Managing Anxiety: Tremors and Rapid Heartbeat in Stressful Situations

Nervous tremors and rapid heartbeat?

Hello Doctor, I am currently studying abroad and I tend to get anxious, which has led to some difficulties in my daily life, prompting me to seek assistance.
Previously, I had issues with arrhythmia (I underwent an electrocardiogram in Taiwan), and my doctor prescribed me Entresto.
Since coming abroad, I have been experiencing significant anxiety due to frequent presentations and reports.
I have had negative experiences in Taiwan that make me very resistant to public speaking, but now I have no choice as I need to present every week, which has become a source of stress.
It has escalated to the point where I experience rapid heartbeat, trembling hands, and chills when called upon in class.
In severe cases, I even experience numbness and weakness in my hands.
I have previously taken Entresto to try to manage this, but I am concerned about taking too much.
I would like to know if it is appropriate to take it before a presentation or if I should take two pills at the frequency prescribed for my arrhythmia, three times a day.
I am planning to return to Taiwan for medical care after the semester ends, and I would also like to ask the doctor if this could be classified as panic disorder.
Would it be appropriate to consult a psychiatrist? Thank you.

An An, 20~29 year old female. Ask Date: 2023/05/25

Dr. Qiu Junda reply Psychiatry

Hello.
You can use Entacapone before going on stage, either 2# or with meals, depending on which method works better for you.
Additionally, your concerns seem to lean towards anxiety.
It needs to be assessed whether it has reached a panic level.
After returning to your country, you may consider consulting a psychiatrist for treatment.

Reply Date: 2023/05/25

More Info

Hello! It sounds like you are experiencing significant anxiety, particularly related to public speaking and academic pressures while studying abroad. Your symptoms, including rapid heartbeat, tremors, and feelings of weakness, can indeed be associated with anxiety disorders, including panic attacks. Let's break down your concerns and provide some guidance.

Understanding Your Symptoms
1. Physical Symptoms of Anxiety: The physical manifestations you describe, such as rapid heartbeat, hand tremors, and feelings of weakness, are common in individuals experiencing anxiety. When faced with stressful situations, the body activates its "fight or flight" response, releasing adrenaline and other stress hormones. This can lead to symptoms such as increased heart rate, muscle tension, and even numbness or tingling in the extremities.

2. Panic Attacks: Given your description of symptoms that escalate during stressful situations, it is possible that you are experiencing panic attacks. These can occur unexpectedly and may include a combination of physical symptoms (like those you mentioned) and psychological symptoms, such as intense fear or a feeling of losing control. Panic attacks can be triggered by specific situations, such as public speaking, especially if you have had negative experiences in the past.

Medication Considerations
You mentioned previously taking a medication called "Entresto" (though it seems you might mean a different medication for anxiety, as Entresto is primarily for heart failure). If you are considering medication to manage your anxiety, it is crucial to consult with a healthcare professional. Here are some points to consider:
- Dosage and Timing: If you have been prescribed medication for anxiety, it is essential to follow your doctor's instructions regarding dosage and timing. Taking medication before a stressful event can be beneficial for some individuals, but this should be discussed with your doctor to ensure it is safe and appropriate for you.

- Consulting a Doctor: Since you plan to return to Taiwan for medical consultation, it would be wise to discuss your symptoms and medication history with a psychiatrist or a primary care physician. They can provide a thorough assessment and determine if your symptoms align with an anxiety disorder or panic disorder.

Seeking Help
1. Therapy: In addition to medication, therapy can be incredibly beneficial for managing anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders, helping individuals identify and challenge negative thought patterns and develop coping strategies.

2. Relaxation Techniques: While you await your appointment, consider practicing relaxation techniques such as deep breathing exercises, mindfulness meditation, or progressive muscle relaxation. These can help reduce anxiety symptoms and improve your overall well-being.

3. Support Systems: Don't hesitate to reach out to friends, family, or support groups. Sharing your experiences with others can provide emotional relief and practical advice.

Conclusion
In summary, your symptoms suggest that you may be dealing with anxiety, potentially exacerbated by the stress of public speaking and academic pressures. It is essential to consult with a healthcare professional for a proper diagnosis and treatment plan. Medication can be helpful, but it should be managed by a doctor. Additionally, therapy and relaxation techniques can provide significant support in managing anxiety. Remember, you are not alone in this, and seeking help is a positive step towards feeling better. Take care!

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