Oh and just an add on. I sem to suffer more from a racing sensation than palpitations.

Okay, welcome to the forum and I've read your posting. I need you to clarify several points for me before we discuss the circumstances.

Please state your age.

When you say "a precautionary angio" are you referring to angiogram or angioplasty? Also please tell me whether you've ever been evaluated for Mitral Valve Prolapse via echocardiogram and if so, what the results were of the study. Also indicate whether you have any serious medical conditions, past or present.

Please describe more specifically what occurs both just prior to the panic attacks and during. Tell me how long the events persist before a return to baseline and if you feel washed out afterwards. If so, for how long.

Also describe more specifically your "stomach problems." I need to know precisely what your symptoms are, whether they wake you from sleep and is there any period where the symptoms become worse or better. Also tell me how long you've been taking Nexium at the dose mentioned and whether you took it at any lesser dose prior to now.

You stated that you had a "reaction" which produced sinus tachycardia. Please clarify whether the reaction was to the bucospan or something else. Also tell me specifically what your blood pressure levels were, since I am unable to determine what "skyrocketing" constitutes in this instance.

Please state the contraception pill prescribed and how long you've been taking it.

Tell me how long you've been taking Lexapro and Xanax. Unless you suffer from clinical depression with anxiety features, then the combination of of Lexapro and Xanax are not the wisest choice, particularly in patients with demonstrated panic disorder.

So provide me with clear and detailed answers to my inquiry and we'll proceed in discussing what's likely taking place and suggestions to get you to the point you want to be with respect to your health concerns.

Best regards,

Rutheford Rane, MD (ret.)

Okay, Alprazolam is the pharmaceutical or generic form of the brand name Xanax.

Your heart is healthy. That much is strikingly evident. Invasive testing at the level of an angiogram rules out heart disease and frankly, you're too young. Only in cases of severe hypercholesterolemia do we see persons in your age group affected by cardiovascular compromise by way of atherosclerosis.

The "twinges" that you are referring to in the left upper abdominal, lower costal rib border of the chest are GI-related and my suspicion would be Irritable Bowel Syndrome, which is extremely common. This is greatly supported by the fact that you soon afterwards find yourself in the restroom for extended periods. IBS is a dysfunction of water re-uptake at the level of the colon and is found to exist in high correlation with persons suffering from significant anxiety and or panic disorder. It is a diagnosis of exclusion, so there is no test to detect its presence, but rather its symptoms which persist to the exclusion of any other probable cause. Realize that IBS can make patients feel extremely ill at times and incidence of colonic spasms also produce benign palpitation events, as well as a strange sensorium that causes light-headedness, shallow breathing due to pressure against the diaphragm, esophageal discomfort, sweating and other manifestations. These collective symptoms oftentimes cause the patient to feel that something dreadful is taking place. Patients with IBS fall into one of three categories, constipation predominant, diarrhea predominant and mixed variant.

It is also of note that Proton Pump Inhibitors such as Nexium do not provide the relief anticipated. Many people with IBS feel sensations of hyperacidity, eructation (belching) and general pressure with cramping that may be only brief or persist for long periods. The general result of an exacerbation of IBS is a bowel movement within one of the three characterizations mentioned. Once complete, the patient often feels tired and much like the sensation associated with over-sleeping.

It is also very significant that you state you are eating a "gluten free" diet. Realize that this is an extremely common pattern among persons with IBS because they feel that certain triggers are inducing the events they suffer by reason of cause and effect. In other words, if they eat high-fiber muffins or other products high in fiber content, the typical outcome with persons suffering from IBS is a rather dramatic response that produces indigestion, bloating, cramping and ultimate need to evacuate the bowel. This is not due to Celiac disease and contrary to popular beliefs, it is far more rare than one might imagine. It also requires specific biopsy of small intestine tissues for confirmation.

People with IBS who choose a gluten-free diet do in fact feel better much of the time, but this is not because they have Celiac disease or even gluten intolerance. It's because these products typically cause an increase in stomach acidity, produce gas and ultimately cause an overt response by the colon. Also realize that gas that becomes trapped in the duodenum can produce significant gastrointestinal distress because it applies pressure against the retroperitoneal portion of the juncture of the stomach and duodenum.

A good trial to determine whether IBS is the actual culprit is to have your doctor prepare what is commonly referred to as a GI cocktail, consisting of 30mg of Maalox, 20mg of Donnatal Elixer, and 10mg of viscous lidocaine (the lidocaine can be withheld if no symptoms of gastric burning are evident). The main ingredient which acts most prominently is the Donnatal, which is a belladonna alkaloid and works very quickly to relax the smooth muscle of the GI tract and often prevents further exacerbation of the IBS event. When an overt incident of IBS symptoms arises, the consumption of this cocktail will invariably produce amazing results. It is not, however, a product that you can take on a regular basis. It simply serves to better identify the underlying cause for your GI distress that typically results in a panic threshold event.

The treatment of IBS in the presence of anxiety disorder is often best accommodated by treating the anxiety. Lexapro is within a class of drugs known as Selective Serotonin Reuptake Inhibitors and work very well in some patients with clinical depression. They are not, however, the best choice when anxiety is predominant and in some instances, can actually exacerbate panic threshold events, although infrequently.

It is also very important for you to consider establishing a relationship with a professional licensed and experienced with patients suffering from panic disorder. The underlying cause and cognitive patterns which predispose a patient to panic disorder must be addressed since medications only suppress symptoms and not the cause. Psychotropic medications are not intended for long-term use, although many persons remain under prescription for years. The best approach is a 16-week maximum prescription, augmented with direct psychological intervention to help establish an approach to permanent resolution.

From a health standpoint, there is nothing wrong with your heart in any manner at all. The tests fully support this fact. In other words, you are in absolutely no danger of suffering a cardiac event and certainly not loss of life. You need to establish a firm plan and do not dabble in self-diagnosis by way of using supplements or non-applicable diets. Make an effort to work through your doctor in finding an anxiolytic which works, determine whether IBS is the underlying cause for your GI difficulties, and seek out psychological intervention to create less dependency upon drugs and the ability to abate panic disorder from daily life.

You're going to be just fine. I was in practice for more than 40 years and this sort of presentation was extremely common.

Best regards,

Rutheford Rane, MD (ret.)