Managing Anxiety and Heart Palpitations: A Journey to Recovery

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 didn't dare to take medication.
I only took a small dose of "Xanax" during occasional panic attacks.
I hoped to overcome this naturally without relying on medication.
Although there has been a gradual trend of alleviation, I still experience occasional panic and anxiety.
In mid-May of this year, due to some family issues, I started to have symptoms of chest tightness and chest pain, and I began to experience 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).
I underwent an electrocardiogram, a 24-hour Holter monitor, and an echocardiogram, which revealed a significant frequency of arrhythmias and ventricular hypertrophy.
The doctor prescribed "Cardizem," "Lisinopril," "Atenolol," and "New Shucan." I have been taking them for about three weeks now.
After taking the medication before noon each day, I feel somewhat emotionally low, but I have not experienced panic attacks.
My blood pressure monitor has not detected any arrhythmias, but my heart rate has significantly decreased, and my blood pressure has dropped to safe levels during relaxation.

I sometimes drink 2-3 bottles of beer before bed, and after drinking, my blood pressure readings are very good.
However, I am afraid of 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 trend of occurring at specific times each day.
During each panic attack, I can clearly feel my heart racing and experiencing 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 transfer to a psychosomatic department and follow the doctor's orders to take medication properly while gradually reducing the hypertension medication, rather than focusing on 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 should be the long-term treatment? Thank you.

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

Dr. Wu Enliang reply Psychiatry

1.
Is ventricular hypertrophy caused by not taking medication properly last year and experiencing continuous palpitations? A: It should not be the case.

2.
Should I consider transferring to a psychosomatic specialist and follow medical advice to properly take my medication while gradually reducing antihypertensive medication, without specifically targeting heart treatment (worried about being on 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 Enliang.

Reply Date: 2023/06/30

More Info

Managing anxiety and heart palpitations can be a challenging journey, especially when it intertwines with physical health issues like heart rhythm irregularities and hypertension. Your experience reflects a common struggle faced by many individuals dealing with anxiety disorders, particularly when they manifest through physical symptoms such as palpitations, chest pain, and elevated blood pressure.

1. Heart Ventricular Hypertrophy and Medication Compliance: Regarding your concern about ventricular hypertrophy, it is essential to understand that this condition can arise from prolonged high blood pressure and increased workload on the heart. If you were not consistently taking your prescribed medications, it is possible that your heart experienced undue stress, leading to this condition. However, it is also crucial to consider other factors such as genetics, lifestyle, and overall health. Regular follow-ups with your cardiologist are vital to monitor your heart's condition and adjust treatment as necessary.

2. Transitioning to Mental Health Support: Given your history of panic attacks and anxiety, it may be beneficial to consult with a mental health professional. Anxiety can exacerbate physical symptoms, creating a vicious cycle of fear and discomfort. A mental health professional can help you explore therapeutic options, such as cognitive-behavioral therapy (CBT), which has proven effective in treating anxiety and panic disorders. While medication can be an essential component of treatment, therapy can provide you with tools to manage anxiety without solely relying on medication. Discussing your concerns about long-term medication use with your healthcare provider is also important; they can help you develop a plan to taper off medications safely if appropriate.

3. Managing Panic Attacks: When experiencing a panic attack, immediate strategies can help alleviate symptoms. Techniques such as deep breathing exercises, grounding techniques (focusing on your surroundings), and mindfulness can be effective in reducing the intensity of a panic attack. For example, try the 4-7-8 breathing technique: inhale for four seconds, hold for seven seconds, and exhale for eight seconds. This can help calm your nervous system and reduce the sensation of your heart racing.

Long-term management of anxiety and panic attacks often involves a combination of lifestyle changes, therapy, and possibly medication. Regular physical activity, a balanced diet, adequate sleep, and mindfulness practices can significantly improve your overall mental health. Additionally, reducing alcohol consumption is wise, as alcohol can exacerbate anxiety and interfere with sleep, leading to a cycle of increased anxiety and panic.

In conclusion, your journey to recovery is multifaceted and may require adjustments in both your physical and mental health management strategies. Collaborating with both your cardiologist and a mental health professional can provide a comprehensive approach to your health. Remember, recovery is a process, and it’s essential to be patient with yourself as you navigate these challenges. Seeking support from friends, family, or support groups can also provide encouragement and understanding during this time.

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