Managing Anxiety and Panic Symptoms After Heart Palpitations: A Patient's Journey

Q: Managing Anxiety and Panic Symptoms After Heart Palpitations: A Patient's Journey

Hello： Anxiety disorders and autonomic nervous system dysregulation often influence each other, creating a vicious cycle that typically requires some changes for improvement. <br>Most causes of onset are not due to a single event; both physiological and psychological factors may

Experiencing anxiety and panic symptoms following missed heartbeats, please consult a physician?

Hello Dr.
Wang, thank you for your dedication and professionalism in addressing everyone's concerns.
After reading your previous responses, I believe you are a very knowledgeable doctor.
I apologize for the length of my message, but I would like you to understand my situation.

On the night of March 11, 2020, I had a hot pot dinner with friends, and when I looked in the mirror in the restroom, I noticed my face was flushed, which made me feel like I had high blood pressure.
I became scared and started to feel dizzy and my heart raced, leading me to the emergency room where my heart rate was around 145 bpm.
On March 13, I visited a cardiologist, and the echocardiogram was normal.
A 24-hour Holter monitor showed 54 ventricular premature contractions (VPCs), which I didn’t feel at all.
Before this incident, I was a very optimistic and normal person.
On May 5, 2020, I visited an ENT specialist due to a cold and experienced a drug allergy, resulting in a red rash on my arm and groin that felt like a burn.
From May 18 to June 4, I began to feel abnormal, experiencing many symptoms of autonomic nervous system dysregulation, starting with gastroesophageal reflux and stomach pain.
I began seeing a traditional Chinese medicine (TCM) practitioner for improvement.
From June 4 to July 28, I started experiencing irregular heartbeats with a sensation of missed beats and a racing heart.
I often felt anxious.
On June 8, I had an examination at Chang Gung Memorial Hospital, which also showed normal echocardiogram results, but the 24-hour Holter monitor revealed over 300 VPCs.
I became increasingly worried and focused on this symptom.
Since VPCs are considered benign arrhythmias in medicine, the doctor could only prescribe medication to slow my heart rate, which didn’t help much.
I felt helpless, experiencing up to 600 VPCs in a day.
In July 2020, I began to experience intermittent chest pain.
On August 26, I found a well-known TCM practitioner online specializing in arrhythmias.
I started weekly visits from Taoyuan to Tainan to get treatment because I genuinely wanted to resolve my symptoms.
During the course of treatment, my condition fluctuated.
On the night of September 25, I experienced an inexplicable panic, pacing around and unable to settle down.
My family noticed my abnormal behavior.
A few minutes later, I felt cold all over, as if my blood was ice, and I panicked, thinking I was going to die.
This was my first panic attack, and I went to the emergency room where I received an injection.
I continued to have intermittent feelings of panic.
I later consulted a psychiatrist who prescribed me medication (20 mg of Xibin capsules twice daily and 0.5 mg of Xanax once at bedtime).
The dosage gradually increased, and I still take this amount today.
Although I’m unsure of its effectiveness, I sometimes take an additional 0.5 to 1 Xanax in the morning if I feel unwell.
For the many missed beats, I take the medications prescribed by my doctor, such as 1.25 mg of Concor or 10 mg of Entresto, but I am resistant to taking heart medications.
Although the cardiologist said it was fine whether I took them or not, I often endure without them, leading to a series of ups and downs in my condition.
Currently, I am stable with regular visits to the psychiatrist and check-ups with the cardiologist when I feel anxious.
I rely on TCM, acupuncture, and self-care for my autonomic nervous system.
In May 2021, I found a good TCM practitioner near my home who genuinely wants to help me.
I started treatment with him and stopped traveling to Tainan due to my panic disorder, as I was afraid to take long-distance trains.
Between May and June 2021, the combination of TCM and psychiatric treatment noticeably reduced my VPCs.
I realized that my anxiety was primarily caused by the VPCs, which ultimately led to my panic attacks.
Until a few days ago, on July 4, I sometimes felt shortness of breath and a slightly elevated temperature of 37.7°C.
I wondered if something was wrong with my body.
The more I focused on my breathing, the worse it became, leading to panic on July 6 when I woke up feeling unable to breathe.
I took half a Xanax and went to see the doctor.
I visited the cardiologist, and both the chest X-ray and ECG were normal, but I still felt that my breathing was not smooth.
The more I thought about it, the more anxious I became.
I know I shouldn’t think about it, as it would help me feel better, but it’s difficult.
I’m also afraid that taking Xanax every morning will lead to dependence.
Now, if I don’t take it before 11:00 PM, I feel strange, and my feet sweat.
I would like to ask you, doctor, if continuing this medication for a period of time can help me return to being a normal person? Or does experiencing panic and anxiety mean that these symptoms will frequently reoccur? Is the feeling of shortness of breath and discomfort caused by anxiety and panic? If so, should I be concerned about it? I also don’t understand why my heart rate goes up to 110-120 just from walking a little.
Before all this, I was a very optimistic and normal person.
Can I return to who I was before? Could my symptoms have started from that incident in March 2020 when I thought I was having a stroke after seeing my flushed face in the mirror? My family keeps telling me to manage my panic and anxiety, and the VPCs will naturally improve, but I experienced the missed beats first, which led to my anxiety and panic.
Is it difficult for me to recover from this panic and anxiety?
Most importantly, I hope you can provide me with any advice you think might help me.
I really don’t want to spend every day lying down, fearing rapid heartbeats, missed beats, or anxiety and panic.
Recently, I’ve noticed that just walking a few steps makes my heart rate jump to 110-120.
I apologize for the lengthy message, and thank you for reading it.
I appreciate your hard work during the pandemic, and I wish you safety!

