Managing Panic Disorder with Heart Palpitations: Is Air Travel Safe?

Q: Managing Panic Disorder with Heart Palpitations: Is Air Travel Safe?

We recommend that you： 1. Discuss the above situation further with your attending physician. 2. Consider seeking a consultation at another cardiology medical facility. Wishing you good health. Thank you!

Panic disorder can lead to palpitations and rapid heart rate?

I would like to inquire about my suitability for flying, given my medical history.
I have a pre-existing condition of arrhythmia, which has recently escalated to sudden episodes of tachycardia, shortness of breath, wheezing, and numbness.
I was diagnosed with panic disorder by a psychiatrist.
Below are the results of my previous examinations:
The Ambulatory Holter ECG report:
1.
The baseline ECG showed sinus rhythm with a heart rate of 46-112 beats per minute (bpm).
The average heart rate was 71 bpm.
2.
There was sinus bradycardia without long pauses.
3.
No paroxysmal supraventricular tachycardia (PSVT), paroxysmal atrial fibrillation (PAF), ventricular tachycardia (VT), or ventricular fibrillation (VF) were noted.
4.
There were a few premature ventricular contractions (PVCs) totaling 42 beats, and premature atrial contractions (PACs) totaling 8 beats during the examination period.
5.
No marked events were reported.
Echocardiogram Report:
- Atria and Aortic Root:
- Aortic Diameter (AO): 31 mm
- Left Atrial Diameter (LA): 26 mm
- Left Ventricle:
- Interventricular Septum (IVS): 7 mm
- Posterior Wall (PW): 6 mm
- End-Diastolic Diameter (EDD): 39 mm
- End-Systolic Diameter (ESD): 25 mm
- Left Ventricular Ejection Fraction (LVEF) by M-mode measurement: 66%
- Valves:
- Mitral Stenosis (MS): nil
- Mitral Regurgitation (MR): nil
- Aortic Stenosis (AS): nil
- Aortic Regurgitation (AR): nil
- Tricuspid Stenosis (TS): nil
- Tricuspid Regurgitation (TR): nil
- Pulmonary Stenosis (PS): nil
- Pulmonary Regurgitation (PR): nil
Conclusion:
- Rhythm and Appearance: Sinus rhythm
- Left Ventricle:
- Systolic function: Normal
- Wall motion: Normal
- Diastolic function: Normal
- Right Ventricle:
- Systolic function: Normal
Holter Report:
- Code No.: LHA110-1124
- Clinical diagnosis: Cardiac arrhythmia
- Test date: 2021/6/23
- Analysis date: 2021/6/24
- Hookup time: 11:41
- Recording Time: 23 hours 57 minutes
- Analysis Time: 23 hours 57 minutes
- Analysis result:
- Technical quality of record: Good
- Dominant rhythm: Sinus
- Total Beats: 101,016
- Minimum HR: 49 bpm at 00:49:29
- Average HR: 72 bpm
- Maximum HR: 120 bpm at 08:17:05
- Heart Rate Variability:
- ASDNN 5: 67.1 msec
- SDANN 5: 95.3 msec
- SDNN: 117.7 msec
- Atrial Fibrillation (AFib) Beats: 0 (0.0%)
- AFib Duration: 0.0 min
- PVCs/couplets/triplets/VT: 0/0/0
- PACs/couplets/atrial tachycardia: 2/0/0
- Fastest: 0 bpm
- Drop (delay > 2.0 sec)/Late: 0/3
- Longest N-N: 1.3 sec at 05:24:06
Comments:
- Sinus rhythm with a rate ranging from 49-120 bpm and a mean of 72 bpm.
- 2 premature atrial beats.
- No AV block.
- No significant long pauses.
Due to my tendency to wheeze, I underwent pulmonary function tests:
Pre-bronchodilator:
- FVC: 2.71L, 97%
- FEV1: 2.11L, 87%
- FEV1/FVC: 77%
- MMEF: 60%
Interpretation:
1.
Rule out small airway disease.
A chest CT scan without contrast enhancement shows:
1.
No evidence of interstitial lung disease (ILD).
No pleural effusion.
2.
Prominent lymph nodes in bilateral neck.
3.
No bulky mass in the upper abdomen.
Gallbladder stone.
4.
No destructive bone lesions.
Remark: Vessels and solid organs are inadequately assessed based on this non-enhanced CT.
Impression: No evidence of ILD.
Prominent lymph nodes in bilateral neck.
Currently, I am taking medications for panic disorder (Lorazepam, Clonazepam, and occasionally Clonidine) but still experience occasional episodes of rapid heartbeat and anxiety, resembling panic attacks, although they are less severe than before.
I sometimes feel my heart racing unexpectedly, but it usually subsides quickly.
I am also taking heart medication (Cardiac Health tablets) twice daily.
Given this information, would it be safe for me to fly for approximately 2 hours? Thank you.

Dou, 30~39 year old female. Ask Date: 2023/12/06

Dr. Chen Jili reply Cardiology

We recommend that you: 1.
Discuss the above situation further with your attending physician.
2.
Consider seeking a consultation at another cardiology medical facility.
Wishing you good health.
Thank you!

