Posted on 10/02/2007 9:58:14 PM PDT by Jubal Harshaw
CHICAGO (Reuters) - People who experience the anxiety, racing heartbeat and rapid breathing of a panic attack have a higher risk of a heart attack or stroke, researchers said on Monday.
"Our study adds panic attacks to the list of emotional states and psychiatric symptoms that have been linked to excess risk of cardiovascular disease and death," wrote study author Dr. Jordan Smoller of Massachusetts General Hospital in Boston.
Previous research found people with persistent feelings of depression, anger and hostility are at higher risk of heart attack, according to the study, published in the Archives of General Psychiatry.
The study identified a more than three-fold increased risk of a heart attack or stroke within five years in 330 women who had originally reported a panic attack in the prior six months. They were among 3,369 women aged 51 to 83 to participate in the study.
Smoller said several factors may be at work, including that the symptoms of panic attacks inflict damage on the heart and the cardiovascular system.
Feelings of panic could induce blood platelet production that increases the risk of a blood clot, which can trigger a heart attack or stroke. Panic attacks also may lead to a spasm of an artery feeding the heart, which can reduce or cut off blood flow, he added.
This happens to be a pet peeve of mine because I've seen a large number of people with just about every possible symptom of myocardial ischemia, who have been told at some point that the symptoms are simply "panic attacks." Apparently, these people went to the ER, had a normal EKG, and were told that they were not having a cardiac event.
Ahem.
12-lead EKGs have, at best, an approximately 50% sensitivity. In other words, if you closely follow people with cardiac symptoms and a normal EKG, you will find that 50% of the people who actually have a cardiac event will have had a normal EKG. EKGs DO NOT rule out cardiac events. I am SICK AND TIRED of hearing patients tell me something like "oh, yes, I wake up in the middle of the night with a squeezing feeling in my chest, but my [other] doctor told me it was just a panic attack, so I'm not too worried when it happens." PEOPLE: when you can describe your emotional state as "not too worried," you are NOT having a panic attack!!
Please note that when I say I am "sick and tired" of hearing things like this, it's not that I blame the patients for their apparent lack of insight. However, blame or not, I still think people should use some common sense when their doctor tells them something that just sounds so divorced from reality.
So, back to the article. A psychiatrist, from MGH (Harvard) no less, looked at a lot of somewhat elderly women with the symptoms of a cardiac event who had been diagnosed with "panic attack," and then, based on the fact that these women later suffered a diagnosed heart attack or stroke deduced that (according to the article) "Feelings of panic could induce blood platelet production that increases the risk of a blood clot, which can trigger a heart attack or stroke. Panic attacks also may lead to a spasm of an artery feeding the heart, which can reduce or cut off blood flow." Yeah, that's the most likely explanation, all right. Couldn't be that the "panic attack" was a warning that something cardiovascular was actually going on, and that some ER doc missed it, or that, in order to save a few bucks, some GP decided not to do a stress test or cath on follow up.
Anyway, I saw this article, and wanted to rant about it. FR seemed like a good outlet. I look forward to seeing if anyone else has anything to say.
I’m not surprised. I used to have them a few years ago a lot. It led me to start getting epileptic seizures. I wouldn’t be surprised at all that they can kill you outright.
duh....been there, lived this
in other news....higher testosterone levels and unwanted erections linked.
I suffered from panic attacks years ago, worst things in the world. Wouldn’t wish them on my worst enemy. I can see why some people would want to jump off a bridge to just make them stop as you feel like you are going to die. They are terrible.
I haven’t had one in about 5 years, thank God!
does anyone know how panic attacks are different then panics that happen as a result of a phobia? They seem the same to me as is also the anticipation of going into the area of phobia. Meaning days before and leading up to the known exposure also causes growing panic and dread. Anyone know if there is any difference?
One of the toughest, strongest, most charismatic, most talented business persons I have ever known began to have them out of the blue. One day he walked to his job and went into a complete panic attack and had them from that day forward until he left the profession. He owned his own very successful business that he built from scratch and ended up selling it.
Did yours just go away or did you have to do a lot to have them move on? Whether you feel comfortable answering that or not, I am so very happy they no longer are here :-) Thanks for sharing this.
Around 10 years ago, when I was 29-30, I started experiencing very odd variations in my heart rhythm; sometimes it was a very slow heart rate, other times it was a five or more minute episode of totally irregular beats. Sometimes it was both; and would go on for 30 minutes or more.
I was terrified, and visited my GP after it went on for about a month.
He hooked me up to an EKG for about five minutes. He actually said that I had some rather odd fluctuations in my heart rate and pointed them out on the EKG readout.
He ordered meds for anxiety disorder. It did not help with the irregular heartbeat at all, but he kept insisting that I should give it time to work (even after 6 months). I told him that the odd heart rate was CAUSING anxiety...not the other way around!
I continued on, terrified that I was going to drop dead at any moment. I also have rather oddly low blood pressure; usually around 90/65...which they assure me is "excellent."
Then, I went home for Thanksgiving and mentioned this "heartbeat" problem while at the table with my parents and paternal Grandparents. My Grandma and Dad both said that they wished I would have mentioned it sooner; that it was a problem that "runs in the family". Both indicated that Doctors had told them that there was no real treatment until the heartbeat was so out of sync that it didn't correct itself.
Grandma was first diagnosed at around 40 after suffering a "heart attack" (which was not a blockage). She spent a week at the Mayo Clinic before they managed to get her heartbeat back to normal. She died two years ago at 93 of congestive heart failure...she did have occasional episodes of hospitalization to regulate her heartbeat. Whatever she had, a pacemaker would not fix, but she did take some sort of heart medication. Dad's showed up at about the same age...he wore a monitor around for a couple of weeks and was also told that he should not worry until it was bad enough to require medication.
I have learned to live with it. When it goes whacky, I go for a brisk walk...it seems to return things to normal. I have asked if I should see a cardiologist; was told I was "healthy as a horse"...not to worry. Generally, I don't worry too much...except when I remember that my Grandma's Father dropped dead of a heart attack at 50.
Reminds me of a joke I thought of once: "I've been having a lot of panic attacks lately, but I've learned to take them in stride."
I know just what you mean, but I might make an exception for some well-known terrorists. LOL
One panic attack is too many. That terrible, frightening experience most likely sets us up for more.
After trying several medications which had no effect, I began taking Nardil. Within one or two weeks, my constant anxiety disappeared. I describe it as "getting my life back." Enough said about that. I couldn't help wondering if you got relief due to taking an antidepressant.
I had panic episodes for 25 years that were brought on by my heart feeling weird around aged 22 or so....first one in Bogotá Colombia at Cafe Piccolo on Carrera Quince in 1980
Doctors could never figure it out and blamed it on my high stress life of adventure and living in war zones exploiting the third world and whatnot
Heart gave out in 2004 and shucks, doctors slice me open (twice...threads even here on the ignominious event)..anyhow, duh...they find out the primary coronary artery is malformed since birth and my heart itself is pinched...the harder it worked, the worse it got.
So all those panic feelings which I eventually just learned to ignore in my brain were afterall for a good reason. My heart was fubar...it was not my imagination.
But...some folks have panic episodes just because....nervous, too much cortisol, and much more...who knows.
I knew when I woke up with diuladid in my shoulders that I suddenly was aware that it was something I had been born with. I’d heard the surgeons talking while I was in deep
And this news will cause tens of thousands of visits to the ER tonight and tomorrow and forever as long as it is on the net for people who suffer from panic disorders and GAD.
The problem is so may symptoms of just about everything mimic a heart attack. A pulled muscle in the back,chest wall inflamation,herniated disc,bulging disc, GERD,acid reflux, panic attacks, gallstones, gallbladder problems, pancreaitis,fibromyalgia etc...
Please note, as you read the following that I am NOT YOUR DOCTOR, and you should follow up with your own physician.
OK, with that said: your story is like that of the people who have chest pains, get told they are having a “panic attack,” and believe it.
What are you thinking? You apparently have a family history of sudden death at a young age (your great-grandfather) as well as apparently near sudden death (your grandmother who required a week’s inpatient stay to be stabilized) and you have a symptomatic and EKG proven history of apparent arrhythmia, and you haven’t seen a cardiologist because some GP says you are “healthy as a horse?”
Better yet, it appears (since you didn’t mention it) that the GP hasn’t even done a real evaluation of this (in my opinion, an EKG is NOT a real evaluation for someone with symptoms and family history of sudden death; a Hoelter monitor is a bare minimum evaluation in such a case).
