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Suggest treatment for palpitation and light headedness

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Posted on Mon, 18 May 2015
Question: nuHello, It all started 11 months back when I had this feeling of palpitations and light-headed one day when I got up in the morning. I was going through emotionally tough time during then. I went to my GP immediately, he checked my BP and temperature and said I am absolutely ok and from then over a period of 4 months I got all my medical checks done including ECG, EV, 24 hr XXXXXXX monitor, thyroid blood test, x-ray, endoscopy. Nothing came up except inactive hernia during endoscopy...my GP asked me to take nexum which I am taking from 2 months but he remotely think that....now the symptoms have changed to stomach heaviness and nausea and light headed...no more palpitations..Doc is not able to diagnose anything ....please advice.

Gradually symptoms changed to nerves movement in the body and numbness in the chest, I also feel emotionally unstable most of the times. There are internal tremors inside my body and I feel like they are linked to my mind.

Whenever I am able to motivate myself and relax myself I feel little better but just for a moment and again this internal tremors takes away everything. I have cold and hot vibes also happening in my body sometimes.

My GP finally told me that I am suffering from severe panic disorder. He has asked me to take propranol hydrochloride 40 mg twice daily...the medicine does not suites me and I start shivering after taking it so I have stopped taking it and anyway if it is panic disorder I want to be cured without any medicines.

My mind is in such a state that I consistently keep on monitoring what’s going inside my body and can't get my head out of this.

Please SAVE me....

doctor
Answered by Dr. Pankaj Borade (2 hours later)
Brief Answer:
more information needed

Detailed Answer:
Dear,
Welcome to HCM
The symptoms you have mentioned here is suggestive of psychiatric symptoms.
There are some conditions like anxiety neurosis, depression with somatic compliant, mood disorder or prodromal psychotic symptoms, that one will need to consider.
I request you to provide information on following
1) Do you persistently feel like anxious most of the day?
2) How do you keep your mood mostly? depressed, irritable, labile or unstable, elated,etc?
3) Do you feel difficulty in falling asleep?
4) since how long are you having these complaints?
5) Do feel decreased interest in work or previous pleasurable activities?
6) Do you feel easily fatigue or tired than before?
7) appetite appears to have reduced?
etc.

kindly revert back soon with the information as it woul help me to have a better clinical picture.
Regards
Dr Pankaj B

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Pankaj Borade (2 hours later)
1) Do you persistently feel like anxious most of the day?

No, I don't free anxious...Its the physical symptoms that trouble me most. I go to office daily and manage to spend 8 hrs there. There is nothing that bothers me other than this problem.
2) How do you keep your mood mostly? depressed, irritable, labile or unstable, elated,etc?
As soon as I feel relieved from these physical symptoms I am very jolly and fun loving, love to laugh and make all around me laugh as well but, when these physical symptoms bother me I am totally depressed and keep on trying to motivate myself that this just anxiety and will go away
3) Do you feel difficulty in falling asleep?
No other than occasionally waking up after 4-5 hrs sleep and then also most of the occasions goes back to sleep.
4) since how long are you having these complaints?

Almost 1 year now...few weeks in between all ok and then all the same. It's now 2 months that it is continuously happening.

5) Do feel decreased interest in work or previous pleasurable activities?
no, I still play tennis that I love too though if my physical symptoms like heaviness in chest is there I can;t focus much but still I can't stop myself playing..

6) Do you feel easily fatigue or tired than before?
Yes but largely because I have formed some belly...no walking or exercise from past 1 year..just tennis 2 hrs on weekend..
7) appetite appears to have reduced?
No, I am big time foody and still enjoy my food
doctor
Answered by Dr. Pankaj Borade (23 minutes later)
Brief Answer:
possibility of panic disorder

Detailed Answer:
well, thanks for the information.
From your answers I could filter out other conditions psychiatric conditions, however possiblity of panic disorder alone remains.
May I ask you few more questions that may strengthen the diagnosis.
1) Are the complaints that you have are episodic? do they tend to occur in episodes that last for few minutes to for an hour?
2) Is it associated with a feeling that something terriblely is going wrong, like if the world is coming to end?
3) Is there associated vertigo, dizziness, vomiting?
4) Are there any particular triggering factors that you can notice of?
5) Do you prefer not be alone while travelling?

Will be very kind to have information on these.
Thank you.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Pankaj Borade (51 minutes later)
1) Are the complaints that you have are episodic? do they tend to occur in episodes that last for few minutes to for an hour?
When it happens it lasts for weeks!! And in those weeks I feel terrible every hour ..but not when I am asleep.
2) Is it associated with a feeling that something terriblely is going wrong, like if the world is coming to end?
The only terrible feeling I get is that my body is out of control and it seems to feel imbalanced. I think as if there is something chemically wrong in my body or my brain.
3) Is there associated vertigo, dizziness, vomiting?
No vomiting but vertigo, only when I get these worst days.
4) Are there any particular triggering factors that you can notice of?
The more I think or realise about it..like the numbness..stiffness and sometimes short of breaths..it aggravates.
5) Do you prefer not be alone while travelling?
Not really
doctor
Answered by Dr. Pankaj Borade (8 minutes later)
Brief Answer:
panic disorder appears likely

Detailed Answer:
thanks for the information again.
It appears likely to be a panic disorder condition.
However I would strongly suggest to consult a local psychiatrist as it would require a comprehensive work up of your history and symptoms for confirmation of diagnosis.
You can discuss with him addition of long acting benzodiazepine like clonazepam in low doses, with controlled release beta blocker drugs. They are much better than usual Propanolol high chances that they suit you better.
Psychotherapy in form of cognitive behavioural therapies are known to be benificial in panic disorder, a local psychologist can be approached for this.

Hope to have satisfied your concern and query.
Welcome for further suggestions.
Regards.
Dr Pankaj Borade
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Pankaj Borade

Psychiatrist

Practicing since :2011

Answered : 571 Questions

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Suggest treatment for palpitation and light headedness

Brief Answer: more information needed Detailed Answer: Dear, Welcome to HCM The symptoms you have mentioned here is suggestive of psychiatric symptoms. There are some conditions like anxiety neurosis, depression with somatic compliant, mood disorder or prodromal psychotic symptoms, that one will need to consider. I request you to provide information on following 1) Do you persistently feel like anxious most of the day? 2) How do you keep your mood mostly? depressed, irritable, labile or unstable, elated,etc? 3) Do you feel difficulty in falling asleep? 4) since how long are you having these complaints? 5) Do feel decreased interest in work or previous pleasurable activities? 6) Do you feel easily fatigue or tired than before? 7) appetite appears to have reduced? etc. kindly revert back soon with the information as it woul help me to have a better clinical picture. Regards Dr Pankaj B