sick, faint feeling with fast heart rate-panic or new development?

[barb47198]

I'm a 47-year-old woman, with a couple of arrhythmias: a re-entry that runs about 180 beats per minute, and ends on its own; and a slower (140 beats per minute) IST or atrial tach that I get more frequently but which also ends on its own. I've had a full work-up - Holters, stress echo, CT scan of heart, loop recorder.

I'm taking Tiazac and Acebutolol, which has really decreased the frequency of episodes. I also take Ativan at the onset of stronger episodes, to take the edge off the anxiety which kicks in every time. I often feel weird and shaky (and scared) during episosdes, but not faint or ill.

This week, I had an episode where, in addition to the fast rate, I felt quite sick, felt sweaty, went pale, and felt like I was going to faint. I was in a bar with friends (was drinking fruit juice). Ten minutes before the episode begain, I felt a big flutter/short series of skipped beats that gave me a head rush and some dizziness. (This only lasted a couple of seconds.)

Then, about 10 minutes later, I started to feel sick at the same time that the heart started beating hard and fast (about 140 bpm). I felt and looked so awful that my friends called 911, but (of course) by the time the paramedics arrived, I had started to feel better.

My question is - does this sound like a panic attack, more than an SVT episode? Or an SVT episode that turned into a panic attack? Or, a new development in my arrhythmias?

Since I was with a group (and in a crowded, noisy bar), I tried to hide what was happening - did vagal maneuvres in my chair, and tried to follow the conversation and act 'normal', when what I should have done was go outside and get some air.  

I have been to see my GP, who has scheduled a two-week monitor just to check things out.  

Your comments would be most appreciated.  

[Michael J. McWilliams, M.D.]

Panic attacks and SVT often have similar symptoms. Usually with SVT people describe a sudden onset and termination.  This can be more confusing with people that panic anxiety because they can go from SVT to sinus tachycardia because the event scared them -- then the heart rate tends to come down more slowly.

An ablation of the SVT would take the wondering out of situations like that.  If your cardiologist/electrophysiologist cures the SVT, the events will less frequent and you will also know that it isn't the SVT.  

There is no way to know for sure what happened at the bar if you weren't wearing a monitor.

I hope this helps.

[marlinspike]

I don't know if your experience represents a change in your arrythmia, but the symptoms are similar to what I have experienced during panic attacks (which began after being diagnosed with multiple ectopic heartbeats).

And of course, when your body panics and releases adreneline it affects your heart-rate. Most people who have anxiety are particularly prone to panic attacks in crowded, noisy places. It could be a panic attack that led to svt, or svt that made you panic - or just a plain old panic attack, as all the physical symptoms you mention can occur during panic.

The thing about panic attacks is that they are physically harmless, but can be very distressing. There is a great book by Dr Claire Weekes called 'Self Help for Yor Nerves' - it has lots of reassurance about anxiety and advice about 'floating' through panic. Hope this helps.