Anxiety and Heart Palpitations: Insights from a Mental Health Expert

Health anxiety, anxiety, rapid heartbeat?

Hello Dr.
Lin, thank you for your professional guidance.
I hope to receive your assistance.
Last year on March 11, I suddenly experienced a rapid heartbeat and went to the emergency room.
Starting in May, I began to experience ventricular premature contractions (VPC).
Many cardiologists I consulted said that I didn't need medication, which was fine, but this sensation of missed beats gradually led to anxiety.
In September of last year, I had my first panic attack, feeling cold all over and as if my blood was ice, prompting another visit to the emergency room.
I underwent echocardiography, electrocardiogram, X-rays, and blood tests, all of which showed no abnormalities.
I consulted a psychiatrist and started taking 40 mg of escitalopram and 0.5 mg of alprazolam at bedtime.
If I felt uncomfortable in the morning, I would take half or a whole alprazolam.
I also tried traditional Chinese medicine and acupuncture.
I have been on Western medication for about a year.

Yesterday, on August 6, I listened to an online gratitude concert that was very relaxing, but suddenly I felt my heart racing.
I didn't panic, but I experienced slight difficulty in breathing, so I measured my heart rate with a medical pulse oximeter and found it was 149 beats per minute.
I was initially very scared and uncomfortable, thinking about going to the emergency room, but I took one alprazolam and one heart rhythm medication.
About 30 minutes later, my heart rate slowed down to around 90-100.

Dr.
Lin, shouldn't panic attacks cause an increase in heart rate? Or is it possible for the heart rate to increase first and then lead to more anxiety? I often worry about having a cardiac arrhythmia due to an extra electrical pathway, but after seeing so many cardiologists, I should have been diagnosed by now.
I also often feel reluctant to get out of bed in the morning, and my feet are frequently damp; could this be caused by anxiety?
Additionally, I would like to ask if RTMS and TBS can help with autonomic nervous system regulation, anxiety, and panic.
Which of these two treatments would you recommend? I apologize for the lengthy questions, and thank you! Wishing you peace!

N, 20~29 year old female. Ask Date: 2021/08/07

Dr. Lin Mianzhang reply Psychiatry

Hi there! Actually, human emotions and physiological responses are closely related.
Sometimes, emotions come first, followed by physiological reactions; other times, physiological responses occur first, leading to the experience of emotions.
For instance, in panic disorder, it is possible to first feel panic and then experience an increased heart rate, or vice versa.
Since your heart condition has been assessed and found to have no major issues aside from VPCs, there should not be any significant problems.
People tend to sweat when they are anxious, so the dampness in your feet could be due to anxiety.
Currently, rTMS and TBS are primarily indicated for depression, but some studies suggest they may also be beneficial for anxiety disorders, although they have not yet been approved by the FDA in the United States (the FDA in Taiwan has only approved them for depression as well).
If you feel that you are still experiencing panic attacks despite your current medication treatment, you might want to discuss with your doctor the possibility of adjusting your medication.
Additionally, combining medication with psychotherapy can also be helpful.
Wishing you peace and joy!

Reply Date: 2021/08/07

More Info

Hello! Thank you for reaching out with your questions regarding anxiety, heart palpitations, and the potential treatments available. It sounds like you have been through a challenging journey with your health, and I appreciate your openness in sharing your experiences.

From what you've described, it seems that your anxiety and heart palpitations have created a cycle of fear and discomfort. This is not uncommon among individuals who experience panic attacks or anxiety disorders. The relationship between anxiety and heart palpitations can indeed be complex. In many cases, anxiety can lead to physiological changes in the body, including an increased heart rate. Conversely, experiencing heart palpitations can trigger anxiety, creating a feedback loop that can be difficult to break.

When you mention that your heart rate increased during a relaxing event, it’s important to recognize that anxiety can manifest even in seemingly calm situations. This phenomenon is often referred to as "anticipatory anxiety," where the fear of experiencing anxiety or panic can itself provoke symptoms. Your experience of feeling your heart racing and then becoming anxious about it is a classic example of how anxiety can exacerbate physical sensations, leading to a heightened state of alertness and discomfort.

Regarding your concerns about your heart, it’s reassuring to hear that multiple cardiologists have evaluated you and found no significant issues. Ventricular premature contractions (VPCs) are common and often benign, especially in individuals without underlying heart disease. However, the psychological impact of these sensations can be profound, leading to increased anxiety and fear of serious health issues. It’s crucial to continue working with your healthcare providers to address both the physical and psychological aspects of your symptoms.

As for your question about RTMS (Repetitive Transcranial Magnetic Stimulation) and TBS (Theta Burst Stimulation), both are forms of non-invasive brain stimulation that have shown promise in treating various mental health conditions, including anxiety and depression. RTMS has been used to help modulate brain activity and can be beneficial for individuals who have not responded well to traditional therapies. TBS is a newer technique that may offer similar benefits with shorter treatment sessions. The choice between the two often depends on the specific protocols available at your treatment center and your individual needs. It would be best to discuss these options with your mental health provider, who can guide you based on your specific situation and treatment goals.

In addition to considering these treatments, it may also be helpful to explore cognitive-behavioral therapy (CBT), which has been shown to be effective in treating anxiety and panic disorders. CBT can help you develop coping strategies, challenge negative thought patterns, and reduce the fear associated with your symptoms.

Lastly, regarding your morning anxiety and physical sensations like wet feet, these can indeed be manifestations of anxiety. The body often reacts to stress with various physical symptoms, and it’s essential to address both the psychological and physiological aspects of your experience.

In summary, it’s important to continue seeking support from both your mental health and medical professionals. They can help you navigate your symptoms and find the most effective treatment plan for your needs. Remember, you are not alone in this journey, and with the right support and strategies, it is possible to regain a sense of balance and well-being. Wishing you all the best on your path to recovery!

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