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Forum Name: Cardiology Symptoms

Question: Panic Attacks or Symptoms of Heart Disease?


 worriedallthetime - Sun Oct 19, 2008 12:32 am

Hi. I am a 28 y/o female. I'm 5'6 and weight 290 lbs. I'm a heavy smoker and drinker, and a not so great eater. I know it sounds bad but I'm trying to be honest and trust me, I'm trying to change! I have been diagnosed with panic disorder, generalized anxiety, depression, and ptsd. I have been experiencing chest pains for years now that all the doctors say are related to anxiety. But lately my symptoms have changed. I have cut down on my drinking because I know it does not help my anxiety and I'm just self-medicating. I've begun to attempt to eat better as well but I am still smoking. It's frustrating knowing something is horrible for you and not having the motivation to change your habits.
Anyway, I am on effexor xr 225mg daily, atenolol 25mg daily (new because for the past few day my bp was up, around 150/95), klonipin 1/2mg twice a day, and prilosec 40mg a day. But lately my symptoms have changed. I have been consistently nauseous 3-4 hours a day and get intermittent chest pains and strange aches, which I attribute to anxiety but lately I've been getting chest pains and dizziness with exertion but not consistently. During these periods my chest on the left side and left arm hurts. I get really hot and sweaty and feel short of breath. I also can feel some pain in my neck and jaw. When this happens I take a klonipin and it pretty much subsides but the tightness is still there in my shoulders and chest.I have had numerous ekg's and an echo all which came back normal. I am just wondering if I need further testing or not. My doctor seems to think that this is all related to my anxiety but lately I've been wondering just because the symptoms seem more severe and different than before. I am also going for a med check with a psychiatrist later this week. So, does this sound cardiac related to you or consistent with anxiety? If I need more testing, what would you suggest? Any insight would be helpful. Oh, my father, whom has been an alcoholic for years had bypass surgery around 50 and my grandfather on my maternal side died from a heart attack when he was 32 y/o but they think that he had a congenital heart disease. Thank you so much for reading!
 John Kenyon, CNA - Tue Oct 21, 2008 9:47 pm

User avatar Hi there -

You have an unfortunate personal and family history combo. The symptoms are very likely due to anxiety-related problems, especially since they seem to respond to a great extent to Klonopin. However, anxiety can sometimes wind up masking actual medical problems, so, given your family history as well as your weight and smoking history, these new (or changed) symptoms should not be dismissed out of hand. While you've had some pretty good cardio exam results, what you describe is more like classic heart symptoms than the previous ones. Again, this can be due to anxiety, since the anxious patient tends to see somatic sensations through the lens of the thing which makes him or her anxious. If you have a chronic concern with the possibility of heart disease you are likely to percieve symptoms in a way that evolves and adapts so that it seems more and more like the classic symptoms. This is not a judgement of you, the patient, who has no direct control over (or awareness of) this process. And still, it doesn't mean the symptoms cannot be, at some point, real. So again, they mustn't ever be dismissed out of hand.

I think perhaps asking your doctor for a referral to a cardiologist would be reasonable, given your personal and family history, maybe even moreso because of the anxiety problem, since it makes it more difficult for everyone involved to differentiate between preceived and actual cardiac symptoms (the symptoms themselves are real regardless -- the question is, are they heart-related or anxiety-related). Your therapist can certainly play a big role in this as well, but a cardiology consult may help ease your mind and also help you to learn better ways to tell when you're having anxiety-related somatic issues and when they may be "real."

I hope this is helpful. Best of luck to you, and please follow up with us here as needed.
 worriedallthetime - Wed Oct 22, 2008 3:13 am

Thank you so much for replying! I feel the same way. I know that anxiety can cause these things but I have always felt that the symptoms I experience warrant further testing, just to be safe. My doc on the other hand has said, and I quote, "Any cardiologist would laugh @ you.", because of my personal habits, which I know are bad and create further anxiety! But any medical doctor would realize, I hope, that its' a vicious cycle...you are anxious so you smoke, drink, and overeat and then what you fear become real! Its' awful and I am trying desperately to get off the "hamster wheel", so to speak. But you have validated for me what I felt in the beginning of all this...that I need to be evaluated by a cardiologist! Thank you again for your response. I don't think you really realize what a difference you and your colleagues are making with this website, I know a lot of people, like me, who don't know where to turn and this is an excellent alternative with common sense advice and answers! Thanks again and I'll let you know how things turn out!
 John Kenyon, CNA - Wed Oct 22, 2008 10:13 pm

User avatar You're very welcome, and I'm glad my response was helpful to you. I think you're doctor is way off base with his "...any cardiologist would laugh at you" comment, as most cardiologists -- and most MDs in general -- are a lot more professional and a lot more compassionate than that. I'm glad you have a good understanding of the situation and I think that will serve you well. You know what your part of the job is, which is great (not everyone will take responsibility for their part in staying healthy), and your doctor would do well to get on board with that attitude. At any rate, I'm sure you'll find a cardiological consult very helpful one way or the other. Again, glad I could help. The doctors and nurses here on the site are just awesome. It's great to hear compliments like yours directed at the people who make this thing work. Best to you.

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