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Panic, palpitations and a fainting episode (Read 5851 times)
rigg
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Panic, palpitations and a fainting episode
Feb 13th, 2013, 4:43am
 
Dear RLR and fellow members,
I hope I'm not breaking any forum rules by repeating my query, but it appears that I was unlucky to post my original question during the period when RLR was away from the forum, and as you all may imagine, I am a bit anxious (pardon the pun) for any opinion and advice.
here's my original post:

I will try to be as concise as possible, but do forgive me if I give you too much unnecessary information on my problem which will probably happen since I have had it in one form or another for over 14 years now, and it's currently causing me a lot of grief. I will treasure any sort of insight or advice regarding it!

I am a 31-year-old female who has been suffering with anxiety most of her life. There are numerous factors I'm aware of that have contributed it to it, but I have never been diagnosed with any other mental or physical disorder other than anxiety. I'm quite fit, I do light exercise regularly, eat healthily, have no family history of serious illnesses, but - due to both unfortunate circumstances and my proneness to anxiety - I always feel worried about something. I had regular psychotherapy from 2002 to 2008 which helped me a lot for a while, but having been unable to resolve all of the issues that cause it, it has always kept coming back, and the main symptoms have always been palpitations.

I developed a horrible fear, and I may even say - an obsession - with my heart and the idea of it causing my sudden death after several months of severe tachycardias I experienced for almost a year in 1998. They started out of the blue one evening and continued daily. Even the lightest physical strain like raising my arms to play volleyball or climbing stairs or walking briskly would cause my heart to go into an overdrive. My fear seemingly dissipated after I underwent all sorts of heart/virus/lung/thyroid medical tests and no cause was found. Also, I was in high-school and had to keep on with my daily schedule. The tachycardias faded and eventually disappeared after a year, but the panic attacks and agoraphobia started soon afterwards and, eventually, in 2005,  heart palpitations made a comeback, but this time they had nothing to do with physical exertion, this time they were a result of anxiety. I had my ups and downs, however I always managed to somehow  pick myself up, alleviate the fear and keep on trudging. I had my heart tested ever couple of years or so (ECGs, ultrasound, halter...) and always got an all clear.

But a year ago, life circumstances pushed me into even more sever anxiety. I started triggering palpitations/tachycardia at will! I am completely unable to control the utter terror caused by the thought that I may kill myself by accelerating my heart rhythm, which I do whenever I'm alone or with somebody who is not aware of my anxiety problem, and therefore can't help me calm down. I stopped leaving the house alone altogether because, as soon as I'd be left alone in the street, I'd give myself tachycardia and couldn't even enter a bus/taxi alone. Someone accompanies me wherever I go! Even to work! The situation is so crippling and insufferable that I seeked a psychiatric help again, and was given 10mg of Cipralex. The doctor calmed me down a bit, but I was unable to continue working with her because she insisted on my coming to her office alone which I am unable to do since the one time I tried it, I barely made it 500 meters from my home when the terror got the best of me and my heart started doing flip-flops (missing beats? I don't have a clue, but it's horrible) and I was certain I was about to drop dead. They probably lasted less than a minute, and I eventually managed to get back home, but I have never been able to leave it again unaccompanied.

I do realise that I need to find another psychiatrist because this situation is unbearable, but since this forum deals with heart palpitations exclusively, and they are my biggest and insurmountable obstacle at the moment, I was wondering if someone could give me any sort of advice which would help me tackle this problem. Has anyone had something similar? Is my fear justified - can I really give myself a heart attack this way or can I simply get out of the house on my own, weather the palpitations and keep going?


---------

I have an additional question as well. There was an incident a couple of years ago that differs from all my other experiences with panic, anxiety and palpitations, and as such, keeps worrying me to this day, especially since I keep reading that no, one canNOT faint during a panic attack. What happened is that I was sitting on a chair, minding my own business but feeling a little anxious as usual. I checked my pulse (on my neck) to calm myself (as I obsessively do) and couldn't find any pulse, then felt a wild thump followed by more complete silence (lack of pulse??) and for the first (and so far only) time, I started fainting. Blacking out, feeling a funny taste in my mouth, losing my hearing. I immediately lay on the floor and called my sister, but even upon lying down, I still kept losing the consciousness. I have no idea how long it lasted, must have been 5 minutes at least, but I never lost consciousness completely, I recovered, stood up and felt completely normal apart from being scared to death.
Is there any explanation for what happened to me? Has anyone experienced something similar? Even though I had my heart examined even after this occurrence, I just can't let go of this until I understand what it was that happened.

I apologise for the length and repetition, but receiving an answer would mean a world to me.