You may want to Google “sick sinus syndrome” for a little more background on this.
Based on the little I know about you, you would be well advised to see a cardiologist, particularly one who specializes in rhythm disorders. Depending on your situation, an electrophysiologist may be appropriate.
Oh, by the way, if your rhythm disorder doesn’t show up with standard monitoring, you may want to look into off-label use of an implantable loop recorder, such as the Reveal by Medtronic (believe me, I get no commission for mentioning the Reveal, I just think it’s a potentially useful device).
Would I see a cardiologist if I was you? OK, here I am NOT telling you what to do, and NOT giving you advice, but simply saying what I would do. I happen to have access to cardiology evaluation on my own, so I would get the Hoelter monitor before seeing a cardiologist, just to get a good handle on what is really going on. If the Hoelter results were as I suspect they would be from your description of the symptoms, then I would probably see a cardiologist. If the Hoelter results were completely normal, then I would probably do the Hoelter again in a year or so, or if symptoms returned. If I continued to have symptoms, but could not “catch” them on a Hoelter, then I would probably get a Reveal placed at that time, just to really get a good handle on what was (or was not) going on. I might also get some tilt table testing. If any of these things (Hoelter, Reveal, repeat Hoelter, tilt table testing) identified a significant abnormality, then I would see a cardiologist, and would probably discuss drugs vs. pacers. If it’s sick sinus syndrome, I personally would get a pacer, but that’s personal preference.
On the other hand, those options probably won’t be available to you. Depending on your insurance situation, you might need to see a cardiologist in order to get evaluated at all beyond an EKG. In such a case, if I was you, I would go see the cardiologist, and get the tests.
In any case, I am NOT telling you not to see a cardiologist. I am simply suggesting that I would do some of the preliminary workup before a first cardiology visit.
Again, I am NOT your physician, and I recommend that you follow up with your own physician. I do not believe that this little internet chat establishes a professional relationship, I’m just trying to share what I think is good advice with whoever (you, for example) happens to read this thread.
Good luck.
Whatever brings on a panic attack, anyone who has experienced one knows exactly what it is. I don't believe there are different kinds of panic attacks.
Hope I've helped.
Uh, yeah.... I think if I was having a heart attack I would probably panic.
I am not a stupid person; I KNOW that this is a potential problem. I posted the story, to confirm your belief that people are not taken seriously.
My original GP decided that I had "anxiety." He left the practice.
His replacement was the sage with the "healthy as a horse" comment...no referral from him!
I have been going to the same clinic for all of these ten years...the second that they look at the charts and see "anxiety"...it really doesn't matter WHAT you say...they cannot see past it. I pay $600/month for my HMO, and cannot see a specialist unless I am referred by these people.
I was planning to switch Doctors, and pursue the course that you suggested when my Dad was taken ill. Frankly, that has consumed the better part of my life for the last two and 1/2 years since his diagnosis and death.
Your post reminded me that I need to take care of myself.
If you’re a woman (especially if you’re peri-menopausal, or menopausal,) oftentimes a dr. will brush away your symptoms and chalk them up to panic attacks.
I have MS, and before I was diagnosed (I was in my early 40’s when symptoms started showing up,) I was told the tingling, numbness, etc. were probably the result of a panic attack. Having never had a panic attack, and not realizing what it was I believed the docs until I ended up in the ER unable to walk (I have RRMS, so I recovered) but I knew then what I had was more than a panic attack. From postings on MS boards, I can say that probably 70 percent of women that went on to be diagnosed with MS were originally told their symptoms were anxiety or depression.
A friend’s mother went to the ER, was told she was having a panic attack, sent home, and died of a heart attack in her sleep that night. (the hospital had not even run an EKG on her, needless to say, they settled “out of court.”)
Panic attack is definitely used too often as a diagnosis, especially for women. I see the study the same as you, these people did not have panic attacks that were a precursor of heart issues, they had heart issues that were misdiagnosed as panic attacks.
Can I ask you something? How did you learn to ignore them?
400 mg of magnesium 1500+mg of fish oil.
most people are deficient in magnesium. If you start taking it, after awhile you’ll see symptoms of depression, panic attacks, etc., go.
fish oil obliterates internal inflammation. great for the heart and every other part.
oh, and, cut out ALL refined sugars and flours. they are highly inflammatory.
