Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Warm Sensation, Cold Chills. High BP And Heart Rate, Normal Sinus Rhythm, On Sectral, Celexa, Ativan
Question: I am a 32 yr old female who is suffering from warm sensations spreading all over my skin, then rapid heart rate, then cold chills and trembling. A week ago I called 911 b/c the episode woke me out of a sound sleep. It was very intense and by the time I reached the hospital my bp was 180/156 with a heart rate of 148. I stayed 3 days in the hospital where they looked at my heart and told me it looked normal. I am wearing an event monitor and it captured the episode which they said looked like normal sinus rhythm. But something is waking me up and speeding up my heart and causing the other symptoms. So I am now on 400 mg of Sectral twice a day and Celexa. They also gave a 1mg tablets of ativan to take during an event to stop them. Last night I had an episode that woke me up I took the ativan and it didn't stop the attack. What could be causing this?
Hello XXXXXXX
Thanks for posting your query.
It is good that your cardiac status is normal and the holter/event monitor has confirmed normal sinus rhythm. From your symptoms, two possibilities could be considered and need to be ruled out.
1) The first possibility is of hyperthyroidism. Some of the symptoms of hyperthyroidism such as tremor and palpitations which are caused by excess thyroid hormone acting on the cardiac and nervous system. You need to get your thyroid profile tested to rule out this condition.
2) There is a strong possibility of these symptoms being due to panic attacks and anxiety neurosis. For ruling them out you need to consult a psychiatrist.
Panic attack is a response of the sympathetic nervous system and is characterized by trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, feeling of warmth and sweating. Symptoms of anxiety neurosis include sweating, headaches, nausea, muscle tension, muscle aches, trembling and hot flashes. Both of them require psychological counseling and anti anxiety medicines which you have already started with.
In addition to the medicines mentioned above, here are some of the other conservative treatment options which you can follow:
1) When you have such symptoms, breathe slowly through the nose and talk to your family and friends.
2) Do not take caffeine of alcohol at night just before going to bed.
3) Indulge in yoga and meditation to calm your mind.
4) You can also indulge in progressive muscle relaxation which is useful in anxiety by alternately tensing and relaxing the muscles.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
Wishing you good health.
Thanks for posting your query.
It is good that your cardiac status is normal and the holter/event monitor has confirmed normal sinus rhythm. From your symptoms, two possibilities could be considered and need to be ruled out.
1) The first possibility is of hyperthyroidism. Some of the symptoms of hyperthyroidism such as tremor and palpitations which are caused by excess thyroid hormone acting on the cardiac and nervous system. You need to get your thyroid profile tested to rule out this condition.
2) There is a strong possibility of these symptoms being due to panic attacks and anxiety neurosis. For ruling them out you need to consult a psychiatrist.
Panic attack is a response of the sympathetic nervous system and is characterized by trembling, dyspnea (shortness of breath), heart palpitations, chest pain (or chest tightness), hot flashes, feeling of warmth and sweating. Symptoms of anxiety neurosis include sweating, headaches, nausea, muscle tension, muscle aches, trembling and hot flashes. Both of them require psychological counseling and anti anxiety medicines which you have already started with.
In addition to the medicines mentioned above, here are some of the other conservative treatment options which you can follow:
1) When you have such symptoms, breathe slowly through the nose and talk to your family and friends.
2) Do not take caffeine of alcohol at night just before going to bed.
3) Indulge in yoga and meditation to calm your mind.
4) You can also indulge in progressive muscle relaxation which is useful in anxiety by alternately tensing and relaxing the muscles.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
We already ruled out thyroid problems. Blood test came back normal. Is it possible I am going through the change of life at an early age? And if it is anxiety why did the Ativan not stop the attack last night? Thanks for your help.
Hello XXXXXXX
Thanks for the clarification. It is good that the thyroid status has come out clear. Ativan alone is sometimes not sufficient to stop anxiety or panic attacks and in addition to Ativan, beta blockers may also be required in some cases. You can discuss about these drugs with your treating physician and get them prescribed.
Regarding premenopause, it is that phase in a woman’s life just before the onset of menopause when a female’s menstrual cycle permanently ceases. It usually starts with erratic menstrual cycles which may be characterized by irregular periods, delayed periods, skipped periods etc. If you are having regular periods, then its chances are less based on these symptoms alone. However to completely rule out this possibility, you can get your hormonal assays done for FSH, LH, estrogen and progesterone levels. If they are in the normal range then this possibility is completely ruled out.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
Wishing you good health.
Thanks for the clarification. It is good that the thyroid status has come out clear. Ativan alone is sometimes not sufficient to stop anxiety or panic attacks and in addition to Ativan, beta blockers may also be required in some cases. You can discuss about these drugs with your treating physician and get them prescribed.
Regarding premenopause, it is that phase in a woman’s life just before the onset of menopause when a female’s menstrual cycle permanently ceases. It usually starts with erratic menstrual cycles which may be characterized by irregular periods, delayed periods, skipped periods etc. If you are having regular periods, then its chances are less based on these symptoms alone. However to completely rule out this possibility, you can get your hormonal assays done for FSH, LH, estrogen and progesterone levels. If they are in the normal range then this possibility is completely ruled out.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
Wishing you good health.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
