Anxiety or a real problem?

[ukbitsps]

Hi. I was diagnosed with anxiety disorder in Jan 2002, after suffering a so called "panic attack" at a roadside. Since then I have been to the emergency room at least 4 times because I felt the symptoms I had were a problem with my heart. I have also been diagnosed with GERD, and am taking OEMAPROZOLE tabs to treat acid reflux and Mirasapine (I think) to control sickness.

I have since seen a specialist privately who did a stress test, and an echocardiogram with no specific problems noted (except non-specific changes in the T wave.) My BP was 127/70 and can go as low as 107/69 during rest and during the tests my pulse was 80bpm. There were no signs of heart disease and no signs that the stress test were promlematic except for the above T wave non-specific changes. Also, I have had a vast number of EKG's and blood tests which have all reported back to doctors as perfectly normal! I do not have raised colesterol levels and is actually lower than normal. I have no family history of heart disease, only that my mother has high blood pressure and diabetes (type 2)

However, I notice sometimes that my pulse can go up to 100bpm and seem to stay that high for days but my BP never seems to go above 120/70 when resting (have home BP testing device.) I also notice my heart beating sometimes, usually when going to bed and usually quite fast. Sometimes also, when I stand up I can feel my heart beating hard and slowly causing some discomfort before shifting back to normal.

I am being treated with Zispin for my anxiety but it doesnt seem to be working as well anymore. I'm not particularly fit (15st 5) but am working on that slowly by gentle exercise and a very low fat diet - plus I'm only just 23.

My questions are these:

1) Is my high heart rate really a problem in the absence of heart disease, or is it just a cause of my anxiety? (My heart rate can drop to 72bpm at times of extreme rest like sitting for hours and hours!)

2) If so what medication could I suggest my doctor tries to reduce my heart rate (in the form of antidepressant or heart medication specifically) - and would this be dangerous.

3) If not, would the high heart rate cause problems in the future? If so, what would they be and could they be treated?

4) Given all of this, does my high pulse rate sound more like anxiety disorder or a specific heart problem given all the tests I've had (EKG, Bloods, Stress Test & Echocardio.)

P.s. I don't drink heavily (5 units a week at the most, not all weeks) and have never smoked.

Your feedback on this is VERY greatfully recieved!!

Regards,
Chris

[Roger Gould, M.D.]

You should ask your doctor all of the same questions, but in general, the kind of shift in heart rate you described is almost always related to stress or exercise, and not an indication of heart disease, so no medications are required.

If you are anxious about something, you should get to the bottom of it, and work out the life problem causing it.  YOu can try www. masteringstress.com or, at that same site, look into the masteringfood weight loss program.

[3rdMajor]

Hey UK!  I'm no doctor, but I did suffer panic syndrome for 20 years, before undergoing 5 coronary artery bypass grafts.
One of the easiest ways to get the diagnosis of panic disorder, is to keep presenting to the emergency room with a pending heart attack.  That is exactly how many people behave when experiencing a panic attack.  Why dont you accept the diagnosis, and find an appropriate treatment, if the zispin isnt doing the trick.
As far as heart rates go, Lance Armstrong has a resting rate of 30 bpm.  Most of us normal types are between 65-80.  I get mine up to 145 or so every day, and keep it there for 30 minutes.
(Its called exercise, and its great for the anxiety and the heart)  Good luck!

[Try_to_be_social]

