose to take medication to lessen their symptoms.

As far as panic and anxiety goes, believe me, I have been where you are now. I suffered with severe anxiety for over ten years (I'm 41 now). Happily, I am now able to manage my anxiety very well.  But unless you have experienced it, no one can know the extreme suffering that anxiety can cause. I went for weeks barely sleeping because I was so worried about my heart. I lost 20 pounds because I couldn't eat - I could only manage to drink smoothies.  I could go on, but I think you get the idea. I didn't start to dramatically improve until I began taking Paxil. I tried a couple other SSRIs but Paxil is the only thing that has worked for me - along with cognitive behavior therapy.  Oh and I also took Xanax to get me through the worst times, until I had been on Paxil for a few months. Then I gradually weaned off of the Xanax. I took Inderal (sp?) also for a while but weaned off of that too.  Now I only take Paxil and I feel great!

Hang in there - you're going to feel a whole lot better - it just takes time to figure out what combination of therapy, doctor reassurance, and medication will work for you.

Take care, my thoughts are with you, Andrea  

I can't thank you enough for your thoughts and advice.  I have been suffering from panic attacks since I was a child.  But these episodes I have been having with my heart are really scaring the hell out of me!!!!  This last one made me feel as if my heart just wouldn't slow down. When it's beating out of your chest and you could hear it in your ears...it's very hard to NOT panic and/or focus on something else.  When I explained how this happened to the cardiologist, he just said that my heart is healthy and 'could handle' these episodes. And from everything he saw on my tests he really believed it was coming from brain (i.e. the panic attacks).  
I find it hard to believe at times, that my heart can behave like that - I mean that drastic of a change up to 200 bpm???? It seems really dangerous to me.  And I'm sure I'm going to die in that moment.

I can't thank you enough Andrea, for the explanation of how an SVT works and what the difference is. I wasn't quite sure what the doctor was talking about because I'm not really familiar with what an SVT is (aside from what i've read on these boards).  My cardiologist never mentioned that word  to me.  I will say that in all of my 'heart racing' episodes it has seemed as if it slows down over a period of time.  (sometimes a long period of time)
But whether or not it's SVT or from panic...having your heart at 200+ must be dangerous no?  Aren't you on the verge of a heart attack at that point?  (Or does it just feel that way?)

As for the panic attacks-
They seem to manifest in different ways throughout my life and yes, I have been under a psychiatrist's care for the past 17 years since the attacks became a daily occurrence.  Throughout the 17 years, I have been on every SSRI out there and xanax when the actual attack happens.  At the moment, the doctor is trying my on a mood stabilizer, Neurontin, and telling me I must take either Ativan or Xanax every day until we find the right anti-depressant to help me.  Nothing seems to be working right now.  I'm even doing yoga 3-4 times a week and working on the breathing.  So if what I had with my heart the other night was another panic attack, then i suppose I need to find something else to do to deal.  Unfortunately, although i know Paxil is supposed to be really good for anxiety, it was the only SSRI i had to get off from an allergic reaction (broke into rash).  Doing therapy weekly now and waiting to see if Neurontin has any effect at all.  
In the meantime, to be sure...I am going to have my doctor do a heart monitor for a few weeks.  Thank you again for all of your help!!! It has made me feel a bit more comforted!
best to all of you!

A couple of things - afib can end in a slow decrease to a normal heart rate, at least it does for me, while when I have an svt episode it does end sharply.  So the monitor is really going to be the definitive word about what is going on.

Also, alcohol can trigger a problem.
Kat4 -

But doesn't Afib cause a very irregular heart rhythm - as opposed to the very fast but regular and steady heart beat of svt?

No, the very fast heart rate associated with anxiety is not related to a heart attack. A heart attack is generally caused by coronary artery disease. A healthy heart can beat at 200 beats per minute for days at a time without sustaining any long term damage (quote from the Anxiety and Phobia Workbook by Edmund Bourne)

Sorry to hear you had a reaction to Paxil. I had to stop taking Zoloft for the same reason - a nasty drug rash!    
Andie, yes, afib is irregular, but it can sometimes be "almost" regular and be hard to tell just by a pulse if it is afib or not.  I just wanted to mention that possibility because there are arrhythmias that decrease slowly, so just because the decrease is slow, that doesn't necessarily mean "it's all in your head."
I have had a few episodes close to what you are talking about...

This happened to me after eating boysenberry preserves..then again after a midnight binge on Mcdonalds..and again after a glass of champagne...

I took .5 of ativan and some mylanta.....could hear the rolling sounds through my bowels..my heart rate was 130 through the night....in the morning I had diareah, and my heart slowed down.