It appears that you don’t mind having this discussion (since you posted back to me). For my part, I prefer having this discussion in an open forum, since it give an opportunity for lurkers to learn something as well.
Again, I am not your doctor, and I refer you to your regular physician for follow up.
That said, if someone needs further evaluation or a specialty consult, there’s a few ways to go about getting it. The most straightforward thing to do would be, of course, to get insurance that didn’t make the patient play HMO games. For $600 / month, lots of people could get old-fashioned fee-for-service insurance. Someone with such insurance could simply go to a cardiologist right off the bat. Even better, someone with such insurance could go to one of the “name” cardiology institutes, such as University of Chicago, Texas Heart Institute, Johns Hopkins, the Mayo Clinic, or others. In general, I would stay away from the University of California, and probably California overall; see the news about stolen cadavers, fraudulent liver transplant program, etc. Also see the research of Dr. Ashish K. Jha of the Harvard school of public health, regarding regions of the country that appear to have lower standards of healthcare than others.
Barring that, another thing to do is simply to document a perceived need with the HMO. Someone could send written letters to their GPs office, with a copy to the medical director of the HMO, and to the HMO HQ. Hypothetically speaking, such letters might get the medical director to arrange a specialty evaluation. That might be either because the medical director sees the clinical need for such an evaluation, or because creating a paper trail documenting requests for such an evaluation is such a legal liability should a patient eventually have a problem.
And, of course, there’s always your friendly neighborhood lawyer to talk to. Frankly, it’s a sign that the HMO concept is completely screwed up, that I think what I’m about to write is even reasonable. Here it is: it might be a good idea to get a law firm to represent a patient who is trying to get a referral to a specialist. Is that crazy? Yes, but such is the world in which we live.
Another option, of course, for those without insurance, is simply to go abroad to get this done. Medical tourism is a thriving business for a reason. Make of that what you will.
Again, I hope this was helpful.
Panic attack is misnamed as it isn’t necessarily related to panic and dread. It can come out of the blue when there is absolutely nothing going on.
God bless em. that ought to ruin the day and give a person who suffers from panic attacks one more thing to worry about.
90/65 is not uncommon for a woman.....in a man it would be really low.....would create dizziness bending over in a tall guy
having been through all of this heart stuff and anxiety about it leading up to two heart surgeries...i would advise you to get a work-up from a good cardiologist.
you could have a prolapsed valve, some arrhythmia or something else while not life threatening needs management
there are a lot of new medications out there that do not make you feel sluggish and can help
or at least to have them when you need them.
I strongly suggest this. Most arrhythmias are benign but better safe than sorry.
The two benchmarks for concern with arrhythmias are dizziness and chest pain and maybe if it goes on for hours ..
“I haven’t had one in about 5 years, thank God!”
What did you do or meds did you take?
when my dad was dying I took klonopin as needed...that helped.
but mainly just time in realizing I could manage the fear in my mind
that morning in 2004 when I woke at 2AM feeling funny and went in the kitchen and checked my BP and it was pretty high, I did not panic.
I felt God around me to be frank and was keenly aware that a distinct possibility existed that I was possibly going to die alone in my kitchen at night if I did not do something.
We have a lot of kids, so I got my wife up and took my phone and got in my old land rover and drove to St Thomas in the snow with her on the phone the whole time
I had surgery 36 hours later and then learned why my heart had always been funky...but I did not panic...I was sad though and worried about my kids....the hardest part was when they brought my 4 year old boy to the hospital the night before the big dig
but....i felt elated after surgery...and vindicated
To my recollection, I first experienced something similiar to an anxiety attack about 1988 ... didn’t know what it was then. I was in lamaz class with my wife as they were talking about “needles in the back” and things like that. I had never been squeamish, having grown up on a farm where doctoring animals was an everyday job but I couldn’t breathe and had to go out for fresh air. The next time was around 1992 as I sat on jury duty. All of a sudden I had anxieties and felt that I had to get up and go walk or get fresh air, of course sitting in jury duty, that’s not an option. For the next 10 years or so, anything resembling sitting in a closed area where my freedom of movement is curtailed brings on an anxiety attack. Meetings, church, restaurants, etc. were places to avoid. My physician prescribed some anti-depressants to help (but I’m not depressed, I love life and being active) which really didn’t help at all. Now I do have high blood pressure, heart murmer, hypertension, GERD, acid reflux, hiatal hernia, and a few other health issues which I take an aspirin, blood pressure meds, and a low dose of Prozac. I quit taking most of the stomach medicines as I’ve learned to control the anxieties somewhat better the last 4 or 5 years. Still hate meetings but I after about the first 30 minutes, the anxiety dissipates. I’m back to eating out and going to church and other social functions but I don’t see any way in hades that I could fly anywhere again, though I’m an Air Force vet and used to love flying and traveling. One poster posted about the fish oil and magnesium ... hmm, might give that a try.
