Anxiety and Panic: Heart Symptoms and Treatment Options

Anxiety and Panic

Hello, doctor.
I apologize for bothering you.
I have been experiencing anxiety and panic attacks since March 2020, with fluctuations in severity.
I previously used fluoxetine but have since stopped all medications except for one Yung-Kang capsule in the morning and half a Xanax as needed.
My anxiety primarily revolves around concerns about my heart, as my heart rate sometimes increases to 90-120 beats per minute.
A cardiologist mentioned it could be related to autonomic nervous system issues.
Is this caused by anxiety? Can anxiety affect the heart and cause discomfort? Additionally, I often feel tightness in my neck, which leads to dizziness and discomfort regardless of my position.
Could this also be related to anxiety? Sometimes I feel I am not anxious, yet I find myself tapping my foot and unable to sit still.
Is this considered an anxiety attack?
Furthermore, I would like to ask if undergoing RTMS therapy in Taoyuan could help alleviate my anxiety.
Is there a risk of RTMS inducing seizures, and could there be other side effects? Thank you for your patience in reading this, and I appreciate your help! Thank you!

Nìmíng, 20~29 year old female. Ask Date: 2023/05/05

Dr. Wu Enliang reply Psychiatry

Hello, I have anxiety and I'm constantly worried about my heart because sometimes my heart rate can be quite fast, ranging from 90 to 120 beats per minute.
The cardiologist said it's a problem with my autonomic nervous system.
Is this caused by anxiety? A: It's very likely that anxiety can affect your heart and cause discomfort.
A: It's possible that you might also feel tightness in your neck and experience dizziness, which can also be caused by anxiety.
A: Sometimes I feel like I'm not anxious, but I still find myself shaking my legs and unable to sit still.
Is this an anxiety attack? A: It could be.
I would also like to ask the doctor if undergoing rTMS therapy in Taoyuan can help alleviate anxiety? A: rTMS is primarily used for treating resistant depression rather than anxiety disorders.
There is a chance that rTMS could induce seizures; is it very dangerous, and are there any other side effects? A: It is not dangerous, but it is not inexpensive.
Some people may experience temporary headaches or a feeling of lightheadedness afterward, but otherwise, it is generally well-tolerated.
Dr.
Wu Enliang

Reply Date: 2023/05/05

More Info

Understanding anxiety and panic disorders, particularly in relation to heart symptoms, is crucial for effective management and treatment. Anxiety disorders, including panic disorder, can manifest in various physical symptoms, many of which can be mistaken for cardiac issues.
Firstly, it’s important to recognize that anxiety can indeed influence heart function. When you experience anxiety, your body enters a state of heightened alertness, often referred to as the "fight or flight" response. This response triggers the release of stress hormones like adrenaline, which can lead to an increased heart rate (tachycardia), palpitations, and even feelings of chest discomfort. In your case, the heart rate of 90-120 beats per minute you mentioned could be a physiological response to anxiety rather than an indication of a heart condition, especially since your cardiologist has indicated that your heart is functioning normally.

The tightness in your neck and the sensation of dizziness can also be attributed to anxiety. Muscle tension is a common symptom of anxiety, and it can lead to discomfort in the neck and shoulders, which may contribute to feelings of dizziness or lightheadedness. The sensation of needing to move your legs or feeling restless can also be a manifestation of anxiety, often referred to as "restlessness" or "psychomotor agitation."
Regarding your question about RTMS (Repetitive Transcranial Magnetic Stimulation), it is a non-invasive procedure that has shown promise in treating various mental health conditions, including anxiety and depression. RTMS works by using magnetic fields to stimulate nerve cells in the brain, which can help alleviate symptoms of anxiety. While it is generally considered safe, there are potential side effects, including headaches, scalp discomfort, and, in rare cases, the risk of inducing seizures. However, the risk of seizures is very low, especially when the procedure is performed by trained professionals in a controlled environment.

If you are considering RTMS, it is essential to discuss this option with your psychiatrist or mental health provider. They can evaluate your specific situation, including your anxiety symptoms and any other medical conditions you may have, to determine if RTMS is a suitable treatment for you.

In summary, anxiety can significantly impact your physical health, including heart function. It is essential to continue working with your healthcare providers to manage your anxiety effectively. Cognitive-behavioral therapy (CBT), medication, and possibly RTMS could be part of a comprehensive treatment plan. Always communicate openly with your healthcare team about your symptoms and concerns to ensure you receive the best care possible.

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