You give a meticulous history of your conditions. It seems that you are still preoccupied with your heart rate. At times, when I stand up I feel my heart pounding. It is a normal reaction of the body in respond to postural change or exertion by increasing the heart rate. Most people don’t usually feel the increase heart rate except those who are sensitized. People with panic anxiety are very sensitive to bodily sensations such as increase in  HR. They misinterpret such normal normal physiological change as serious heart disease. This is called catatrophizing or catatrophic misinterpretations.  When asked how would they rate the belief in their negative thought, they usually overestimate their certainty as say 80%. Therfore, they frequent ER and undergoes repeated and comprehensive medical tests that are essentially normal. When they were asked what evidence that they have heart disease, they cannot provide. All they can say is palpitation. They usually underestimate their confidence of such evidence against a heart disease, and rate them say 20%. They still believe they have heart illness, as they re-rate such belief as say 60%. So, they still have to go to the ER. Are they jumping to conclusion of heart disease? Is their view of the cause of palpitation being heart problem the only one possible? Any alterantive explanation say panic anxiety? What is the effect of such belief of having heart ailment? Do such negative automatic thoughts help or drain them? What is the advantage of such negative thinking? Immediate attention or avoidance of the label of panic anxiety or…? What is the disadvantage of such automatic thoughts? Repeated extensive cardiac tests, repeated ER visits, indecision of diagnosis, no correct treatment is instituted, panic anxiety left untreated,... How would someone else think about the palpitation (objective)?  Are your judgement base on how you felt rather than your correct diagnosis (subjective feeling rather than reasoning)?Are you underestimating what you can do to deal with the palpitation? How will things in 2 years’ time? In a word, you need CBT for your panic anxiety. Please see post dated 16NOV at <a  href=http://www.medhelp.org/perl6/MentalHealth/messages/C32374-5.html>; http://www.medhelp.org/perl6/MentalHealth/messages/C32374-5.html </a> for diary of CBT and messages dated 20OCT, 25OCT and 26OCT at <a href=http://www.medhelp.org/perl6/MentalHealth/messages/C32351-11.html>; http://www.medhelp.org/perl6/MentalHealth/messages/C32351-11.html </a> for sleep, relaxation and progressive muscle relaxation in CBT respectively.

[ukbitsps]

Thanks for all your comments. I know that I have panic disorder, and I know that it can affect your reasonable thought. I am being treated by means of CBT. It has helped a little, but I still have these overwhelming sensations.

For example, yesterday I went to town to get a new bookcase. As I was walking along, I started getting a pain next to my nipple on the left side. I ignored it, and it went away. Shortly after this I went into the store and as I was queing the pain came back. Immediately, I became dizzy and very faint and my heart started pounding. I still had the pain. Once I was out of the shop, it almost completely stopped.

I walked into the next store to buy some pain killers, and the same thing happened again whilst quing.

It's an almost terrifing experience constantly having these sensations and feelings just standing in a que but I do manage to stand and stand and somehow conduct myself properly - pay for my goods, talk to the person serving all whist I'm going out of my mind with pain and sensations!

It's almost too much to bear sometimes, and I feel it's going to crush me inside. I fear a nervous breakdown is just around the corner, and I have no idea at the moment how to stop it.

I've tried desperately to go to the gym but if I get the slightest pain, I go mad and almost run out or just sit on the equipment until it stops.

I'm pretty sure that all these so called roblems with my heart racing & stuff are probably all in my head. I've more than likely had these sensations before but have never paid much attention to them where as now I'm just exagerating them masively and turning them into something that it's not.

I'm just worried that all these flighty feelings and racing heart beats is going to cause me to have a heart attack or something. I know the answer is to just calm down, but I find it so hard to do these days.

Does anyone have any suggestions as to what medication they have tried & found sucess with treating anxiety disorder?

Thank you all,
Chris

[Try_to_be_social]

The goal of medication is to treat the panic anxiety not the individual symptoms, such as fluctuation in heart rate, dizziness, chest pain,.. There are two classes of medications for panic anxiety, namely, antidepressant and Benzothiazepines. Zispin is also known as Remeron, which is a SNRI antidepressant. You can increase the dose of Zispin if it did not render you unduely tired in the day. Xanax is an anxiolytic, which is effective against panic anxiety but it can cause dependence in the long-term and drowsiness.

[pandora9048]

two peas in a pod, me and you are.
   I also get a racing heartbeat frequently and I know just what you're talking about with your heart beating slow and hard after standing.  My ordeal started this past summer out of the blue. I woke up from a sound sleep w/ my heart racing, sick in the stomach and felt something like a hot flash followed by shaking from head to toe.  after some heart tests, the doc said anxiety.  that same feeling happened to me 2x and I was put on xanax.  
First off, while the xanax help, I dont recommend them.  I have never felt worse in my life.  I dont know if its because of the xanax, which ive become addicted to, but when I get up in the morning, I feel like im literally jumping out of my skin until I take one.  I wish I never started w/ them. they do calm me down, but they're really not for palpitations.
I also feel like im on the verge of a nervous breakdown.  Ive become so obsessed w/ my heart rate and just dying from it in general that I feel as though I have no life left in me.  My heart tends to race quite often after I eat.  it's gotten to the point where im literally afraid to eat and have lost about 30 pounds since august.  I dont know what to do or how to feel better.  Ive gotten really depressed because of this.  I rarely go out at all anymore and Im in danger of losing my job because Ive been calling out sick so often.
Since Ive always been somewhat of a hypochondriac (as my doctor calls me) I cant even get him to take me seriously.  he just sweeps me under the rug and says, oh, its anxiety.  he acts like Im wasting his time.  my thing is that I think my heart behaving the way it does causes my anxiety, not the other way around.
I would give anything not to feel this way anymore.  Im constantly on edge, constantly wondering when my heart is going to act up.  One thing that does help me sometimes w/ the rapid heart beat is if I run very cold water over my wrists (where ur pusle is) or to actually stick ur head in very cold water.  this is supposed to slow the heartrate down. it sometimes works for me.  the water has to be really cold though.
Best of luck to you,
Pan

