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Have LVH and heart enlargement due to weight. Extreme anxiety and BP shoots up. Chewing or moving hands trigger BP. Is it anxiety attack?

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I have put this similar question to endocrinologist and cardiologist. I would like the view point of a psychiatrist. I am a 49 year old male. I am overweight and a non smoker. No coffee or alcohol. No drugs. I have some LVH and some heart enlargement from my weight. My blood sugar level after a meal is approx 113. I am having spells of extreme anxiety in which my blood pressure shoots up some times to 220/123. It lasts about 20 minutes. I have pretty normal blood test. I have a very good diet, I just eat to much of it. I become very hot and sweaty. I have tightness in chest. My heart rate stays normal at around 80 bpm. I do have some pvc,s. My avg. blood pressure is about 148/ 72. I wonder if its hormonal or anxiety attacks. I noticed it often happens after eating or when first waking up in the morning. My blood pressure soars even after a small anger or emotional conversation. I noticed even the simple act of chewing or moving hands can sometimes trigger it. I went through a spell a few years ago where my body locked up with tension and stayed that way for months. I have agoraphobia and transient panic attacks. My heart no longer races but my blood pressure goes way up. I feel I have way to much adrenaline response to small thing. I am concerned that this time it is not just panic but something medical. Please give your opinions.
Posted Wed, 30 Oct 2013 in Sexual Problems
Answered by Dr. Ashish Mittal 3 hours later
Brief Answer:
There is need to manage panic disorder.

Detailed Answer:
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     49 year old male
•     Known case of hypertension, obesity, agoraphobia, LVH and PVC.
•     Complaints of: episodic rise in blood pressure with severe anxiety symptoms.

Considering sudden onset of symptoms, duration of episode (20 Min), symptoms profile (severe anxiety, hot/sweaty, chest tightness and palpitation), non conclusive opinion from endocrino/cardio-logist and history of agoraphobia, your symptoms are due to panic attacks in my opinion.

Typical symptoms in Panic attack which may or may not be present in your case: severe attack of anxiety, choking sensation in throat, nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body/chest, increase sweating, hot/cold feeling in body, headache, sleep disturbance, palpitation, dry mouth and fear of dying during attack. Each episode develops in few minutes and last for 20-100 minutes. Each episode followed by the fear of developing another attack in future. It is not necessary to have all symptoms to diagnose panic attacks (5-6 symptoms are sufficient).

Panic disorder and agoraphobia are type of anxiety disorder. Anxiety can cause chest tightness by causing muscle spasm, as we used to have headache during tension due to forehead muscle spasm.

Thyroid hormone imbalance and excessive caffeine (tea/coffee and cold drinks) intake also increases panic attacks. Hope it is not the cause in your case.

I have many patient who have fluctuation in blood pressure during the panic attacks. Many come after non-conclusive cardiac investigations. Their blood pressure stabilize after treatment of panic disorder. In my opinion same will happen in your case.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Have LVH and heart enlargement due to weight. Extreme anxiety and BP shoots up. Chewing or moving hands trigger BP. Is it anxiety attack? 14 hours later
Thank you for your detailed reply. I am concerned with the level my blood pressure is rising to. When I had panic attacks in the past I saw my blood pressure at 220/123 but it did not hurt. The other day during an attack I saw it at 187/135. In the last couple years I seem to have a form of constriction with it that is painful. I feel sections of my spine that even hurt with pressure. Even a simple conversation or phone call I feel stress from. I want to know what danger I am in from these temporary blood pressure spikes. I fear I will have a stroke during the attack. This probably feeds that fear. I do not take blood pressure medication as my diastolic is normally under 70. It was in the low 60s yesterday. I would like information concerning how high blood pressure goes during a panic attack and if its XXXXXXX
Thank you.
Answered by Dr. Ashish Mittal 9 hours later
Brief Answer:
Need to manage panic attack to prevent BP spike.

Detailed Answer:
Hello again,
Thanks for follow up.

Anxiety not only cause psychological symptoms but it can also cause somatic symptoms (pain, tightness, rigidity, tingling-numbness) by causing muscle spasm. Same may be the reason for pain complaints.

In severe anxiety there is Fight or Flight response in body due to adrenalin rush, which can also increase blood pressure. Rise in BP 220/123 can lead to stroke. But same time you are unable to take antihypertensive due to normal blood pressure.

With experience in such cases, I can say, there is very good chance, that spikes in BP problem will solve with control in panic attacks and agoraphobia in your case.

Wish you good health.
Above answer was peer-reviewed by
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