I do get regular heart checks along with stress tests and am still in good shape by coaching youth sports and walking many miles a day. Have not had a heart attack or stroke (I’m 48, my parents just turned 70 and haven’t had any either). Anxiety/panic attacks are a social crippler and its hard to explain to those who haven’t had one why you “just don’t want to go do some of the things that you used to do”. Fortunately, I have a wonderful understanding wife and we’ve been married going on 20 years. Without her support, the road would have been much harder.
I have suffered from panic attacks for over 40 years. Nothing worked - Valium; hypnotherapy; psychiatric care - until a new doctor prescribed Paxil. Took it for about two years - quit about two years ago. It helped a lot. However forty years of conditioning to avoid certain situations has not gone away.
Good luck and best wishes to all of you experiencing these dreadful feelings.
Yeah, I went on some medication too and it’s worked. I was just promoted last week and I have to tell you after 2 days I was on the verge of another one for the first time in years because I was so overwhelmed with my new responsibilities. But I fought through it and everything’s cool.
Mine started after my dad died of a heart attack and I was married, carrying the load for my wife and I, two kids under the age of 4....lots of pressure.
This happened to me. I am a woman who had a heart attack at the age of 47 on a treadmill during a stress test. I had EKG leads attached, but nothing was showing on the EKG.
Meds and just trying to deal with stress differently. The meds were Paxil, very low dosage once a day. 10mg. I also take fish oil, vitamins and other things that probably help.
I still take the meds but I’ve gone many days forgetting and been just fine. Learning to cope with stress has been a help. I certainly haven’t mastered that, but I have become better at it.
Mustang, that’s exactly the feeling. I’d be in a meeting or something and I had to get up immediately or I felt like I was going to scream and go Jimmy Pearsal (climb the backstop).
Part of that was a fear of giving presentations, etc....but now I give them quite frequently.
I’ve never had an attack on a plane but that worried the heck out of me when they started because there is nowhere I could go. Haven’t had a problem. The biggest thing is the mind game. If you can get past the mind games that are played on yourself by your own mind, then I found that to be the greatest sense of relief.
Some time ago I was reading how the symptoms of heart attack in women are often different from those in men. One of the unusual ones for women was “Feelings of impending doom”. But isn’t this also one of the symptoms of a panic attack?
I hope you gave yourself a big pat on the back. It sounds to me like you gained some insight into the tricks our negative emotions can sometimes try to play on us.
Makes sense to me.
In my case, bio-feedback. Just telling my body to slow down, breathe normally, etc.
It can happen.
~Part of that was a fear of giving presentations, etc....but now I give them quite frequently.~
What’s funny about me is that giving presentations or heading up a meeting does not bother me, I guess cause I’m the one in control and dictate the agenda and tempo. I’ve read that an anxiety disorder is the result, out of many things such as genetics, a slight hormone imbalance in the brain. Adrenaline is more easily accessable to the body when its put into a “fight or flight” mode.
Amazing stuff really but something that I’d much rather observe from a distance.
I have been reading these posts with great interest. Last month I went to the ER thinking it might be a heart attack. They ended up keeping me overnight, doing the blood work every few hours, stress test in the AM, CAT scan, the works.
Nothing was wrong. Though the docs (all 5 of them in the room) didn’t spend a lot of time talking to me about it, the idea that it might have been a panic attack did surface.
No offense to anyone who has had them, but I’m a person who just doesn’t believe in them. I think I handle stress well. In addition, this ‘attack’ came from out of nowhere, after a meal (again, more like a heart attack), when the most anxiety I was having at the time was deciding what channel to watch.
