Anxiety? Arrythmia?

[njrob]

I am 40 y.o. old male, exercise regularly, no history or family history of heart disease.  Last August I woke from sleep with the sensation of an adrenaline rush, numbness in both my hands, lightheadedness, and racing heart (150 bpm).  I had never had any similar symptoms before, became quite worried and went to the ER.  After 35 minutes my hr came back to normal. All blood tests came back normal.  After a cardiac exam (stress test, echo) that came back normal a holter monitor captured a second episode (146 bpm) while relaxing on the couch.  The cardiologist told me it was sinus tachycardia- possibly due to stress.  My internist diagnosed GAD and prescribed first xanax and then Zoloft 50mg (I stopped the xanax). I also stopped all caffeine and alcohol (never excessive to begin with). I have been feeling much better, however sometimes as I am doing cardiovascular exercise, after approx 15 minutes I am feel some PVCs followed by heart racing (approx 140-150) that lasts approx 5-10 minutes (with no pain or tightness) then goes back down to normal.  Also, certain nights I experience the numbness in the hands, jitteriness, racing and pounding heart, and insomnia.  I have tried relaxation breathing but seems difficult for me  to break the sensation or to feel calm.  When I am sleep deprived the symptoms come back more often and stronger.  The internist has told me that he attributes these problems to the anxiety.  I am worried that the underlying problem is an arrythmia or heart condition, and the anxiety has arisen from this.  My questions are:
1) Do my continued problems while exercise sound consistent with symptoms of GAD? Can anxiety cause episodes of sinus tachycardia?
2) Should I avoid the exercise right now or fight through it?
3) If this is the anxiety triggering the tachycardias how do I determine if the medication needs to be increased or changed.
4) Should I ask my internist to refer me to a mental health physician or do I continue under his care?
5) Do The nocturnal problems I'm having point more to anxiety than arrythmia?
6) What is the prognosis for improvement with this problem.
    
Thank you

[Roger Gould, M.D.]

First of all, the prognosis is very good, and that is most important. Yes, anxiety can cause a tachycardia and arrhythmias, so if your internist does not have any other physiologic reason for the tachycardia, that is the best bet.  Regarding sleep, yes, it can definetly wake you up, just like a scary nightmare can wake you up with a tachycardia, here you have the effect without any memory of the image that caused it.  I think your doctor, or a psychiatrist, can find a more effective medication to control the anxiety.

[susans]

Don't be afraid of Xanax. My psychiatrist has told me that people with GAD are so afraid of being addicted they rarely abuse it. I've been taking it for a number of years for severe GAD and panic disorder. I rarely experience panic attacks. I do not take the full dose that I'm permitted to, and my doctors have told me that if I need it it's OK to take an extra one. I'm also on Lexapro but I haven't found the SSRI's very effective on anxiety in my case. The Xanax brings immediate relief, no need to suffer - you'd take insulin if you were diabetic. I never find that it makes me feel that good or "happpy" that I would abuse it - when you have such a high anxiety level it doesn't work the way it does in non-anxious people. What it does do is take the edge off and restore me to a functioning human being. Hope you feel better.

[pandora9048]

hi,
I also take xanax, and while I agree that it helps a great deal for anxiety, it is addicting.  Ive been taking them every day for about 7 months and i now i feel like i cant get thru the day w/out them.  if i dont take them, i literally feel like im jumping out of my skin, and i wish i had never started taking them.  I wouldnt be afraid to take them on an as-needed basis, but if i could go back, i would never have started taking them every day, but thats just me.
hope u feel better,
Pan

[kennyd]

Your experiences are very similar to mine.  I highly recommend that you find a good therapist.  Remember that medication is not a magic thing -- it treats symptoms but does not cure.  Therapy is essential.  I have been seeing a therapist for 8 months after I started having panic attacks, followed by bad anxiety and chest pains.  I chose to do it without medication, but admittedly it is probably the more difficult route.  Depending on how badly your symptoms affect your ability to function normally, a combination of therapy and medication might be the answer...a psychiatrist could help you determine what has to be done.  If you are like me, you're probably thinking about this all the time, and you are acutely aware of every feeling in your body.  It takes some time to get yourself away from that, and this is where therapy is really helpful.

I had a really hard time getting back to exercising after my difficulties started...probably in part because as I ran on the treadmill I would be worrying about elevating my heart rate and collapsing.  This of course is the cycle that creates the anxiety symptoms like dizziness, chest pain, palpitations, etc.  I am now able to exercise without worrying about that, but I still get chest pain and it is sometimes still hard to accept that it's "all in my head".  But at least walking down the aisle of a supermarket doesn't make me dizzy anymore!

