Cardiac Neurosis?

[beerhoch]

Hello,

I am a 38 yo white male with a family history of heart disease (Dad died of CAD at 42, maternal Grandmother had 1st heart attach at 52). I was diagnosed with CAD in June and had angioplasty & 4 stents (Cordis drug eluding type) for 2 blockages each in my LAD & RCA. I suffered a complication, my artery was perforated during the proceedure and a pericardial effussion started, leading to cardiac tamponade and a near death experience. An emergencey Pericardiocentisis followed along with days in the ICU with a drain in my chest, then several months of steroids to shrink the effussion. Follow up echoes show the effussion to be gome and no damage to my heart. I am now on Lipitor80 & Zetia10, and my ldl is down from 160 to 72. I'm also on Plavix, Enalapril, asprin and Atenolol (25mg x2). I have Gerd to add to all this.

I constantly feel chest, gastric pains & palpitaions and these lead to what I believe are panic attacks. I have had 2 thallium stress tests at 2 different facilities in the last 6 weeks, both of which were negetive. My cardiologist assures my that I am fine, I do not have a new blockage or restenosis. He believes that I am suffering from anxiety problems, which I am now forced to agree with. I believe that I am sufferuring from a panic disorder (cardiac neurosis?); I take my pulse and check my BP constantly and I panic at every discomfort I feel in my chest. It is becomming a problem for me.

Do you come across this sort of thing very often? What treatments or therapies do you recommend for your patients who suffer from similiar problem?

[~*CaMeO*~]

You GO, Girl!!!  Great comment!!!  Am with you 100%!!!

[Linda123]

Well - I've got to comment on this one!
I was a cardiac cripple, cardiac nutcase, whatever term you want to use - I was scared out of my wits with heart arrythnias for about 5 years.  I found out eventually I had some scar tissue in my atrium which accounted for a lot of my arrythmia - but it took me a long time and a lot of feeling humiliated infront of various doctors before I did find out.  The arrival of menopause sent my palpitations into overdrive, I felt unbalanced in my chest the whole time, and my life became one of continual fear.  Taking HRT helped enormously to bring me back to feeling normal and I have now topped this up with the anti-depressant seroxat and I can honestly say I feel wonderful.  My palpitations have all but vanished and I never stop being grateful.  Perhaps I am in remission - who knows - perhaps they'll be back, but right now I'm really living.
So - the moral of this story to the person that originally wrote in is - anti depressants can really, really, help - I am a living example of that, and I don't see why anyone with our problem should feel ashamed of taking them. I discovered the meaning of the word "fear" when I started experiencing palpitations.
Best Wishes to all, Linda

[~*CaMeO*~]

Thanks so much for the reply - you answered my question completely!  Might be something to request as I have all the above mentioned symptoms and it would be nice to rule out a physical problem and then deal with just plain old anxiety (right!).  My Doc did 'scribe Paxil but I'm just not comfortable taking any meds that I really don't need ------ an occasional Valium works just fine when required.

[beerhoch]

Thanks to everyone for your posts. It helps to know that there are others out there with the same problem. My PCP started me on cymbalta for anxiety last week. He says it is quick acting and that he has had very good results with it. I am hopeful of feeling better soon.

[Paule]

For patients that present with anxiety or high bp etc. in what should be an otherwise healthy person, too many doctors like to write a script for xanax or a ssri and say "your suffering from anxiety.." which I'm inclined to say that they are often 95% of the time correct.  However, that is not the appropriate standard of care in my opinion.  A doctor should rule some things out. One is checking stress hormones with a 24 hr. urine.  You avoid certain foods and pee in  a jug for 24 hrs ( a jug provided by the doctors office or lab ) and store in your refrig until you drop off ( warning, don't drink, Ha ) they will see the levels of catecholamines and other stress hormones.  If the test finds that they are spilling into your urine then your releasing too much and need to get them in check.  The test primarily rules out a very very rare condition that causes runaway hypertension (pheochromocytoma) a ususally benign tumor that causes the release of epinephrine and norepinephrine, which in turn causes severe hypertension which may be persistent or intermittent.  Also, this condition may cause the following symptoms:  headache, sweating, palpitation, apprehension, tremor, nausea, pain in the chest etc....see the similarities to anxiety??? HOWEVER, before anyone thinks they have this...THERE ARE ABOUT 800 CASES A YEAR IN THE US!! I'VE SEEN ONE IN 16 YEARS!  ALSO, even if your 24 hour urine is high, to have a PHEO your levels will have to be mutifold out of range, or very very out of range!

Hope this helps.

[~*CaMeO*~]

Taking something you said out of context:  please explain a 24 hour urine test for stress hormones.  I was told that there is no test to measure stress, excess adrenalin. etc., but apparently I was told wrong???  Yes, I have PVC's and yes, I am an uptight personality and yes, I KNOW that the "adrenalin rush" will trigger the skipped beats as I am a case in point.  Please elaborate and thank you.