Reply Date: 2023/12/06

More Info

When considering air travel for someone with a history of panic disorder and heart palpitations, it is essential to evaluate both the cardiac and psychological aspects of the individual's health. Based on the information provided, your cardiac evaluations, including the Holter ECG report, indicate that you have a normal sinus rhythm with some occasional premature atrial contractions (PACs) and premature ventricular contractions (PVCs). Importantly, there are no significant arrhythmias such as atrial fibrillation or ventricular tachycardia, and your left ventricular ejection fraction (LVEF) is within normal limits at 66%. This suggests that your heart function is generally stable, which is a positive sign for air travel.

However, the presence of panic disorder complicates the situation. Panic attacks can manifest with symptoms such as rapid heartbeat, shortness of breath, and feelings of impending doom, which can be exacerbated in stressful situations like flying. It is crucial to manage these symptoms effectively to ensure a safe and comfortable travel experience.

Here are some recommendations to consider before your flight:
1. Consult Your Healthcare Providers: Before making any travel plans, it is vital to discuss your situation with both your cardiologist and psychiatrist. They can provide tailored advice based on your current health status and medication regimen. Given that you are already on medications for panic disorder, they may adjust your treatment plan to better manage anxiety during the flight.

2. Medication Management: Since you mentioned taking medications such as Lorazepam (Rofis) and Clonazepam (Klonopin), ensure you have enough medication for the trip and consider taking it as prescribed before your flight. These medications can help mitigate anxiety and prevent panic attacks during travel. Always follow your doctor’s advice regarding dosage and timing.

3. Breathing Techniques: Learning and practicing relaxation techniques, such as deep breathing exercises, can be beneficial. If you start to feel anxious during the flight, focus on slow, deep breaths to help calm your nervous system. This can also help alleviate some of the physical symptoms associated with panic attacks.

4. Stay Hydrated and Avoid Stimulants: Dehydration and stimulants like caffeine can exacerbate anxiety and palpitations. Make sure to drink plenty of water before and during the flight, and avoid caffeine or other stimulants that could increase your heart rate or anxiety levels.

5. Familiarize Yourself with the Flight Environment: Sometimes, anxiety can stem from the unknown. Familiarizing yourself with the flight process, including boarding, takeoff, and landing, can help reduce anxiety. Consider visiting the airport beforehand or watching videos about flying to ease your mind.

6. Plan for Comfort: Bring items that help you feel secure and comfortable during the flight, such as noise-canceling headphones, a neck pillow, or a favorite book. Having familiar items can provide a sense of security.

7. Inform the Flight Crew: If you feel comfortable, inform the flight attendants about your condition. They are trained to assist passengers with anxiety and can provide support if needed.

8. Consider Professional Support: If your panic attacks are severe, consider seeking therapy focused on anxiety management, such as cognitive-behavioral therapy (CBT). This can provide you with tools to cope with anxiety in various situations, including flying.

In conclusion, based on your cardiac health and the management of your panic disorder, it appears that a two-hour flight could be safe for you, provided you take the necessary precautions and consult with your healthcare providers. With proper planning and support, many individuals with similar conditions successfully travel by air. Safe travels!

Similar Q&A

Coping with Panic Attacks During Flights: Tips for Travelers

Hello, doctor. I have a question. I'm going to travel abroad by plane, but I experience panic attacks every time I fly. My doctor advises me to take a sedative beforehand, which usually helps, but if it doesn't, it can be really distressing. I experience high blood pres...

Dr. Huang Xiaoxian reply Psychiatry
Dear Qinglongzi, thank you for your question. Panic is usually accompanied by sympathetic nervous system activation, which often leads to sensations such as rapid breathing and increased heart rate, along with feelings of impending doom. The duration of these episodes is typicall...

Overcoming Anxiety Symptoms: Tips for Students Facing Transportation Stress

Hello, doctor. I am a student preparing for university entrance exams this year. Previously, I experienced palpitations during exercise and consulted a cardiologist. Both the exercise electrocardiogram and the 24-hour Holter monitor results were normal, but the electromyography t...

Dr. Liang Sunyuan reply Psychiatry
Hello Mr. Hong: Anxiety and panic often come with many worries, but the more one worries, the higher the level of anxiety and the more uncomfortable one feels. Pharmacotherapy, relaxation training, and cognitive-behavioral therapy are all helpful for anxiety. Many hospitals'...

Understanding Anxiety Disorders: Overcoming Social Phobia and Panic Attacks

Hello, doctor. I believe I have social anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder. The following issues are my symptoms, which have led to me having no friends and being unemployed for over a year. I would appreciate your help in addressing these...

Dr. Liang Sunyuan reply Psychiatry
Hello: Based on your description, you are experiencing a lot of anxiety and worry, which is indeed affecting your daily life. Medication, psychotherapy, and lifestyle changes can all help alleviate these symptoms. It is recommended to incorporate more activities that you enjoy or...

Managing Panic Attacks and Autonomic Nervous System Disorders

Dear Doctor, I hope you can help me (I hope you can read through this lengthy message). Since childhood, I have experienced sudden awakenings during sleep, feeling as if the objects around me were distorting and that the walls and items were expanding. In those moments, I would ...

Dr. He Dongjin reply Cardiology
Hello, regarding issues with autonomic nervous system dysregulation and panic disorder, I suggest discussing it with a mental health specialist. The medication "Xinkang Le" (心康樂) is a low-dose option that can be taken as needed without any issues. I believe that using s...