What causes the skipped heartbeats during a panic attack?

[alvaa]

My heart normally beats about 75-90 a minute during the day and maybe 70-80 at night. I have heart arrhythmia's ever so often. My doctor knows about it. I know it has to do with some electrical firing off stuff, but when I have a panic attack like I just went through, many times (like this one), my heart beats like 100-120 a minute and "skips" like 15-20 in some minutes. When it does it 3 or 4 times in a row, I feel faint.

[birdie0907]

You can take the girl out of the country but you can't take the country out of the girl seems to apply to her and her therapy training.
I was lucky to be on Celexa which was working fine when I had a problem with a lying co-worker with a mean attitude which ended up in me being fired. I never missed a heartbeat, so to speak,  because I didn't need the money while the Celexa helped me immediately forget her attitude - which shows if we can control our minds some problems go away. I am off it now so have to deal with problems alone, but often look back to that moment when I am tempted to get angry with someone, using the philosophy that if it won't be a notable event 1,000 years from now how can it be important today?

[alvaa]

The weird thing is, I work for an IT department for a mental health clinic. She is our clinical IT person, so she should be understanding and supportive, lol. She has computer knowledge and a masters degree in psychology/therapy, and she knows of my anxiety, but I think her own life experiences and childhood have made her the way she is. She knows she gives me anxiety and when I point it out she tries to calm down, but sometimes it doesn't help.

[nursegirl6572]

Sweetie, the thing to hang onto is that you're still trying and giving this your all.  You're much more familiar with your anxiety/panic and the patterns you have NOW, so you kind of know what to expect with it, versus when it was knew to you.  It ***** having to be an "expert" on our own anxiety, but it does really help.  The better we understand it, the less scary it becomes.  When we're all new to it and clueless, it's the scariest thing in the world.  True?

It's going to be a while before those more negative thoughts/images of your Mom fade into the background.  Remember that that's all normal hon.  It's impossible not to think about things that make such a big impression on us.

When you find yourself thinking something negative and upsetting like that, TRY to replace that thought with a more positive one.  Find a pic of your Mom that you just LOVE, one that depicts EXACTLY who Mom was in your memory, and carry it with you.  When the vision of her in her final moments pop up, pull the picture out and look at it, and then think of some of your memories.  With time, it will get easier to dismiss those images.  Even though you don't want to think of her like that, it WAS something that stuck with you, it's just a normal reaction.  Don't let that upset you.

When I lost my grandparents, I did the same thing for quite a while, and NOW (it's been many many years), I couldn't pull up that mental image (the neg one) if I tried.  

Keep up the good work, and in your mind, picture your jerky co-worker naked, or something silly.  LOL   Speak up, tell her (calmly) that she is free to discuss anything with you, but you would appreciate her doing it respectfully.  If she really gets bad or flips out at times, tell her you will talk to her when she calms down..and walk away.  Have you told your boss about this?  I would just pull her aside and tell her you really don't appreciate it.  

If you THINK she's an okay person, maybe sharing with her that you suffer with anxiety and that her harshness causes you to be quite upset, maybe she'll be compassionate to you?  A lot of people don't even realize how they come off, or how they affect people around them.  You don't have to be afraid to share with people that you suffer with anxiety..it may help people be more empathetic.  Of course, some people are just jerks...and those kind of people will use that info to act worse.  

Take care sweetie.

[alvaa]

Thank you! Thank you! Thank you! You're insight to this is awesome. I always heard the fight or flight term but no therapist or psychiatrist ever explained it in that sort of detail.

It is getting better. Most of my anxiety still comes from work. I have a coworker in my department that is loud, rude, and just annoying. We had written a report a few months back and had to modify it and everything went wrong so we thought we fixed it these past 2 weeks and she pointed out, loudly while snickering, that it was still wrong and my boss has been on my tail about it because we have to get all of these things fixed before we do a major upgrade in a few weeks. This had me literally shaking, and of course I retreat to my safe haven at home in my room for a couple of hours while taking my xanax.

The depression comes and goes. I think about certain things and it gets worse. I picture her the last time I saw her just minutes after she died in the bed and even writing this now it makes me cry. Everyone says focus on the good times but it's really hard for me.

[nursegirl6572]

By the way sweetie, how you holding up?  How are you in the grieving process?  Are you talking about it?  Leaning on others?

I'm sure it's been sooo darn hard!

[nursegirl6572]

Panic directly affects the heart, and when an anxious person feels the symptoms related to the heart, it exacerbates the panic.  The two definitely greatly feed off of one another.

A panic attack is actually a physiological response, I'm sure you've heard of it, it's called the "fight or flight response".  It's MEANT to protect us in REAL life threatening situations.  For example, if you were attacked, or robbed, or were caught in a tornado or something, the fight or flight response would kick in.  It's an activation of the sympathetic nervous system, and it's all about preservation.  The body releases a huge surge of norepinephrine, or adrenaline, to prepare the body to either fight or flee a life threatening situation.  The adrenaline naturally causes the heart rate to increase, blood pressure to increase, etc.

What happens is, the heart rate increases, and blood flow is increased to certain area of the body, like the extremities, to allow for running, or strength for fighting, etc.  As a result of that, there is decreased blood flow to other parts, like the brain (which explains the dizziness), senses (which explains the funny vision we all describe during a PA).  Basically, it's our bodies' way of making the maximum most optimal use of our body to do whatever we need to do to save our lives.  Like a shut down of the less essential areas of our body, so the blood flow can be better utilized to fuel the parts that we would need to fight or flee.

Now, in a PA, that same response is initiated, only there is no real threat, which of course is what makes those sensations so scary, because when they're taken out of context, it's terrifying.  It's like a fire alarm without the fire basically.  Eventually the brain figures out that there isn't a real threat, and the parasympathetic nervous system kicks in, which switches off the FOF response and brings us back to a normal state.  Even if you're never able to control panic, your body will always do it for you automatically.  It's kind of neat if you think about it.  Our bodies are incredible machines.

So, as you can imagine, with such a strong physiological response, there are bound to be some symptoms that relate, including PVCs, or premature ventricular contractions (the skipped beats you're describing).  While they FEEL scary, they're harmless in almost everyone.  It's a benign cardiac symptom, just like palpitations.

The FOF response is an incredible thing if you think about it, but it's also very draining.  It's totally normal to have the kinds of symptoms you describe during a panic attack.  As scary as they are, they won't harm you.  You're not going to have a heart attack, and anything like that.

Hope that helps.