How to distinghuish between arrhythmia and panic disorder?

Question

I would like to ask what is the test to determine whether a heart rate above 180 bpm when waking up at night without any other obvious symptoms is caused by a heart arrhythmia or a panic disorder. Is the only way to make the distinction by having an ECG recording during the tachycardia? Are there other, simpler tests to try? Would there be signs and symptoms to watch?

This discussion is related to Evening Tachycardia.

achillea · Answer

It is worth noting that Nocturnal Panic Attacks are a different animal from the daytime variety.  The symptoms tend to be more 'cardiac' in nature, too.

More info here about this interesting disorder:

http://www.livestrong.com/article/125335-symptoms-panic-attack-during-sleep/

londinium · Answer

You could get an aliveCor heart monitor to put on your smart phone.  I know they work on iPhones, as I have one.  That will take a simple ECG (two lead, not the 12 lead which they give you in hospital), but your physician can see how your heart was acting.  You save the ECGs and can print them out.
  
What does it look like?  A phone cover with two strips of metal on it.  Very simple. Works very well, user-friendly.  You'll be helping heart research as well.

I'd particularly get one if I was having panic attacks so I could actually see with my own eyes what was happening in my heart.  It might give you confidence to see what is/is not happening with your own eyes.  Who knows, you may have a minor heart issue and you can catch it fast.

MichelleP_3811 · Answer

All great advice from the others.  I don't believe that bp monitors or the wrist kind for running can get an accurate reading when it reaches over 200.  Mine didn't work at all.  Like the others said if it is stopping and starting on a beat you may have an accessory pathway svt that can be corrected.  I too had a few very long episodes without any really long term heart complications.  The first one I probably should have went to the ER but the episodes always stopped so I didn't worry but it wound up lasting for 8 hours.  Needless to say I did have a couple of very weak days following but bounced back pretty quickly.  That said, after that episode I decided to add some cardio to my routine and I have to say the difference in my tolerance level of the tachycardia was very noticeable.  Where before I added the cardio I had to pretty much lay down when I was in tachycardia but after I started to run daily I was able to almost function when having an episode and I did have one that lasted 12 hours without feeling any affects from it the following days beyond a bit of an elevated heart rate.  I am not at all condoning prolonging a tachycardia episode that lasts for hours without going to the er but only mention it to highlight how beneficial getting cardio into your routine will help you out regardless if your tachycardia is from an accessory pathway or panic disorder.  Though to be certain I would push your doctor to get a 30 day event monitor if you think you will have an episode in that time period so that you can know for sure what you have.  I will say though I never panicked about my episodes likely because I grew up with them and didn't know any better but the feeling itself was very manic so I can see how one might have trouble distinguishing the difference so I would say try and get what you are feeling caught by a 30 day so you can begin to take the proper steps to treat and manage your issue.  Take care.

tigi321 · Answer

I used an automatic blood pressure monitor once to measure my heart rate. The first time it did not work; maybe my heart rate was too irregular. The second time a rate of 180. Counting I find really difficult. I do not feel particularly anxious with them and do not have the other typical panic attack symptoms. The rate drops at some point, but not all the way to 50-60 (more around 90).

tom_h · Answer

Yes, try to get a 30 day monitor as I mis-typed above and as ireneo mentions.  They are worn almost continuously (except for bathing), and are programmed to auto-record tachycardia events even while you're asleep.  They can auto catch the onset of the event as well as the termination of the event as long as it falls within the preset recording time.  You can also press a button with with record the event as well.  It's very easy to replace the two chest electrode pads, and after a couple of days, you forget you're even wearing it.  Let me go out on a limb here and state that other than capturing a recording of the event in the ER, it's the only way your physician will be able to see for himself what's going on.  And as I said int he above post, quite often when a physician listens to your reported symptoms, then takes an EKG of your heart and it looks perfectly normal, it's written off as a panic attack.  You're misdiagnosed, mis-medicated, and you still have the problem.

ireneo · Answer

I agree that having a high heart rate near 200 or a bit over is not particularly dangerous if its origin is in the atria. I've had almost 60 years of this nonsense. I can't imagine having that kind of tachy for 9 hours. Whew. Before my ablations mine would go on for 30 -45 minutes and I hated it. My chest would ache and I just wanted to lie down. Now my tachys only pop in for less than a minute.