So now to the stress that I won’t admit to: 1) finishing and defending the Phd; 2) move across country to new job; 3) parent dies; 4) a month later uncle dies from diabetes, I am diabetic and always worried about my health; 5)son moves across country to live w/me (a blessing, but still stress); 6) worrying about mother’s health and situation, tho she seems to be hanging on; 7)teaching and researching and trying to get published. While young profs take time to have fun on Friday nites, I’m writing and working hard. FR accounts for most of my free time, mostly ‘cause I can flip back and forth while working on other stuff.
So, I can understand that there might be stuff there that could induce a panic attack; but how can I be having them if I don’t think it’s possible? How can you have a panic attack when you aren’t in a panic situation? I’m stumped.
The doc gave me Propranolol, which I haven’t started taking, just because I don’t know if this is the correct diagnosis. I was a little concerned when he said I “absolutely” should be taking them and gave me a big script for them. Sounded a little glib to me.
Any thoughts? This is driving me nuts. Of course, maybe I’m there already. I’ve got the meds for it. Sorry for the long post.
As always, I am not your doctor, and I recommend you follow up with your regular doctor.
That said: the beauty of propranolol for symptoms which might be due to either panic attack or cardiac problems is that propranolol will treat both. It’ll reduce the physical symptoms of anxiety which may be part of a panic attack, and it’ll drop the blood pressure and heart rate a bit, which can ease the stress on the heart in case of a cardiovascular event. That’s probably why your doc was so certain it would be a good drug for you.
Of course, propranolol has all the normal beta-blocker side effects IN SOME PEOPLE. It can slow you down, make you lethargic, etc. If you have type II diabetes (like 85% of diabetics), slowing down can be a real problem.
Also, once you start propranol, you would be well advised not to go off it suddenly, lest you develop rebound hypertension. Rebound hypertension is just what it sounds like: you can get higher blood pressure by suddenly quitting propranolol than if you’d never been on the stuff in the first place.
Also, I want to stress (because I know of people who have died at a young age after not taking the following advice) that, if you have continued symptoms that might be cardiovascular, then you may want to get an angiogram or perhaps a stress perfusion study even after having a normal stress test. An angiogram is an invasive procedure, with significant risks, so it should not be done lightly. At the same time, repetitive symptoms that were apparently severe enough to warrant an overnight stay / stress test / CAT scan should not chalked up to a panic attack without a thorough workup.
Knowing when to get an angiogram after a normal stress test depends on a lot of factors, almost all of which cannot be addressed on an internet message board. Therefore, I again recommend that you follow up with your regular doctor.
Good luck.
I’ve taken anti depressants for my anxiety . They worked to some degree for me . Understanding what they are helps a lot. I used to think I was dieing and that just feeds on itself making it worse. Lucinda Bassette has a wonderful tape series that was VERY helpful for me .
Re the propanolol- I’m supposed to take it ‘as needed.’ I was also told it was only in the system for a couple of hours. So, how does this affect the issue of not stopping the medication suddenly? If I take it a couple of times on one day, but then don’t need it until a month later, then what?
Of course, if I ever get the script filled, I should ask the pharmacist these questions, huh? : )
Re the tests in the hospital, as a Type II, middle aged female diabetic, I think they weren’t taking any chances. Also, because women present heart attacks differently, again, I think they weren’t taking chances on missing something. I’m glad they were so thorough, but in a way, the incident opened more questions than it answered.
Re the propanolol- I’m supposed to take it ‘as needed.’ I was also told it was only in the system for a couple of hours. So, how does this affect the issue of not stopping the medication suddenly? If I take it a couple of times on one day, but then don’t need it until a month later, then what?
Of course, if I ever get the script filled, I should ask the pharmacist these questions, huh? : )
Re the tests in the hospital, as a Type II, middle aged female diabetic, I think they weren’t taking any chances. Also, because women present heart attacks differently, again, I think they weren’t taking chances on missing something. I’m glad they were so thorough, but in a way, the incident opened more questions than it answered.
Again, I refer you to your regular doctor. However, if you are only taking propranolol occasionally, then you probably won’t have a problem with rebound hypertension. Sorry to worry you; I didn’t realize you were just going to be taking it as needed.
To the best of my knowledge, however, the rest of my comments are still valid.
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