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Panic attack and anxiety sufferer, taking sertraline, diazepam. Had panic attack. Need opinion on reports

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Hi I have been a panic attack and anxiety sufferer on and off for 22 years and had a severe panic attack 4 weeks ago
I pushed my reluctant gp for a stress test referral and went on Tuesday

Resting ECG normal but 101 bpm PR interval 142 ms BP 128/61
Results not back from X-ray yet
ECG stress result positive
Max worl load 10.3
Ex duration 9 mins
Pred HR 178BPM
% pred HR reached 97.19%
ETT stress test stopped at the end of 3rd stage of XXXXXXX protocol at 97% of target HR due to fatigue. No chest pain or shortness of breath. No significicant ST-T changes noted injuring exercise
0.5 ST depression and T inversion have been seen in the recovery period at 02.31. Adequate BP and HR response
Prescribed Biscoprolol 2.5 mg and 75mg aspirin
24 hour holtar ECG in 2 weeks
Diagnostic coronary angiogram in 6 weeks
I am very very anxious re angiogram
Is there another test which is less invasive ? And could these results be due to anxiety, just before my test I had a call to say my mother had been rushed to hospital with kidney failure
I take sertraline and diazepam for extreme anxiety and panic attacks
Posted Fri, 22 Jun 2012 in Anxiety and Stress
 
 
Answered by Dr. Anil Grover 13 hours later
Hi XXXXXXX

Thank you for writing in.

Panic attack is a form of anxiety for which doctors cannot do much to prevent. You wait for one and treat it with tranquilizers; it is not a very situation for in. Yes, one can be prescribed long term anxiolytics which have sedative effects too. The biggest danger in such a situation is missing a cardiac emergency like angina or even myocardial infarction, both of which demand an early treatment if one wants to salvage the every part of heart and perhaps life.

Regarding the tests performed, there is suspicion on Thread mill test (TMT) for a possible coronary artery disease.

The other non-invasive tests like stress Thallium or stress echo will not remove this doubt with 100% certainty; whereas Computed Tomography (CT) angiogram (if you can call the test non-invasive; for it involves almost similar amount of XXXXXXX and exposes you to greater amount of radiation) is taken as almost as specific - but there are cardiologists who do not subscribe to this view. Reason is the procedure cannot be continued to curative form.

On the other hand, coronary angiography, which is equally invasive (here artery is pricked instead of vein as in CT angio) and the XXXXXXX is injected and you are free the same day. It is the Gold Standard.

Moreover, if anything is found the procedure can be extended to balloon dilatation and placement of stent. Patient is sedated but the procedure is done under local anesthesia.

You ought to XXXXXXX someone who had undergone it to realize how "painless" and "hassle-free" the coronary angiography had been. I am sure once the results are out your anxiety will lessen significantly that is the bonus.

I hope I have been able to answer your question. If there is a follow-up query, I will be only too happy to take that.

Best Wishes

Dr Anil Grover
Cardiologist
Above answer was peer-reviewed by
 
Follow-up: Panic attack and anxiety sufferer, taking sertraline, diazepam. Had panic attack. Need opinion on reports 6 hours later
What's the chance my anxiety and hyperventilating caused this result?
 
 
Answered by Dr. Anil Grover 16 minutes later
Hi XXXXXXX

Thanks for asking a very pertinent question.

Stress test is about 75%-80% specific meaning thereby there are one in 4 or 5 chances that it is positive and you do not have any significant coronary artery disease. Then it is called false positive test.

Chances of false positive tests are more in hypertensive individuals and also in individuals where hyperventilation can bring about these changes. Again a depression of 0.5 mm if interpreted as positive in absence of angina or other symptoms is more likely to be false positive.

Hope this answer your query. Let me know if you have any more queries.

Best Wishes.

Dr Anil Grover
Cardiologist
Above answer was peer-reviewed by
 
Follow-up: Panic attack and anxiety sufferer, taking sertraline, diazepam. Had panic attack. Need opinion on reports 55 minutes later
What about the T inversion though
 
 
Answered by Dr. Anil Grover 25 minutes later

Hi XXXXXXX

Thanks for your follow up query.

What I meant was when a test is declared positive on "softer" criteria then the chances of it being false positive increase.

"Hard" criteria would have been 2 mm or more; horizontal ST depression (it is ST depression which denotes ischemia or relative lack of blood supply to muscle) associated with some angina like symptoms. All others like up slopping ST depression, a minimal ST depression with T inversion form some of the softer criteria.

These are good enough to suspect Coronary Artery Disease and advise further test like coronary angiography; but if it comes out be normal your cardiologist will not be surprised.

It is always better to be sure by doing test with almost 100% positive predictive accuracy than remain in doubt. That is the principle we follow in cardiology. That is why a coronary angiography has been advised to you.

Hope this clarifies your doubts. Should you have any more queries, I will be glad to address them.
If all your queries are answered, please close this discussion

Best Wishes

Dr Anil Grover
Cardiologist
Above answer was peer-reviewed by
 
Follow-up: Panic attack and anxiety sufferer, taking sertraline, diazepam. Had panic attack. Need opinion on reports 1 hour later
Sorry just one last question
I'm terrified off the. XXXXXXX angiogram and really am I an anxiety state, my mum had a bad reaction to the XXXXXXX 7 years ago
Isn't there a less invasive test first
 
 
Answered by Dr. Anil Grover 20 minutes later
Hi XXXXXXX

No problem. The questions are genuine and worry is natural phenomenon.

Well the XXXXXXX used is non-ionic. In my experience of some ten thousand patients, I have not seen a reaction to non iodine XXXXXXX In fact the same XXXXXXX is used for "non invasive test" that is CT Angiogram. This XXXXXXX is used in dozens of other radio logical investigations like MRI, CT, Angiography, IVP and so on.

Previously, an iodine containing XXXXXXX was used and one would come across a reaction. You can confirm this with your doctor.

Have no fear on this or any other count.

Best Wishes

Dr Anil Grover
Cardiologist
Above answer was peer-reviewed by
 
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