[shygirl22]

Chris I know exactly how you feel!!! I hate the panic attacks. I was rushed into the ER yesterday because I have had it with it. They did two tests and they both came out normal. My highest heart rate was 86 which seemed normal they said. I hate this feeling. I just got on Celexa(5 days ago) but it is very scary for me. I think I am dying or something. I really don't know what to do.  I can't sleep because the heart wont stop beating to fast, it is really pissing me off. I am scared, I am crying, I feel like there is no way out of it.

[xty0]

well. it has been a year for me with anxiety and panic disorder. ive started seroxat(paxil) 3 weeks ago. i feel much better -almost back to normal again. im taking half the required dose... i dont dare taking the whole pill...the side effects i encountered when i started were terrible and the withdrawal process doesnt seem to be smooth as everybody is saying.

one thing that can help with the heart beat rate is to forget about it. i used to measure it every now and then and used to be 80-100 all the time... it drove me crazy and many times triggered a panic attack. at a later point i accepted the fact that it was fast because of anxiety and that wasn't dangerous... it was just a normal reflex of the body. u wont die when your heart is beating fast... check the statistics... many suffer from anxiety and panic disorder..no one died of this.

My heart beat rate is now 62. i first thought it was too low... but then i accepted it was normal and im not worrying anymore. Many of the things we feel are wrong will turn normal again as soon as anxiety goes. by the way, i'm hypochondriac as well. but again this is because of anxiety...

[regan]

I started getting panic attacks at fourteen. I'm now twenty nine. They went away around nineteen came back when I was twenty -one. I was agoraphobic for about a year and a half until I got on Paxil. At twenty-five I went off Paxil because I was excercising and feeling so good I forgot what a panic attack felt like. It was misery for about six months. They say paxil isn't habit forming but my body went through some major stuff.(extreme panic, depression, faint, and so on...) After that I got pregnant with my son and once again I was fine. I breast-feeded him for a year and then a year after I stopped I started having weird heart palpitatins that the doctor has called premature ventrical contractions. They feel like skipped beats, or extra beats, or like my heart stops then starts again with a thud. They scare the heck out of me and give me some major anxiety which now sometimes cases a panic attack.My doctor says I am fine the palps are benign, but they are hard to ignore. I too feel like I am on the verge of a mental breakdown. For some reason I feel alot of this is hormonal. I was never plagued by this during pregnancy only after. And it seems to get worse around my time of the month.

[ledwards]

I have that same "thud" you are talking about.  Mine is a valve prolapse, also deemed "benign".  It makes me panic and feel even more anxious than usual.   I tried some Inderal (Beta Blocker) when I was your age and it helped a little.  Exercise helped a lot (cardio).   It hardly bugged me at all for 20 years, so there is hope.

[regan]

What lifestyle changes did you make to help the skipped beats? Did you do anything special or did they just go away? Do you have an anxiety disorder or do you think the heart irregularity makes you anxious.. I do have anxiety but I was able to control it alot better before the pvc's. About how often did you get the skipped beats (pvc's). I get alot throughout the day.

[ledwards]

Every day.   Like I said, the cardio working out helped.  I don't know what comes first and worst, the thuds or the anxiety.

[susans]

I am 50 years old and have had panic disorder since age 24. Somehow I got so used to it the panic attacks became infrequent. I do still have GAD. I've been on Zoloft, Paxil, Celexa, Wellbutrin, Atavan, Xanax and an currently taking Xanax on a regular basis (controlled amount - I never go over) and Lexapro. I envy those of you who have been helped by the SSRI's. The only thing that's happened to me was gaining 50 lbs in 3 years, probably started with Paxil. Being in perimenopause is probably an additional factor (I had been very thin through Weight Watchers). This is the heaviest I've been in my entire life. I do not feel any difference from SSRI's - but I have to admit that in my case, Xanax does stop palpitations and heart raciness immediately and if I'm not having a huge attack of palpitations once I take the Xanax it carries me through the day. My neurologist recently put me on Inderal after testing my nervous system, to slow it down but I'm not really noticing a difference with the physical symptoms. I'm afraid to continue with the beta blockers because I hear they cause weight gain, not something I need. Have any of you been given beta blockers for the heart raciness and do you know if they do, indeed, cause weight gain?
I'm feeling a bit better lately, but until recently I was feeling so stressed out and overwhelmed that I felt like jumping out of my skin. I find it hard to concentrate and cannot get organized, am bogged down by loads of papers and mail and just keep shuffling them around because I'm too anxious to just sort them and organize. I'm usually better when I'm out of the house. I have started exercising -- don't really notice much of a difference but I enjoy this type (circuit training for women). Did yoga for three years - meditation, the whole works - couldn't counteract the natural adrenaline that triggers anxiety, only thing that seems to work is Xanax. People put it down as being addictive, but so is insulin if you're a diabetic, meaning, if you need it to function and you're not abusing it, it's OK. I was also adverse to taking it but my doctors were the ones that convinced me that people with anxiety disorders, unless they have addiction problems, generally don't abuse these medications. I don't really see why it's so much worse than needing an SSRI, you sort of get dependent on them as well if they help you function. For those of you who are finding the panic attacks overwhelming - I did go thru that when I was in my 20's, avoided restaurants, stopped driving for 10 years and was not even able to work for one year. These extreme attacks seem to level off as you get older, you sort of build up a tolerance to them to the point where you no longer think you're dying because you know you're not from experience and they just turn into a more even level of anxiety that's not pleasant but not as frightening. I hope this helps those of you who are suffering from the intense attacks.

[ukbitsps]

Well, just thought I'd update those who kindly responded to my original post.

It's been nearly two months... and I am beginning to resign myself to the fact that all these symptoms are anxiety. I am, however, being reffered back to the cardiologist to put my Doctors mind at rest (good for him.) P.s. I can't stand doctors, I don't trust them at all! No offence meant to those who have posted to this group, perhaps it's just mine??

The Cardio is probably going to do a 24hr holter test because I keep getting a racing heart in the mornings. Overall the racing has or seems to be coming down, and generally I can control much of my panic by saying to myself "I am not going to live like this" and "I'm not going to let this rule my life."

In fact, during a very scary panic attack (palpitations, hr over 180, sweating, dizzy etc) I just looked at myself in the mirror, stopped checking my pulse and just took deep breaths. Went back to my desk, continued not to check my pulse, and reaffrim my well being by saying to myself "I'm OK, I've got no real pain, and I'm going to be OK." It stopped in 10 mins, I was back to normal in less than an hour.

I did NOT flee work, call an ambulance and remained calm. I think this is the cure to my problem, mastering this is the real challenge.

I'm still taking Zispin, but I've noticed it has started causing me postural hypotention (chest pain thumping heart when standing, dizziness etc) which isnt nice. But, Im beggining to question even that because it doesn't always happen! I'm thinking this is Anxiety taking different forms. It's a strange condition isn't it!

Oh yes, I went up to London yesterday and walked 11 miles!!! I was well impressed with myself and dispite the fact I was a bit scared, my heart was racing quite considerably I put up with it and got on with my life! I felt really auxillerated after I came home.

If there's anything useful I have learnt from all of this is that you should NOT let this rule your life. If you have a bout of racing heart, just carry on and ignore it (providing you've had it checked out by your GP!!) Let's face the facts, if the specialists cant find anything wrong, who am I to question that!?

It's all a case of putting everything into perspective and getting on with things as much as possible. Talking helps.. if there's anyone who wants to discuss their anxiety with me I would be happy to chat by email back. You can get me at:

christopher.***@****

Anyway, I'll update you if anything else happens in the mean time. So far, I'm not on Beta blockers because I can sometimes control my heart rate!!!!! Unbelivable isnt it...

Take care peeps
Chris

[deb723]

I am currently doing research for an upcoming book which deals with the side effects and withdrawals people have experienced from Effexor XR and other (like) anti-depressants. I am interested in receiving any information current or former users would like to share concerning their experiences with these drugs. Please email me @:
beach-***@****
and thanks!
deb