Heart Palpitations: Panic Attacks or Cardiac Issues? - Cardiology

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Understanding heart palpitations can be a complex issue, especially when distinguishing between panic attacks and potential cardiac problems. Based on the information you've provided, it seems you have undergone extensive cardiac evaluations, including echocardiograms and 24-hour Holter monitoring, which have shown that your heart function is generally normal. Your heart rate has varied from 49 to 120 beats per minute, with an average of 72 BPM, and you have experienced a few premature atrial contractions (PACs) but no significant arrhythmias or heart block.


Heart Palpitations: Panic Attacks vs. Cardiac Issues
Heart palpitations can be caused by various factors, including anxiety, stress, and panic attacks, as well as underlying cardiac conditions. In your case, the episodes of palpitations accompanied by feelings of tightness and difficulty breathing, especially during stressful situations, suggest a possible anxiety component. Panic attacks can manifest with physical symptoms such as rapid heartbeat, shortness of breath, and feelings of impending doom, which can mimic cardiac issues.


Cardiac Evaluation
Your cardiac evaluations have shown normal left ventricular function with an ejection fraction (EF) of around 66%, which is within the normal range. The Holter monitor indicated that while you have experienced some PACs, there were no concerning arrhythmias such as atrial fibrillation (AFib) or significant pauses. This suggests that your heart is structurally sound and functioning well, which is reassuring.


Symptoms and Anxiety
The symptoms you describe—such as sudden feelings of tightness, difficulty breathing, and increased heart rate—could indeed be linked to anxiety or panic attacks, especially if they occur during stressful situations. The fact that you have experienced these symptoms more frequently in recent times, particularly after the discovery of lymph node enlargement, may indicate that stress and anxiety are playing a significant role in your overall well-being.


Medication and Management
You mentioned that you have been prescribed medications such as "心康樂" (likely a beta-blocker or anti-anxiety medication) and "心律整錠" (possibly an antiarrhythmic). It is important to follow your physician's guidance regarding medication, especially if you have found that your symptoms improve with their use. Adjusting the dosage or frequency of your medications based on your symptoms is a common practice, and it can help manage both anxiety and palpitations effectively.


Lifestyle Considerations
In addition to medication, consider lifestyle modifications that can help reduce anxiety and improve your overall heart health:
1. Stress Management: Techniques such as mindfulness, meditation, and deep-breathing exercises can help manage anxiety and reduce the frequency of panic attacks.

2. Regular Exercise: Engaging in regular physical activity can improve cardiovascular health and reduce anxiety levels. However, consult your doctor before starting any new exercise regimen.

3. Healthy Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support heart health.

4. Sleep Hygiene: Ensure you are getting adequate rest, as poor sleep can exacerbate anxiety and heart palpitations.

5. Avoid Stimulants: Limit caffeine and nicotine, as these can increase heart rate and anxiety levels.


Conclusion
While your heart evaluations have not indicated any serious cardiac issues, the symptoms you are experiencing may be related to anxiety or panic attacks. It is crucial to maintain open communication with your healthcare provider about your symptoms and any changes you notice. If your symptoms persist or worsen, further evaluation may be warranted to rule out any underlying conditions. Regular follow-ups and a comprehensive approach to managing both your physical and mental health will be key in addressing your concerns.