Niming, 20~29 year old female. Ask Date: 2021/07/07

Dr. Wang Yaoting reply Psychiatry

Hello: Anxiety disorders and autonomic nervous system dysregulation often influence each other, creating a vicious cycle that typically requires some changes for improvement.
Most causes of onset are not due to a single event; both physiological and psychological factors may contribute.
Research indicates that individuals with anxiety disorders exhibit abnormalities in the secretion of neurotransmitters in the brain (serotonin, norepinephrine, dopamine), which is why pharmacological treatment is generally effective.
Xanax is an anxiolytic medication that can quickly and effectively alleviate symptoms, but it may also lead to drug dependence, so it is advised not to use it frequently.
The primary treatment medication should be Buspirone; if there is no significant effect after a period of use, considering a medication change may be appropriate, and psychological therapy can also be arranged.
Additionally, lifestyle changes may be beneficial: 1.
Ensure adequate sleep and avoid staying up late.
2.
Limit blue light exposure from phones before bedtime.
(There are photosensitive retinal ganglion cells in the retina that regulate circadian rhythms and physiological functions, and blue light exposure before sleep can stimulate these cells, disrupting the natural nighttime cycle.) 3.
Wake up early and engage in regular, moderate exercise and sun exposure.
4.
Reduce intake of stimulating foods.
5.
Stay away from noisy and disruptive environments.
To restore the dysregulated nervous system, the best approach is not to rely solely on medication but to return the body to its natural physiological cycles.
I hope this answers your question :)

Reply Date: 2021/07/07

More Info

Managing anxiety and panic symptoms, especially after experiencing heart palpitations, can be a complex and challenging journey. Your detailed account highlights the interplay between physical sensations, anxiety, and the psychological impact of health concerns. It’s important to understand that anxiety disorders, including panic disorder, can manifest with a variety of physical symptoms, including palpitations, shortness of breath, and feelings of dizziness or lightheadedness.
From your description, it seems that your initial experience of palpitations and subsequent anxiety may have created a feedback loop. The fear of experiencing palpitations can lead to increased anxiety, which in turn can exacerbate the physical symptoms. This cycle is common among individuals with anxiety disorders. The key to breaking this cycle often involves both psychological and physiological approaches.

Firstly, it’s crucial to continue working with your mental health professionals. Cognitive Behavioral Therapy (CBT) is particularly effective for anxiety and panic disorders. CBT helps you identify and challenge negative thought patterns and beliefs that contribute to your anxiety. Additionally, exposure therapy can be beneficial, where you gradually face the situations that trigger your anxiety in a controlled and supportive environment.

Medication can also play a significant role in managing anxiety symptoms. It’s understandable to have concerns about dependency on medications like benzodiazepines (e.g., Xanax), especially if you feel you might need to increase your dosage. Discussing these concerns with your psychiatrist is essential. They can help you weigh the benefits and risks and may suggest alternative medications or strategies to manage your anxiety without increasing your reliance on benzodiazepines.

In terms of the physical symptoms you’re experiencing, such as the feeling of shortness of breath or a racing heart, these can indeed be manifestations of anxiety. When you focus on these sensations, it can create a heightened state of awareness and fear, leading to further anxiety. Practicing mindfulness and relaxation techniques can help you manage these sensations. Techniques such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation can help you regain a sense of control over your body and reduce anxiety levels.

It’s also important to maintain a healthy lifestyle, which includes regular physical activity, a balanced diet, and adequate sleep. Exercise, in particular, can be a powerful tool for managing anxiety. It releases endorphins, which can improve your mood and reduce stress. However, if you find that certain activities trigger your symptoms, it may be helpful to start with gentler forms of exercise, such as walking or yoga, and gradually increase intensity as you feel more comfortable.

Regarding your concerns about returning to your previous self, it’s important to recognize that recovery from anxiety and panic disorders is often a gradual process. Many individuals experience fluctuations in their symptoms, and it’s normal to have good days and bad days. With the right support and treatment, many people find that they can manage their symptoms effectively and regain a sense of normalcy in their lives.

Lastly, if you continue to experience significant physical symptoms or if your anxiety worsens, it may be beneficial to consult with a cardiologist again. They can provide reassurance and rule out any underlying cardiac issues, which can help alleviate some of your fears and anxieties.

In summary, managing anxiety and panic symptoms requires a multifaceted approach that includes therapy, medication, lifestyle changes, and self-care strategies. It’s important to remain patient with yourself and to seek support from healthcare professionals who can guide you through this journey. Remember, you are not alone in this, and with time and the right strategies, it is possible to regain control over your anxiety and improve your overall well-being.

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