[Honeybear's mom]

I have had similar experiences - I had a run of PVCs in a row one day 5 years ago, which threw me into a full-blown "panic attack," including tachycardia, sweating, hyperventilation, thinking I was dying, etc.  The problem was I didn't know it was panic, and I thought my heart was killing me!  I didn't know there was such a thing as a "panic attack," a true, physiologic response that could be that powerful.  For me, realizing that they wouldn't kill me helped, but I still need to distract myself if I feel them coming on.  Because even though I knew they were related to my heart, now that I knew I could have these attacks, I was waiting for them.  My cardiologist told me that people with mitral valve prolapse and/or PVCs have a higher sympathetic nervous system tone (adrenaline - fight or flight), and are more prone to anxiety.  I recommend that you keep exercising!  It's a great stress reliever, and actually you will have decreased PVCs at a higher intensity.  Stay off the caffeine, too.  And before getting onto Xanax or any other tranquilizer, I would suggest using beta blockers (atenolol, propranolol) only before an event that you know will make you nervous (i.e. plane ride, presentation, etc.).  Xanax can be addictive, and if you can deal with it on your own, great.  However, taking Xanax is a helluva lot better than spiraling into depression about it (which I did, at one point).  If you can afford therapy, it always helps.  So bottom line - PVCs are considered normal in healthy individuals, and it sounds like you've had the tests to confirm that.  The anxiety is most likely related, but can be controlled.  During an "attack," breathe from your abdomen, not your chest, and distract yourself, if possible.  Sometimes I'll just move, or eat something.  I hope this helps!  Best wishes!

[anacyde]

I've been suffering from panic attacks ever since I went to see a counselor for my anorexia.  She used "scare therapy" and said my heart would "explode" and I'd die.  Two days later I had my first panic attack and called 911 because I was convinced I was dying.  

I'm recovered now, several years later, because I realized that all the help out there is nothing unless you decide to defeat something.  Plus, after developing an anxiety condition from my last attempt to seek help, I'd never seek counseling again.  

It took thousands of dollars and five cardiologists before I could begin to relax about my condition.  What you're experiencing is exactly what I experience.  Today I was exercising at 140bpm and suddenly got scared that I would overtax my heart (panic attack out of the blue) and shot up to 180 bpm standing still.  I went tingly and numb and dizzy and my ears were ringing.  My chest tightened, my arms ached from the tense muscles, etc.  So I kept exercising.  Would you believe my heart rate came down to 120?  Yep.  I made myself halt that attack.

I know it is hard to believe it is just anxiety.  I still have moments where I think I have fifty medical conditions instead of just one simple anxiety explanation.  But can five cardiologists and more ER doctors than I can count all be wrong?  More likely that my fears are wrong.  And yours, too.

The best way to combat this is exercise and stress management techniques.  Read.  Walk.  Remain socially active.  MAKE yourself confront what frightens you.  And don't expect overnight results.

My palpitations are terrible when I'm anxious.  When I was pregnant last July, I went to the ER beause they got so frequent.  They admitted me overnight (due to being pregnant, to be safe) and did every non-invasive test known to the field of cardiology.  I was fine.

I hope all of my rambling helps you to feel more at ease about this.  Best wishes!!!

[njrob]

I really appreciate the feedback and advice from all that responded;  it really helps when you hear that other people experience similar symptoms and condition, and is helpful to see how others are dealing with it.
Thanks and best wishes.

[ledwards]

I agree with all of these folks, especially susans.  Maybe we see the smae therapist, cause she has told me all those things.  Why must we feel guilty about the GAD.  Geez, we didn't ask for it.  You are so right about the Xanax and the high anxiety level and it not being addicting.  When I got divorced (after 23 years)  I started taking 2-3 mgs a day, way more than I was used to..just to be remotely normal and be able to function.   As things calmed down, I was able to decrease with no problem back to the .5 a day I was taking to begin with.

[fastsilicon]

For the last nine months now, I’ve also been afraid that there is something terribly wrong with my cardiovascular system. I experienced my first “attack” after drinking a highly caffeinated soda. However, my experience seems somewhat different than the “average” panic attack (if there is any average).

Besides having a very high resting heart rate, my left arm and cheat are also numb and sour most of the time. I’ve convinced myself I have Angina, or CAD, or IST..anything I can get my hands on to explain my weird symptoms. Moreover, I also have visual problems (double vision, weird fading out effect ect).

I’ve been told many things by many different doctors. They couldn’t just tell me I was suffering from Anxiety because a few of my cardiac tests came back abnormal! My EKG showed sings of a past heart attack and my stress test was abnormal.. After hearing the results, I went into a horrible panic. Ever since then, I’ve spent every single day inside my house convinced I’m going to drop dead for the last eight months! Most of the time, I’m also very dizzy, sad, lonely and scared.

Because I am only 18 years of age, the doctors are convinced the EKG was just some type of normal variant. We have had many different doctors look at the tests; no one can come up with a definitive answer. They have more tests planed…I’m very worried.

In the mean time, I was wondering if anyone has any ideas of what I can do. I live in a constant state of fear… I always feel as if I’m going to pass out. I’ve been seeing a physiatrist, but he only seems to focus on my heart, and dealing with health problems. I think maybe I’ve got myself so afraid it’s just making whatever philological problems I have much worse than they really are.

