IST and stress

[Lextgrim]

Help - Wrote messgae but kept exceeing limit of characters.  Sinus tachy - constant/sustained since April this year, high bp also, on beta blockers, last night hr raced on climbing stairs as usual, even on betas, ached all over as usual, took half beta blocker, it didn't work, waited for it to kick in and it didn't.  Fell asleep, this morning, rate was still above 100.  Worried.  Been told by Dr. it's stress and anxiety because had full phyiscal blood work ups done and saw cardio.  Had echo and holter, told heart is perfect, but still have a constantly elevated rate so need to take betas.  Now getting neuro symptoms, over past two months, depersonalisation feeling, voice cutting out at times, stammering a bit, saying wrong words, pupils uneven sometimes, no headaches but struggling to even type the right letters and am a writer by profession and can type fast nornally.  Struggling to get people's names right too, people I knopw well.

So scared.  I was totally healthy till I had strep in my womb after giving birth, since then I have been getting profgressively ill.  

Hormones, thyroids, glucose, cbc, esr, ana, ace, serum levels, the lot!  All normal.  Drs refused referred for MRI because they think it's psychological.  On SSRIs and Beta Blockers.

How do I stop this tachy?  It is constant, sustained.  MD on allexperts said anxiety can cause it and I have been under severe stress for a few months, plus panic attacks.  Scared though about what's happening.  Have a baby and want to just be his mum and look after him.  I lost lots of weight too and have GI symptoms, and get food stuck in my throat when I try to swallow.  Dr again says that's anxiety and stress.

Need advice.  Can anxiety do all of those things?  How do I get my rate back to normal?

[circadrt]

Hello Doctor M;

I'm so glad to see someone knowledgeable about something like this, which scares so many people, offering their time and expertise to help out! Kudos to you.

I am VERY glad you point out the anxiety-stress componant. It exacerbates ANY illness or dis-ease state. As you know, adrenaline, catecholamine and norepinephrine, which anxiety (the adrenals) releases in large amounts (Panic Disorder or G.A.D.) can trigger PVC/PAC events in someone who normally gets very few or does not feel them. I am one of those people I am sure. I am a 57 year old male. I would suspect the majority of people find this place due to anxiety ABOUT their palpitation issues, whether they are age 20 or 50, PVC or PAC, had all the tests and "reassured" or not, etc. Studying medicine since the age of 12 seriously did not help matters. I became a textbook case of the "medical student hypochondriac." And I so much wanted to be a doctor. Oh well...

I have had anxiety and panic disorder off and on since age 19 when I started off to college. Separation anxiety probably triggered it. I was very insecure and very close to my parents. Very unsure of the world out there. Wish I had gotten into counseling-therapy around my anxiety much earlier. It could have saved me decades of distress.

Anyhow, I also, as many with anxiety do, had periods of inaction and depression, which made me stay in bed and be very still and not do much, for fear I would trigger these scary "cardiac events." The end result was that I got badly de-conditioned, which most doctors and therapists will tell you makes anxiety and depression (and even many issues with palpitations) worse. So until I saw a therapist and got on some MILD medication to help me get out and about more, it was a vicious cycle. I also would constantly take my pulse, and "tune into" my body feelings, and wait for the next PVC/PAC to hit! What a self-fulfilling phrophesy. Of course what we think about often we can make to come about. People who do that need to break that habit.

Doctor after doctor and all the tests were negative and all reassured me in their own way it was normal. But the bad part was that I felt them whereas many or most people do not feel PVC's or PAC's. Or if they do they do not tune into them, which only makes them stronger and worse. So it got back to the "mind over matter" getting over the anxiety disorder, and the poor way of dealing with stress and tuning into my body sensations.  We as patients have to do some of this work ourselves. The doctor and the medications cannot do it all for us (darn it!).

I have had all the echos, EKG's stress tests, thallium scans, Holter monitoring, and other things to rule out anything but benign, ectopic PVC's and PAC's. The doctors know I have anxiety and say that causes 90% of it when it happens, and the other 10% is normal even if I were not an anxious, sensitive person. I don't drink alcohol, caffeine and don't smoke. I TRY to get myself to exercise, but am still struggling with that! I have some very good relaxation and self-hypnosis tapes on anxiety that help alot. I also had some hypnosis and learned that to keep the anxiety levels down. I also have an odd thing where I get VERY strong back muscle tics/twitches, and at the same time, I will "throw" a PVC/PAC. It's been documented on an EKG that this happens. ***I also have Fibromyalgia,***  which makes anxiety, and also from what I have read, having palpitations, more common.  I am sure many of the women posting here might also have FMS, diagnosed or not.