I also misjudged my rate. I thought it ran 140-150 but one monitor result showed it ran more like 150 - 198. Not a huge difference but I learned I can't count very well.  LOL

tigll321 - a monitor is the best way to know what's happening electrically in the heart. The docs like to see how the event starts and stops so perhaps one of the monitors that trigger themselves would be helpful since yours happens at night. I've only had the monitors where I had to push the button to record.

abc85 · Answer

A heart rate over 180 is not necessarily life threatening and doesn't necessarily cause VF.  You would be surprised at how long people can tolerate a HR in this range, especially for younger people.  Before my ablation, I would have SVT close to the 300 range and while it wasn't comfortable, I could tolerate it ok.  I've also had an episode of SVT that stuck at 190 for 9 hours straight because I was too stubborn to go to the ED and I tolerated it really well.  Panic can also cause a sinus tachycardia in this range as well.  I've seen people having a panic attack with HR's of 200 and it was confirmed as they were hooked up to a monitor.

My questions for the original poster.  How have you determined that your HR was this fast?  Did you palpate your own pulse or use something else?  Often times palpating a pulse at the higher HR's is not very accurate and I've often seen medical professionals get rates wrong just by palpating anywhere from rates of 140 and up.  Using a HR watch or an automatic BP cuff is not always the most accurate as well.  I've had the HR watches say that I'm having rates of 180 when in fact it was 110 and had it say 60 when it was getting closer to 170ish.  I know that when I have a tachy episode start, often I'm not able to get an accurate rate, but I know that it is at least 150 or so.  Also, when you have these episodes, how are you feeling?  Are you feeling nervous?  Do they stop and start suddenly, like flipping on a light switch?  Honestly the best thing will be to get an event monitor and go from there.

tom_h · Answer

I have an advantage, if you want to call it that,  of having had a near life time of supra ventricular tachycardia, along with a wife who suffered from severe panic neurosis.  She was awakened many evenings from a panic attack, shaking, and unable to calm herself.  I've been awakened from a dead sleep with a sudden and abrupt jump in my chest as my heart took off, racing over 200 beats per minute.  The difference between us was I knew I had no anxiety, and displayed no other symptoms.  Also, having this condition since six, I knew what to expect.  For someone like yourself who suddenly out of the blue experiences something like this, it could be misconstrued as a panic attack.  This is why I encourage forum members to question what they're experiencing because treatment is very different for each condition.  A heart rate of 180 is extremely high for a panic attack, but is right in the range for some form of supra ventricular tachycardia.  When my wife would say her heart was racing form a panic attack, I'd often check her pulse and was surprised to see that it was only 120 or so.  For me, that' s half of what I would see with my SVT.

The EKG waveform of a person in SVT is distinct, and a physician can immediately identify it.  SVT starts and stop abruptly.  Often, it will convert to normal sinus rhythm spontaneously, and the sufferer will feel immediate relief.  Often a person will report the experience to his physician who administers an EKG.  Unfortunately, unless the patient in having an SVT episode, the results will appear normal, and the physician writes it off as a nocturnal panic attack, and treats it as such.  See the problem here?

My advice is if you get these on a regular basis, have your physician prescribe a 30 monitor with will catch the rapid heart rate.  Finally tachycardia, whether the sinus form or some form of SVT is not life threatening. A person in SVT can experience heart rates of 200 to 250 and higher for hours. It's very different than a sustained episode of ventricular tachycardia which can be dangerous.  We shouldn't make assumptions of what it is without seeing it "in action".  SVT symptoms are usually unmistakeable, with the main one being a steady, but rapid heart rate.  Have I given you any imformation that would help in determining what you're feeling?

caregiver222 · Answer

A rate of over one eighty beats per minute is a heart arrythmia, and life-threatening. It is due to overstimulation of an overly sensitive atrial node. Development of such a rate requires immediate medical intervention. Such a rate is very close to the point where ventricular fibrilation can occur, which will result in death. This is not something to self-diagnose or guess the etiology. It is a 911 call. The problem may be something that can be treated with medications, but is something that requires an in-person evaluation by a cardiologist as of yesterday.

abc85 · Answer

You would have to have an event monitor to catch a rhythm strip of it to really be sure.  Not sure that anything else would be able to figure it out for you.