On June 19th 2009 I had my first panic attack. I went to Urgent Care and got a chest x-ray and an EKG. I thought something was wrong, but everything came back normal. They said it was just anxiety. The symptoms went away until July 25th, when I had my second panic attack. The symptoms haven't gone away since that day. So I went to a Dr. yesterday, and had some blood work done. I don't eat well or get enough minerals being a vegetarian. And all this year I had a big Red Bull everyday in the morning, ate starchy foods, and drank a ton of diet soda everyday too. At Urgent Care, I was told to get off caffeine. Now I only drink diet soda w/out caffeine. But my symptoms are worse then ever. I feel it has to be something worse then anxiety. I get dizzy, out of breath, chest/rib pain for long periods, sore muscles, back pain, shoulder pain, jaw/toothache, inner chest and outer body tingles, and extremely fast, terribly freighting heart palpitations that last all day/night. I feel I'm having a heart attack! But I'm only 17 years old! I get these symptoms everyday. I fear I'm going to die soon of a heart problem that the Dr. hasn’t found yet; or a heart problem that won’t be found till I’m already dead or in critical condition. Worrying isn’t helping, but I can’t stop thinking about it when the symptoms are so constant and freighting. My heart rate is a bit high but normal, usually 100 beats/minute. I am thin, I exercise, I don't drink or do drugs, and I have normal blood pressure. My uncle who is 54 had a heart attack recently, but other then that I don't have a history of heart problems in my family. Can I have Coronary Artery Disease, Heart Attack, or Heart Disease at such a young age? Did all of the caffeine I drank in my childhood/adolescence possibly have an effect on my heart? And if it did have an effect, is it life threatening? PLEASE, anyone who can give me advice or who goes through the same thing please let me know. Some hope and peace of mind is very much needed.
Obviously without evaluating you myself, I can’t tell exactly what is going on with you. First off, I would definitely avoid evaluation at an Urgent Care clinic, if there is nothing emergent going on. Definitely get with your primary care provider for further evaluation of these symptoms. That said, there is likely one of a couple of things going on. The most common thing that I see, especially in adolescents, is that they tend to be relatively dehydrated. Unfortunately, in the pediatric and adolescent population, the thirst center in the brain activates a little later than you would think, so it is easy to be even a little dehydrated and not feel it—until your heart starts beating fast for no good reason. I would recommend that you drink four 8-12 ounce glasses of fluid (skim milk, water, juice) a day and have a salty snack (pretzels, saltines, pickles) to make sure that your “tank” remains full. Also, you should not skip meals and you should eliminate caffeine, since it is a diuretic, which means it makes you urinate and dump fluid. It sounds like you’ve at least done that.
Your history suggests that you may also be hyperventilating somewhat, since you are so worried about this and getting tingling in your body. Hyperventilation occurs when you breathe faster than normal and exhale too much carbon dioxide. This causes your blood vessels to squeeze down, which increases your heart rate, makes you dizzy, and gives you a tingling sensation. The problem is that this can be a bad feedback loop, in which your fear causes you to breathe harder, then you hyperventilate, then you feel more symptoms, then you get more scared, etc. The goal here is to try not to do that.
The other potential problem is that you may actually be having an arrhythmia, or an abnormal heart rhythm. If you are not having the arrhythmia at the time of your evaluation, then it won’t be seen on an EKG. It would be helpful to measure a pulse rate, or your heart rate. If it is greater than 180 beats per minute at rest, this is probably more consistent with an arrhythmia. An easy way to measure a pulse rate is to count the number of pulsations in 6 seconds and multiply by 10. Another way to assess this is by using an ambulatory EKG monitor, sometimes called a loop recorder or an event monitor. These are monitors that you take home and wear that continuously record your heart rate. However, they only remember when you push a button, which you do when you have an actual “event.” Caffeine again should be avoided in this situation, as it is not only a diuretic but also a myocardial irritant, which means that it stimulates the heart to have early beats or sustained arrhythmias. However, stopping its intake typically eliminates this effect.
Finally, your history does not sound like that of coronary artery disease or a myocardial infarction (heart attack). This is classically described as the worst chest pain ever, like an elephant sitting on your chest and crushing you. The pain radiates up to the neck or left shoulder, or down to the upper part of the abdomen. Your description does not suggest that this is happening, which should be reassuring. If , in your evaluation, adequate hydration does not help, and you are found not to have an arrhythmia, your primary care provider should evaluate you further for panic attacks, as there are very good medications as well as relaxation techniques available for treating this.
Wow, feel for you....
I have recently went to doctor because my hear rate is high -- 90 bpm and jumps to 110-125 during day.... I was freakin' out over it.
Doctor is checking my thyroid and running an EKG, but suspects that stress hormones that can build up over time are the root cause.
The doc registered it in my file as tachycardia = rapid heart rate. Little google search on my own for "tachycardia" told me to watch our for caffeine and dehydration.
I am not a doctor, but I would say stay off the caffeine, speak to a dietition to be sure you are getting the proper proteins and such given your diet. My diet in the past was a lot of bad carbs and I was always tired and hungry even after being a piggy. Changing eating habits has helped a lot. Basically, it was recommended to me to eat lower on the food chain. If the food is processed, comes in a box, or has an ingredient list of more than a couple things, things you cannot pronounce -- don't eat it! Was told to stay away from bread, pasta, rice, potatoes, chips and similar snack stuff.... Maybe stick to fruits, veggies, beans, and nuts :) Convenience makes this difficult, but with a little planning, or going to Quick Trip instead of McD you can get fruit, salad, on the go...
Thank you so much for all your advice. I really do appreciate all the time you took to write. I have been drinking a ton of water lately, and it seems to be helping. I do not think I have a arrhythmia because I always only have 100 beats/minute. But I will definitely still ask my Dr. to look into it. As far as heart attack goes, sometimes the pain is unbearable, and it radiates into my shoulder and jaw. But I hope it is just anxiety considering my history and age. Thank you again for you advice!!!
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