I suggest to all having these problems to sleep well at night and *stay in the present* and not get into the "Oh no! Not again" way of thinking if they feel something, since it only makes things worse, and triggers "hyper" hormones into the bloodstream. It is a daily, hourly struggle sometimes. If people who suffer from this (and assuming they have no actual cardiac, electrolyte or other medical reason for the PVC's or PAC's) can get a strong grip on the stress/anxiety, it will clear things up nicely, and make episodes of this much less frequent and manageable and not scary.  I try to remember "what we I think I attract or create to myself," and I can think myself into anxiety, which causes adrenaline, norepinephrine, and catecholamines to be secreted into the bloodstream. And once that happens, I will get those uncomfortable symptoms. If I catch it early (the negative thoughts) and do something to take my mind off of any sensations, things will calm down alot faster. Beta blockers can work, but most doctors feel they can cause more problems than they help, unless the sufferer is having a severe time with palpitations, and then it's a last resort. I assume you agree, but perhaps not.

Thanks again for helping everyone here out! I hope the forum contributors will keep talking, and keep trying to talk in a positive and supportive way to others here. "Swapping symptoms" can only make things worse. Success stories and stories of relief and encouragement will help everyone much more than merely sharing symptoms, which for most have been told to doctors already. I know it is not easy, but it will be a good habit to develop! :)

Your professional input helps greatly in reassuring and educating as much as you can, given the limits you have on accurately assessing a person's situation. I wish I had a computer and access to you and this forum 35 years ago! Keep up the good work, sir.

[Michael J. McWilliams, M.D.]

It sounds very complicated.  I hope you get to see a neurologist soon, although I am not sure what one syndrome could cause all those problems -- that is why they are suggesting anxiety.  It certainly could cause many of those symptoms.

I hope you feel better soon.

[tickertock]

WOW! You have very similar symptoms as myself though the tachycardia is controlled with atenolol(beta blocker) but lately I have been feeling real rotten. I have been diagnosed with AS(ankylosing spondylitis) a connective tissue /autoimmune disease, It has also been suggested by an internist that I might also have MS and a mild form of dysautonomia. I would say in my opinion of myself Anxiety plays a big part in my symptoms, but my whole nervous system over reacts in an abnormal way to which I have very limited control. This does affect one mentally as i know by myself as one is only left to ponder what might be wrong and trust me I know it's not all in my mind, but it sure as hell plays havoc with my mind!

[Lextgrim]

The bp remains the same on standing, it was checked.

More recently, I have noticed that my beta blockers are not working.  The rate is constantly fast resting and on standing.  I was told that it is anxiety and that I am in constant fight or flight mode.  My doctor said that the beta blockers work but when adrenalin is released the heart rate will go up regardless of the beta blocker.

I have had all sorts of probs, pins and needles in my arms on waking, painful legs on walking, climbing the stairs puts me in pain all over and I get short of breath and the rate goes up. I have been unwell particularly today, waking up with pins and needles down both arms and in one side of my face.  It went away after a few seconds.  I seem to also have a very tight muscle at the back of my neck leading up to my head.

I get pain in my right arm from typing.  A lot of the trouble seems to be on the right hand side.

I have not been right since giving birth.  

I am tired a lot too.

I was checked for autoimmune disease and my tests were negative.  They have suggested anxiety or ME but they have not sent me to a neurologist.  I have asked for an MRI but was refused.  They think it is a mental illness that I have.  I am in the UK.

[Michael J. McWilliams, M.D.]

Hello,

From what you describe it sounds, it sounds like you need to see someone that specializes in autonomic disease.  Many of the symptoms you describe are associated with the autonomic nervous system-- heart rate and swallowing.  There are two syndromes that come to mind -- both often associated with anxiety.

Inappropriate sinus tachycardia is a condition associated with abnormally heart rates when compared to the level of exertion.  It is often treated with beta blockers or calcium channel blockers.  SSRI's (anti depresants) are sometimes helpful to deal with the anxiety component.  Inappropriate sinus tachycardia is complicated because there is a strong association with overlap syndromes like fibromyalgia.  In cases when the heart rate is controlled, some people continue to feel the fatigue from the fibromyalgia type syndrome.

Another possibility is POTS (postural orthostatic hypotension syndrome) or other auntomic syndromes.  You mentioned that your blood pressure is high -- has it been check in both standing and lying position?  POTS is a syndrome where the heart rate may increase with standing to compensate for a drop in blood pressure.  The reason I mention this syndrome is because it tends to affect the autonomic nervous syndrome and therefore may affect blood pressure, heart rate, swallowing, etc. It often occurs in young women after a viral infection (not usually strep, but it is an infection) Many people with this syndrome suffer from confusion with standing because of a drop in blood pressure -- this may affect your speech and/or memory.  It is thought to be caused by an auto immune reaction against the autonomic ganglia.  If the diagnosis is not obvious from  history and physical exam, a tilt table test is often helpful.

This can be a tough diagnosis to make because there is no gold stardard test.

It is possible for depression (post partum depression) to cause all sorts of symptoms including some of the symptoms you describe.

Sometimes teaching hospitals are best places to have these questions addressed because they often have someone that specializes in autonomic function.  If you live near Akron, OH, Blair Grubb is a world renowed expert in POTS and IST.

I hope this helps.  I can tell you are struggling and wish you all the best.  Thanks for posting.