Overcoming Anxiety and Heart Palpitations: A Journey to Mental Wellness

Anxiety for a year, afraid to take medication, experiencing arrhythmia?

Last June, I visited a psychosomatic clinic due to panic attacks, but I was afraid of dependency and did not dare to take medication.
I only took a small dose of "Sertraline" occasionally during unpredictable panic attacks.
I hoped to overcome it naturally without relying on medication.
Although there has been a gradual trend of relief, I still experience occasional panic and anxiety.
In mid-May of this year, due to some issues at home, I began to experience symptoms of chest tightness and chest pain, and I started having panic attacks again (about once every 1-2 days).
I consulted a cardiologist and found that my heart rate was elevated (over 90 bpm) and my blood pressure was high (150/90 at the hospital, 130/85 at home).
An electrocardiogram, 24-hour Holter monitor, and echocardiogram were performed, revealing a significant frequency of arrhythmias and signs of ventricular hypertrophy.
The doctor prescribed "Carvedilol," "Lisinopril," "Atenolol," and "Diltiazem." I have been taking the medications for about three weeks now.
After taking the medication before noon each day, I feel somewhat emotionally low but have not experienced panic attacks.
My blood pressure monitor has not detected arrhythmias, and my heart rate has significantly decreased, with blood pressure dropping to safe levels during relaxation.

I sometimes drink a couple of beers before bed, and after drinking, my blood pressure readings are very good.
However, I am concerned about developing an addiction, so I started to control my alcohol intake.
When I do, panic attacks occur.
Since last week, for some reason, I have suddenly started experiencing panic attacks again, with a tendency for them to occur at specific times each day.
During each panic attack, I can clearly feel my heart racing and arrhythmias, which is very uncomfortable.
My questions are as follows:
1.
Is the ventricular hypertrophy due to not properly taking medication last year and the ongoing palpitations?
2.
Should I switch to a psychosomatic specialist and follow their advice to take medication properly while gradually reducing hypertension medication, without specifically targeting heart treatment (as I fear being on blood pressure medication for life)?
3.
When I experience a panic attack and feel my heart racing, how can I alleviate it in the moment, and what is the long-term treatment plan? Thank you.

Mr. Hsu, 30~39 year old female. Ask Date: 2023/06/29

Dr. Wu Enliang reply Psychiatry

1.
Is ventricular hypertrophy caused by not taking medication properly last year and experiencing persistent palpitations? A: It is likely not the case.

2.
Should I transfer to a psychosomatic specialist and follow medical advice to properly take my medication while gradually reducing my antihypertensive medication, avoiding direct treatment for the heart (as I fear taking blood pressure medication for life)? A: If you have been experiencing panic attacks consistently, it is indeed advisable to consult a psychosomatic specialist.
3.
When I experience a panic attack, my heart feels like it is racing significantly.
How can I alleviate this in the moment, and what is the long-term treatment? A: When you feel very uncomfortable at that moment, you can take some short-acting sedatives.
In the long term, you should learn relaxation techniques, consider psychological therapy, or follow a regular medication regimen.
Dr.
Wu En-Liang.

Reply Date: 2023/06/29

More Info

Overcoming anxiety and heart palpitations can be a challenging journey, especially when intertwined with personal and familial stressors. Your experience reflects a common struggle faced by many individuals dealing with anxiety disorders, panic attacks, and physical symptoms that can often feel overwhelming. Here’s a comprehensive response to your questions, along with some additional insights into managing anxiety and heart-related concerns.

1. Heart Ventricular Hypertrophy and Medication Compliance
Heart ventricular hypertrophy (enlargement of the heart's ventricles) can indeed be influenced by various factors, including chronic stress, anxiety, and inconsistent medication adherence. If you have experienced episodes of panic and anxiety without consistent treatment, it’s possible that these factors could contribute to changes in your heart's structure. Stress and anxiety can lead to increased heart rate and blood pressure, which over time may affect heart health.
However, it’s essential to consult with your healthcare provider regarding the specific causes of your heart condition. They can provide a thorough evaluation and determine whether your heart changes are reversible or manageable with lifestyle modifications and medication. Regular follow-ups and adherence to prescribed treatments are crucial in managing both anxiety and heart health.

2. Transitioning to Mental Health Care and Medication Management
Given your ongoing experiences with panic attacks and anxiety, it may be beneficial to consult a mental health professional. A psychiatrist or psychologist can help you explore the underlying causes of your anxiety and develop a tailored treatment plan. This plan may include therapy, such as cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety disorders.
Regarding medication, it’s understandable to have concerns about long-term use of blood pressure medications. However, managing anxiety effectively can also lead to improvements in physical symptoms, including heart rate and blood pressure. A collaborative approach with your healthcare provider can help you find a balance between managing anxiety and minimizing medication dependence. They can guide you on how to taper off medications safely if appropriate.

3. Managing Panic Attacks and Long-Term Treatment Strategies
When experiencing a panic attack, there are several strategies you can employ to help alleviate symptoms:
- Breathing Techniques: Focus on slow, deep breaths. Inhale deeply through your nose, hold for a few seconds, and exhale slowly through your mouth. This can help calm your nervous system and reduce feelings of panic.

- Grounding Exercises: Engage your senses to bring your focus back to the present moment. For example, identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

- Mindfulness and Relaxation: Practices such as meditation, yoga, or progressive muscle relaxation can help reduce overall anxiety levels and improve your response to panic attacks.

- Avoiding Alcohol and Stimulants: While you mentioned that alcohol seems to lower your blood pressure temporarily, it can also exacerbate anxiety and lead to dependency. Reducing or eliminating alcohol intake may help stabilize your mood and anxiety levels.

Long-Term Strategies for Anxiety Management
- Regular Exercise: Physical activity is a powerful tool for managing anxiety. It can help reduce stress hormones and increase endorphins, which improve mood.

- Healthy Lifestyle Choices: Eating a balanced diet, getting adequate sleep, and practicing good self-care can significantly impact your mental health.

- Support Systems: Engage with friends, family, or support groups. Sharing your experiences with others who understand can provide comfort and reduce feelings of isolation.

- Therapeutic Interventions: Consider therapy options that focus on anxiety management, such as CBT or exposure therapy, which can help you confront and manage your fears in a controlled environment.

In conclusion, your journey towards overcoming anxiety and heart palpitations is multifaceted, involving both physical and mental health considerations. It’s crucial to maintain open communication with your healthcare providers, adhere to treatment plans, and explore therapeutic options that resonate with you. Remember, recovery is a process, and seeking help is a strong and positive step forward.

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