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Overweight, LVH and heart enlargement due to weight. BP shoots up. Is it anxiety attack?

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Practicing since : 1998
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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 in which my blood pressure shoots up some times to 220/123. Today after eating some cherry pie, it went up to 187/135. It lasted about 20 minutes fluxuating and then came down to 140/69. I have pretty much perfect blood panels. 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. I noticed even the simple act of chewing or exertion can trigger it sometimes. Once my catecholamines were slightly elevated on one of my blood test. I was tested for pheochromocytoma years ago and was negative. I have a small nodule on my pituitary.
I very much need some answers.
Thank you.
Posted Mon, 28 Oct 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 5 hours later
Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. Large fluctuations in blood pressure occurs with unusual increase in physical/ mental stress, poor compliance to blood pressure lowering drugs, pheochromocytoma, chronic kidney disease and in patients with autonomic nervous system failure (including alcoholics & very elderly patients).
2. We always look for the triggering factor when we see such episodes of transient rise. Any increase in physical / mental stress or activity leads to rise in blood pressure. An anxiety attack may also lead to same. But episodes of hypertension/126" >high blood pressure without any apparent anxiety symptoms speaks against it.
3. When we suddenly wake up from sleep, both heart rate and blood pressure tend to increase for some time.
4. A sudden rise in BP with some foods in susceptible individuals in known and one should avoid those foods.
4. Since your average blood pressure is 148/72 mm Hg, you have LVH on cardiac ultrasound but you are not receiving any medication for hypertension, It would be prudent to get evaluated. We recommend a 24 hours ambulatory blood pressure for such patients. This picks up all the fluctuations, requirement of drug therapy and has better prognostic information.
5. If required, a repeat evaluation for pheochromocytoma may be on the cards (your physician will decide that). Episodic rise in BP with sweating and "hottness" are its indicators.
Hope this helps. Feel free to raise further queries.
Above answer was peer-reviewed by
Follow-up: Overweight, LVH and heart enlargement due to weight. BP shoots up. Is it anxiety attack? 6 hours later
I am usually very anxious during these attacks but how do I tell the difference between an anxiety attack and real medical cause?
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer:
please see below.

Detailed Answer:
Dear Sir
1. When we talk of episodic or paroxysmal hypertension (high blood pressure) which comes in form of some "type of attacks", the first and foremost cause is "Pheochromocytoma" (PCC).
2. Anxiety or panic attack has most of its physical manifestations attributable to same mechanism which causes features of pheochromocytoma. The release of catecholamines (noradrenaline and adrenaline) is responsible for pheochromocytoma as well as for features of anxiety attacks. Hence clinically it may not be possible to differentiate between two.
3. Initiation of attacks after abdominal compression, positional change, exercise, urination favors PCC. Persistent hypertension , severe headaches, vomiting, marked giddiness also favors PCC.
4. In panic attacks usually there is a fear of something and more features are psychological rather than physical.
Whenever there is a doubt , we tend to rule out PCC and other causes of hypertension first. Therefore I would like you to get evaluated for hypertension.
Hope this provides some insight. Feel free to discuss further.
Above answer was peer-reviewed by
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