Kind regards,

Zoya
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Re: Panic, palpitations and a fainting episode
Reply #1 - Feb 14th, 2013, 5:21pm
 
Okay, welcome to the forum and my apologies for overlooking your original posting.

As you've probably already learned by reading the other postings on the forum, your symptoms and concerns are very much like others who visit here or become members. Let's spend a few minutes talking about your health concerns.

Firstly, the palpitations you are experiencing are entirely incapable of causing you to suffer any type of sudden cardiac event or place you at risk of dying. Throughout the entire history of medical record, there has never been even a single case of a patient succumbing to any harm whatsoever as a result of the kind of palpitation events you and others here on the forum are experiencing. Not a single case.

That you believe such an outcome is possible is largely what creates persistence with respect to health anxiety. The specific type of palpitation events you are experiencing actually originate from outside the heart altogether and only stimulate the heart much like a muscle twitch affects other muscles in the body from time to time. Remember that the heart is as much a muscle as it is an organ and due to its extremely dynamic nature, even slight departures from normal performance can be readily detected by persons vigilant to any signs of change.

The reason that you experienced near-syncope actually has its origins in the same cause; The vagus nerve is responsible for vagal tone and relative tone changes depending upon a variety of factors, many of which include interaction with the environment. I'm sure you've heard of soldiers who pass out while standing at attention. Well this is due to a brief and sudden reduction in vagal tone. Realize that relative tone is derived by constant feedback through the sensory network of the central nervous system. When a person stands completely still, particularly in an upright position, less and less feedback is being generated by movement and adjustments to vagal tone become infrequent. Understand that the body must constantly adjust for the forces of gravity which work to draw blood into the lower limbs. In order to maintain adequate perfusion to the brain, vagal tone must be such that the vascular network compensates for gravity and through a variety of methods, achieves adequate perfusion to the brain to keep you from losing consciousness. In the case of fainting soldiers, the threshold is simply overcome by decreasing feedback until perfusion is diminished and syncope, or fainting, occurs.  

Vagal tone can be disrupted by other factors as well, including being suddenly startled. Many people have experienced fainting immediately following events which suddenly startle or frighten them. Visual exposure to morbid or particularly horrifying events can also produce a vasovagal response, or sudden decrease in vagal tone, resulting in fainting.

In your own case, the fear that something imminent was about to occur produced the requisite response in order to experience a vasovagal event and although not complete, caused you to suffer near-syncope and as your body began to adequately compensate, the sensorium gradually lifted. This is nothing serious at all and does not constitute any type of warning sign of greater complication.  

You should also be aware that it's entirely impossible to be conscious in detecting the absence of a pulse. Unconsciousness is virtually immediate under such circumstances and you simply aren't able to sit around fully alert while taking notice of such an event. Regardless, you are at no risk of any such occurrence and only irrational beliefs are driving such perceptions.

Simple tachycardia is not a life-threatening event at all and although frightening, will never put you at such risk. Many people who become vigilant to such a premise produce a very particular type of fear that induces what is known as a fight-or-flight response. It is the mechanism which compels you to seek constant safety and support. There is a belief that your life is potentially at risk and the brain reacts very innately to defend against such a potential. The ability to move beyond the oftentimes social paralysis induced by such anxiety is centered upon a far better understanding of what is actually taking place during these events rather than being helplessly guided by irrational fears which have no basis in reality.

Understandably, persons so afflicted actually produce a rather cyclic nature of existence wherein any movement outside the perceived boundary of safety induces the physiological manifestations sufficient reinforce irrational beliefs regarding threat to one's existence. Again, it's important to better understand the role that the brain and body have in this rather unusual symbiosis in order to gain insight necessary for positive change.

You're going to be just fine and the entirety of your symptoms are the consequence of significant anxiety. It's also critical to realize that anxiety is purely a state of mind and does not constitute any type of disorder or disease. It's influence, although somatic or physical in some instances, is nevertheless fully capable of being stemmed to the extent that normality recognizable to the patient can be restored.

I would also advise you to consider seeking another counseling source to help you both define and come to terms with the actual underlying case for your state of anxiety. The time period mentioned is wholly sufficient to have done so by this point and the precise match between counselor and client is sometimes achieved through trial and error in order to reach ultimate success.

Spend some time visiting with members here and you'll find that many of them share your symptoms and can provide you with a wonderful sense of support.

Best regards,

Rutheford Rane, MD (ret.)


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Best Regards and Good Health
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rigg
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Re: Panic, palpitations and a fainting episode
Reply #2 - Mar 12th, 2013, 2:33am
 
Dear RLR,
Thank you so very VERY much for your reply, as well as for all the effort you put in helping us all through this forum. Your words are a great comfort to me, and a great help in getting through this difficult period.
All best,

Zoya
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