Thanks for your support,

-Nigel

[2monkeys]

HELLO AND THANK YOU ALL FOR SHARING YOUR LIVES WITH ME, IT COMFORTING TO KNOW I AM NOT ALONE, EVEN THOUGH EVERYTIME I HAVE AN ATTACK I FEEL SO ALONE I CANT TRUELY EXPLAIN TO ANYONE HOW IT FEELS SOMETIMES I FEEL PEOPLE JUST LOOK AT ME AND SAY "THE DOCTORS SAY SHES FINE, ITS ALL IN HER HEAD.  ALL MY LIFE I HAVE LIVED WITH STRESS PLAYING EVERY SPORT IMAGINABLE, TAKING ON PROJECTS THAT WERE STRESSFUL, SPORTS, GARDENING, BRICK LANDSCAPING, FAMILY DEATHS,TWINS, AND LOSS OF SOLE INCOME
STRESS TO ME IS NORMAL. UNTIL ONE DAY MY WHOLE WORLD SEEMED TO CHANGE AND I CANT REMEMBER MY LIFE BEFORE THIS.  10/13/03 I HAD BEEN SICK WEEK BEFORE, ONE MORN WOKE UP TO SHOOTING PAIN IN MY LEFT ARM WITH IT ALL NUMB BACK PAIN AND CHEST PAIN.   I AM NOT A PERSON THAT GOES TO DOC OR EVEN TAKES ANY MEDICATION BUT THAT NIGHT I GOT WORSE SO I DROVE MYSELF TO ER MY EKG ABNORMAL NO SIGN OF HEART ATTACK X-RAYS FINE, SINCE THAN I HAVE SEEN MY DOC BEEN TO ER ONCE MORE ,ECHO, TRED MILL BLOOD WORK EVERYTHING FINE, SO DOC SAYS IT MUST BE STRESS, I ASK MYSELF HOW CAN IT BE I HAVE BEEN STRESSED WORSE THAN THIS, BUT NOW I AM HAVING HEART MUMURS OR AN UNEXPLAINED OUT OF THE BLUE !WAM!! IT LASTS FOR 5 TO 10MIN. IT KNOCKS ME FORA LOOP, DOC PUT ME ON ZOLOFT 50MG AND FOR 2WEEKS I WAS GREAT BUT JUST LIKE BEFORE WAM!!!  I NEVER WAS BE INTO CAFF. AND SUGAR BUT NOW I AM FINDING I CANT EVEN HAVE ONE PIECE OF CHOC. OR EVEN ONE POP. I JUST WANT TO BE MYSELF AGAIN LIKE I SAID I CANT EVEN REMEMBER WHO I USED TO BE I AM SCARED THAT ALL THESE TESTS ARE WRONG AND ONE DAY I COULD JUST GO TO SLEEP AND NOT WAKE UP, AND I HAVE 2BEAUTIFUL BOYS THAT NEED ME, I AM ALL THEY HAVE. I AM SORRY TO DRAW THIS OUT IT HAS BEEN GOOD TO WRITE MY FEELINGS DOWN TO PEOPLE WHO HAVE DEALT  WITH SIMILAR PROBLEMS.  THANK YOU FOR LISTENING I PRAY I CAN FINDMYSELF AGAIN AND FIND OUT WHAT IS WRONG. WENDY

[Lisa_inCA]

Dear fastsilicon and 2monkeys,
I lived with terrible anxiety for years, an unbearable sense of vertigo, as though the earth were tilted and I was about to fall off. I had to have a drink of wine before picking up my children from school! (A drink in order to drive!) Virtually by accident I found that Clonapin (clonazepam) cured this miserable condition. I can do all the things other people do now, even travel, and I can't imagine having to live like that ever again. I also have PVC's, as does everyone else in my family (my grandmother is 95!). I never understood how my heart eventually returned to its normal rhythm after some of the weirder gallumphing it does (though it helped to know that this happens to everyone from time to time), but after my husband's cousin in England died of sudden cardiac arrest I educated myself. The AMA has a wonderful, clearly illustrated booklet at this website, packed with everything that science understands about the heart in the 21st century -  http://www.americanheart.org/downloadable/heart/1056719919740HSFacts2003text.pdf
For example, the "massive heart attack" is an urban legend. People who have a clot blocking an artery are in a painful medical crisis, but the victim almost never goes into cardiac arrest. As for PVC's, the reason a heart goes back to a normal rhythm is that there is a main "pacemaker" node, a main backup node, and other built-in pacemakers ALL THROUGH the heart to sort itself out - most of the time. It's ventricular fibrillation from severe stress that causes sudden death, "the massive heart attack": Our cousin's father had just died that morning and it turned out that her heart was infected. With a simple jolt of electricity she could have lived another 40 years. It's such an unnecessary and tragic way to die that laws prescribe defibrillators in all public buildings now, and you can even buy little ones for home if you live with someone old enough to understand the instructions.

You don't need to live like this! Hunt down the medication that calms you, download that booklet, and ask for the amazing new diagnostics they have for the heart. This is no way to live, and the suffering can truly stop. Please tell me how you're doing!

[I'mallheart]

i have the same typr of things also, mine sometimes goes on for a hour or two..dr has me on ATENOLOL..maybe try this it has helped me alot