Medications and Related Issues
Hello Doctor: I have a more introverted and repressed personality, with tendencies toward worry, anxiety, and obsessive thinking, and I am quite sentimental.
Two years ago, after drinking black coffee and engaging in intense exercise, I experienced a panic attack.
This was triggered by the sudden death of the artist Gao Yixiang, who collapsed during a marathon due to illness and overwork.
During a break between sessions, I began to hyperventilate and felt anxious due to this incident, thinking I was having a heart attack, which led to over-breathing.
Recently, feeling depressed, I mistakenly accepted an intravenous injection of ketamine (Ketanest) at the encouragement of a friend, with a dosage of about 0.15-0.25g, lasting approximately 12 hours.
During this time, I had some light meals, rested, and maintained hydration.
Besides the typical symptom of tachycardia, I also experienced increased premature beats (ectopic contractions) and panic symptoms during the withdrawal period, suspecting that the stimulant effect led to rapid breathing, resulting in hyperventilation, dizziness, chest tightness, difficulty breathing, muscle spasms in the chest, and fear of arrhythmias leading to death, all of which made me mistakenly believe I was having a heart attack.
(I have heard of users experiencing psychogenic sudden death due to drug overdose.) Aside from this, I did not have any other severe symptoms.
After this incident, due to my ongoing anxiety and the occasional premature beats (both atrial and ventricular), I first went to a cardiologist for a resting electrocardiogram (ECG), which showed normal results.
I then went for a health check-up.
The health report indicated no major issues, and the chest X-ray (cardiopulmonary) also showed no significant problems, except for cholesterol levels exceeding the normal range (208) and the ECG report indicating left posterior fascicular hemiblock.
Although I followed up with the cardiology department the next day, the doctor stated that my cholesterol level was not excessively high and that the likelihood of a myocardial infarction at my age was low.
After reviewing the EKG, he also mentioned that there was nothing to worry about, attributing it to different interpretations by physicians, stating he would not have written it that way, but he did not elaborate further or conduct a new EKG or other tests.
He simply advised me against heavy weight training after learning about my long-term training habits, mentioning that he had recently treated a 30-year-old man who suffered a heart attack during weight training.
I felt some doubt and unease about this point but did not argue further and left the consultation room.
It has been over six months since that experience, and I have not had any further exposure.
I have also eliminated coffee, tea, and other stimulants from my diet.
I do not have issues with drug addiction or dependence, nor do I have any bad habits such as smoking or drinking.
I would like to ask you a few questions that are troubling me: 1.
Does intravenous injection really cause permanent damage to blood vessels? Is there a risk of developing atherosclerotic plaques? I never thought about this before during blood draws or treatments, but some online information claims that venipuncture can cause damage to the vascular endothelium, leading to uneven scarring and concerns about embolism or pulmonary embolism.
2.
So far, my anxiety and fear of exercise have gradually alleviated, and I do not have many issues in daily life.
However, I occasionally still feel a few premature beats during training, which affects my mood (triggering panic memories and worrying that the stimulant has caused damage to my myocardium, leading to the recent LPH report).
I suspect that similar situations may have occurred in the past, but this incident combined with anxiety has led me to overreact and misinterpret my bodily responses, creating a vicious cycle.
If future ECG follow-ups are normal and I do not feel particularly uncomfortable, can I stop worrying about these issues and return to my normal life? 3.
Can hyperventilation have any long-term consequences?
David, 20~29 year old female. Ask Date: 2021/08/22
Dr. Wu Enliang reply Psychiatry
Hello, online user:
1.
Does intravenous injection really cause permanent damage to blood vessels? Is there a risk of developing atherosclerotic plaques? In the past, I never considered this during blood draws or treatments, but some online information claims that venipuncture can cause damage to the vascular endothelium, leading to uneven scarring and concerns about embolism or pulmonary embolism.
A: No, it does not.
2.
So far, my anxiety and fear of exercise have gradually alleviated, and I do not have many issues in daily life.
However, occasionally during training, I still feel one or two premature beats that affect my mood (triggering panic memories and worrying that stimulants have caused damage to the myocardium, as indicated in the recent LPH report).
I suspect that similar situations may have occurred in the past, but this incident combined with anxiety has led me to overreact and misinterpret my physical performance, creating a vicious cycle.
If future electrocardiograms are normal and there are no particular discomforts, can I stop worrying about these issues and return to my normal life? A: Yes.
3.
Are there any long-term effects of hyperventilation? A: No.
Dr.
Wu Enliang
Reply Date: 2021/08/22
More Info
Understanding anxiety and panic, especially in relation to heart health, is crucial for managing symptoms and improving overall well-being. Your experience highlights a common struggle many face when dealing with anxiety, particularly when it manifests physically, leading to a cycle of fear and health concerns.
Firstly, it's important to recognize that anxiety can produce a range of physical symptoms, including palpitations, chest tightness, and shortness of breath. These symptoms can mimic serious heart conditions, which often exacerbates anxiety. Your history of panic attacks, particularly after stressful events, indicates a heightened sensitivity to bodily sensations, which is common in individuals with anxiety disorders. The fear of having a heart condition can lead to hyper-vigilance about your health, causing you to misinterpret normal bodily functions as signs of serious illness.
Regarding your specific questions:
1. Impact of Intravenous Injection on Blood Vessels: While intravenous (IV) injections can cause temporary discomfort and bruising, they typically do not lead to permanent damage or the formation of atherosclerotic plaques (cholesterol deposits in arteries). However, repeated or improper IV access can lead to complications such as phlebitis (inflammation of the vein) or thrombosis (blood clots). If you have concerns about potential damage, it’s best to discuss them with your healthcare provider, who can assess your specific situation.
2. Managing Anxiety and Physical Symptoms: It's encouraging to hear that your anxiety and fear of exercise are gradually improving. The key to overcoming these fears lies in understanding that occasional palpitations or early heartbeats (premature contractions) are often benign, especially in individuals without underlying heart disease. If your follow-up EKGs and other tests continue to show normal results, it is reasonable to conclude that your heart is functioning well. Engaging in regular, moderate exercise can actually help reduce anxiety and improve cardiovascular health. If you find that your anxiety resurfaces during exercise, consider speaking with a therapist who specializes in cognitive-behavioral therapy (CBT), which can help you reframe your thoughts and reduce panic responses.
3. Consequences of Hyperventilation: Over-breathing or hyperventilation can lead to temporary symptoms such as lightheadedness, tingling in the extremities, and increased heart rate. While these symptoms can be distressing, they typically resolve once normal breathing patterns are restored. Chronic hyperventilation can lead to a cycle of anxiety, but it does not usually result in long-term physical damage. Learning breathing techniques, such as diaphragmatic breathing or paced breathing, can help manage these episodes and reduce anxiety.
In summary, your symptoms are likely a combination of anxiety and physiological responses to stress. It’s essential to continue working with your healthcare providers, including both mental health and cardiology specialists, to monitor your symptoms and ensure a comprehensive approach to your health. Engaging in relaxation techniques, regular physical activity, and possibly therapy can significantly improve your quality of life. Remember, it’s okay to seek help and discuss your fears with professionals who can provide reassurance and support.
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