I would start to doze off and the surge of adrenaline would wake me again..even with the ativan.  You can have symptoms of panic while on the meds...they are just milder.

Hi Kim,

As someone who suffered form anxiety disorder/panic attacks/agoraphobia for over 30 years (since *I* was a child) before I got a handle on it, I can tell you this: Just taking pills will NOT cure your anxiety/panic disorder, nor will it always take the symptoms away. Your mind and hormones are more powerful than almost any medication. If you want to get rid of the anxiety,  despite what is causing you to feel the palpitations, taking your blood pressure, reading about heart diseases and symptoms, and continuing to scare yourself about your heart rate etc., will only add fuel to the fire and make them worse. I would also include reading forums and writing on forums as well. What you focus on will become stronger! Whether it is something positive and fun or negative and not so much fun.

The only thing that has been [b]proven[/b] from many years of study with tens of thousands of patients is that to cure anxiety disorder one needs to get the patient a combination of cognitive therapy and possibly medication short-intermediate term. That has been mentioned here by other people. The medications are NOT something you will always need. But you need to go see someone who does something but push pills on you, and uncover the reasons for the anxiety and also [b]learn the things you can do - from foods to avoid, to how you think, to what you think about, etc.[/b] - or you will continue to have anxiety "attacks" and the many symptoms associated with them -  elevated BP, fast or irregular heart rate, dizziness, and on and on, the rest of your life.

Psychiatrists are basically trained to prescribe medications and to work with people who have very severe emotional illnesses like bi-polar or schizophrenia or severe depression or Borderline Personality Disorder. A good [b]cognitive therapist[/b] - whether they are a psychologist, an MSW, or other trained counselor, can help you learn how YOU can control and recognize high stress and early anxiety symptoms before they snowball into more uncomfortable symptoms. And they can teach you ways to stop them. I did it, and I had all kinds of tests on my heart and brain and [b]entire body[/b], because I did not have someone say to me, "You do NOT have any physical disease in your heart or brain. If you want to get well, you need to learn how to control this yourself, rather than relying on popping pills for the rest of your life." Once I saw someone in person it took months, but I got better and better week by week, and I have not had a panic or anxiety attack in many years. I have had some anxiety, sure. But it did not get to the place where I allowed it to scare me or cause me to run to the ER or get panic symptoms as it did many years ago. I wasted alot of time looking for something much more serious, and I ignored the many specialists I saw who told me I had to learn to deal with my anxiety issues.

I know what you are going through is painful and tormenting and very uncomfortable. [b]I lived it myself.[/b] I had very similar symptoms and many other symptoms as well. Now I do not. I do not because I got help from a trained therapist who showed me how I was creating the anxiety [b]myself[/b] by my thoughts and actions, and then of course the hormones that were secreted into my blood each time I said "Oh no! Not this again!" - cortisol, nor-epinephrine, catecholamines, and other things, made my BP rise, my hands get cold and clammy, my heart skip beats (extra beats actually) my feeling like I could not get enough oxygen, like I would pass out, die, etc.

I hope you will go and get ALL the tests you need from a heart specialist or others so that you can see that your heart is normal, and that your heart rate changes and other symptoms are a result of anxiety or panic disorder. If you truly DO have a physical problem, then by all means have it treated. If you do not, you can then make the decision to continue to take pills and just "mask" the symptoms, or to go to see a person who can help you get to the bottom of controlling and getting rid of anxiety symptoms and panic attacks, so YOU are in control, and it will be lasting and very comforting.

I wish you the best, and I hope for your future you will investigate all possibilities and in the end, even if you have a physical issue, you will still talk with someone about how to get rid of the anxiety and panic symptoms, so you can have a good quality of life instead of living from day to day with apprehension and fear about the next attack and what it means or how bad it might be.

Most sincerely,

The pounding and the panic attacks sound to me like thyroid disease.  I had been written off as a loony - especially after one locum gp said I was suffering "anxiety".  After that, every visit "anxiety" was mentioned and I felt that because of anxiety, you never then get another hearing from your doctor.  In the end I was vindicated with Hashimoto's thyroid disease.  I believe the pounding and heart palps are caused by adrenal fatigue caused by the Hashimoto's.  
Get a thyroid test and demand they check thyroid antibodies as well as the TSH.  Get a copy of the lab results for yourself (it's your right) and check it out for yourself on any thyroid site.  
My heart palps were jumping from my hear to my neck (where your thyroid lives) and I got pretty frightened when they were making me cough.
I too had the heart holters and was told there was nothing wrong with my heart.
So please get your thyroid checked.
p.s.  39 was when it all started for me and I didn't get an answer until I was 47.  Don't let that happen to you.
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