Panic Attacks: Impact on Heart Health and Biomarkers

Panic disorder emergency room visit (CPK and Troponin)

Hello, cardiologist.
I have been taking medication for panic disorder for over ten years (Xanax).
On April 10, I went to the emergency room due to a panic attack, where my blood pressure was 177/133 and my heart rate was around 140-150.
After receiving a sedative, my condition improved, and I was discharged.
At that time, my EKG was normal, but blood tests showed creatine kinase at 213 (normal range 25-175), lactate dehydrogenase (normal), and cardiac troponin I at 0.067 (normal range 0-0.018).
Do these results indicate a myocardial infarction? I had a normal EKG and echocardiogram at Tzu Chi Hospital.
I would like to know if severe panic attacks, which cause elevated blood pressure and increased heart rate, can affect cardiac troponin I levels.
I do not experience chest pain or discomfort, only severe panic attacks that require emergency treatment with sedatives.
My blood pressure and heart rate normalize within half an hour.
This has been the case for several years, and I had a complete cardiac evaluation in 2017 that was normal.
Therefore, I would like to ask if panic disorder can lead to high blood pressure and increased heart rate that might affect the aforementioned test results, and whether a cardiac troponin I level of 0.067 is considered significantly elevated.
I am now worried about this every day, even when I feel fine.

Chen, 30~39 year old female. Ask Date: 2020/06/18

Dr. He Dongjin reply Cardiology

Hello, a slightly elevated level may not necessarily be significant, so there's no need to worry.
If there are no symptoms, and both the EKG and echocardiogram are normal, it is advisable to just monitor the situation.
If you are constantly concerned about considering a self-paid CT scan, it is recommended to observe first.
Changhua Hospital cares about your well-being.

Reply Date: 2020/06/18

More Info

Panic attacks can have a significant impact on heart health, particularly in individuals with pre-existing anxiety disorders. Your experience of elevated blood pressure and heart rate during a panic attack is not uncommon. When a panic attack occurs, the body enters a state of heightened arousal, often referred to as the "fight or flight" response. This physiological reaction can lead to increased heart rate (tachycardia) and elevated blood pressure, as you experienced with readings of 177/133 mmHg and a heart rate of 140-150 beats per minute.

Regarding your laboratory results, the elevated levels of creatine kinase (CK) and troponin I are noteworthy. CK levels can rise due to various reasons, including muscle injury, strenuous exercise, or even stress. Troponin I is a more specific marker for cardiac injury, and while your level of 0.067 ng/mL is above the normal range, it is essential to interpret this result in the context of your overall clinical picture. Elevated troponin levels can indicate myocardial injury, but they do not necessarily confirm a myocardial infarction (heart attack), especially in the absence of chest pain or other symptoms typically associated with cardiac events.

In your case, the acute stress from the panic attack could have contributed to the transient elevation of these biomarkers. Stress-induced cardiomyopathy, also known as "broken heart syndrome," can occur in response to severe emotional or physical stress, leading to temporary heart dysfunction. However, given your normal EKG and echocardiogram results, it seems less likely that you have sustained significant heart damage.

It is crucial to address the underlying panic disorder, as recurrent panic attacks can lead to chronic stress on the cardiovascular system. Chronic stress is associated with various cardiovascular risks, including hypertension and heart disease. Therefore, managing your anxiety through therapy, medication, or lifestyle changes is essential for both your mental and physical health.

In summary, while your elevated troponin I and CK levels are concerning, they should be interpreted with caution, especially in the context of panic attacks. It is advisable to follow up with your healthcare provider to discuss your symptoms, the implications of your lab results, and the best approach to managing your panic disorder. Regular monitoring and a comprehensive treatment plan can help mitigate the risks associated with panic attacks and improve your overall well-being.

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