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Overweight, BP Shoots Up And Tension. Having Vasoconstriction And Tightness In Chest. Is This A New Panic Attack?

Posted on Fri, 25 Oct 2013

Question: I am a 49 year old male. I am overweight and a non smoker. No coffee or alcohol. I am having spells in which my blood pressure shoots up some times to 220/123. and I lock up with tension. It hurts. My pvcs often occur after eating certain foods especially MSG. The term vasoconstriction seems to describe best what I am feeling. I have some history of LVH. I have a lot of pvcs and some heart enlargement. I have pretty much perfect blood panels I have a near perfect diet, I just eat to much of it. I have had anxiety issues often in the past. I become very hot and my blood pressure goes very high. I have tightness in chest and arm. I overcame my panic attacks years ago and my heart no longer goes fast. The spells last about 15 to 40 minutes and then my blood pressure goes back down to about 148 over 72 which is average for me. my heart rate remains normal but feels hard. I wonder if this is a new type panic attack. I have to have cold towels on me and my whole body just wont loosen up. I wonder if its hormonal. I remember even as a child any confrontation would make me nauseous. I noticed even the simple act of chewing would shoot up my BP very high. I am very confused by all this. I am worried I am going to stroke during one of these attacks. Once my catecholamines were slightly elevated on one of my test. I dont know what to pursue here Psychological or medical. No mental help has done any good.
Very confused, I need a direction and some ideas.

Answered by Dr. Anantharamakrishnan (3 hours later)

Brief Answer:
Need more investigations

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

Discuss with your Internist...
A cardiologist can assess and help further.
Get yourself examined / at times, a host of investigations may be necessary...

     Panic may explain the situation / but it ought to be an exclusion diagnosis.
     A Psychiatric assessment and assistance can help to evaluate the role of Anxiety…

     Increase of Heart rate, Blood Pressure, Anxiety – all of them can be from a common cause / sudden outpouring of adrenaline is a classical situation. Pheochromocytoma (tumor of adrenal medulla) typically causes this. Your cardiologist (Or Nephrologist or Endocrinologist) may order a battery of blood (and urine) tests / MRI and so onto evaluate…. / several other hormones like thyroid, cortisol, spironolactone and so on may also have to be looked into.

     EKG / HOLTER (24 to 48 hour ambulatory monitoring) / ECHOcardiogram / TMT (Treadmill exercise ECG) / LABORATORY work-up – may all be necessary for further assessment and assistance. You may even need Electro Physiological Studies (EPS)

The treating doctor may suggest them depending on need, based on his assessment of the situation.

Take care
Wishing all well
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (6 hours later)

I weigh 400lbs. I am wondering if my enlarged heart can remodel by losing a lot of weight or is the damage permanent?

Answered by Dr. Anantharamakrishnan (15 minutes later)

Brief Answer:
It can and it will...

Detailed Answer:
Hi,

yes, for sure...
If there is no permanent damage, it will be back to normal / even if there is, it will – to a great degree

     You have to reduce the QUANTITY of your food and change the QUALITY too. It is not possible to explain or understand the nuances on a single occasion. To start with, reduce the amount to one third of what you are presently taking. Avoid all fats – they have double the energy of carbohydrates. You should see a good DIETICIAN - One generally needs SEVERAL sessions, to master concepts of calories, nutritional values, biological value, vitamins, minerals and so on.
     Exercise helps But you need to do really severe and prolonged exercise – several hours. Start half an hour a day and slowly step up every week. Its role is however is limited. For example, in walking 1 kilometre, one spends 1 Calorie per kilogram of his body weight! A cup of rice or an average bar of chocolate has approximately 200 calories. A treadmill may help. The ideal solution is to get yourself enrolled in a Gym and have a supervised program.
     These life style changes ensure excellent outcome
     Some people may benefit from operation. It is called Bariatric surgery – reducing the size of the stomach and has proved benefits.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (2 days later)

During these spells I feel constricted and some warm feeling. My blood pressure reaches systolic 220
and diastolic 120
after about 20 minutes my blood pressure goes back down to approx 148 over 78
I have these spells sometimes after exertion but mostly after mental stress. I have maybe 1 to 3 spells per week.
Most important question for me is, am I in danger even if its only anxiety attack with my blood pressure spiking to this?

Answered by Dr. Anantharamakrishnan (3 hours later)

Brief Answer:
Yes / high spikes are not always safe

Detailed Answer:
Hi,

This level of pressure is rather high and may lead to problems / even if it is from anxiety / even if is only lasting for short times.

As suggested earlier, typically Pheochromocytoma is the most common in this type of situation / it has to be investigated – 24-hour urine VMA, serum catecholamines, abdominal scan are necessary. It is often curable and no curable condition should be left un-investigated…

Regards

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar