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Treated and controlled hypertension. Have anxiety disorder. Feeling light headed and nausea. What to do?

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General & Family Physician
Practicing since : 2009
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I am a 37 year old male, 370 pounds. I have treated and controlled hypertension (Micardis 40 mg). I have anxiety disorder.

Today, about 4 hours after breakfast while at a particularly stressful day\week of work, I began to feel nauseous (like a hunger pain at first but grew constant). I began to feel light headed and clammy and flush. I could feel my heart pounding and the feeling of nausea grew a bit intense. I got up and walked outside and felt a bit light headed as I walked. After I ate, it got markedly better but continues now. During the afternoon, I got intermittent periods of light nausea and at the same time lightheadedness and difficulty concentrating. After I ate dinner, I again felt markedly better.

My bp when I got home was 128 over 81 and blood sugar of 105 (I am not diabetic).

Most of my symptoms are physical and so when instances like today happen, I have a hard time deciding at what point should I seek medical help or even if I should. My mind tells me that it is all in my head, my body screams that something is dreadfully wrong. This has gone on to varying degrees now for several days\weeks. My mental quality of life is declining rapidly and I am going intensely stressed out. My ability to function at work is being impacted and my interactions with my spouse and children are suffering because my mind is always on the physical "symptoms XXXXXXX

How do I determine that something IS anxiety and not an emergency without going into the ER and spending a minimum of $1k? How can I begin to improve the quality of my mental health and how do I treat the anxiety symptoms?

I'm incredibly lost right now and would appreciate any help.

I know the canned answer is that if you feel like it is an emergency go to the ER, but for someone with anxiety it isn't that simple. Please help!
Posted Wed, 8 Aug 2012 in Anxiety and Stress
Answered by Dr. Aparna Kohli 1 hour later
Thanks for writing in.
You're right, it does sound like an emergency and I would strongly recommend you to go the ER and atleast get an ECG done. This will tell us whether you really did have a heart attack or not. This is important for me as a physician as you do have high blood pressure, are overweight and we dont want to be missing something here.
Spending $1000 may be tricky but it can save you from a whole lot of very costly complications later on.
These symptoms could be caused by an anxiety attack as well, but I think at this stage, I would want to be safe than sorry. Apart from running a few tests, there is really no way of distinguishing between the two.
Treating anxiety is complex but the following things can significantly help:
a. Yoga and meditation are great ways to start with. Just put on some soothing music and allow all thoughts to cross your mind. Just dont ponder on any thought.
b. Have a balanced diet. Avoid excessive caffeine, cigarettes and alcohol. Eating every few hours and having more of fresh produce can help.
c. Take time out for yourself. Talk to friends, read a book, do something you really like.
d. Try and understand why are you having this anxiety. Anxiety is usually the result of some unresolved conflict or something you have been trying to fight over the years. take a go at it. Write down your feelings in a journal and take care of 1 conflict in every 1-2 weeks.
Hope this helps
Above answer was peer-reviewed by
Follow-up: Treated and controlled hypertension. Have anxiety disorder. Feeling light headed and nausea. What to do? 23 hours later
I should have put this in the original question. I have had similar types of feelings before during stressful situations and have gone to the ER. I have had an ECG, I wore a Holter monitor for 24 hours (the results showed some additional heart beats) and I had the ECG after that result. The cardiologist detected the high bp (140's over 90) and put me on a beta blocker for the extra beats.

I did not like the side effects I was feeling with the beta blocker and through my PC D.O. have moved to Micardis 40mg to control the bp. (last reading was 116 over 78).

I've tested myself in every way I can from heart structure to endocrine problems (tested for a pheochromocytoma thinking it might be responsible for episodic increases in BP). My cholesterol numbers are normal even for a big guy 182 total (41 HDL and 118 LDL). Triglycerides were at 113. Fasting glucose 95. All blood tests came back normal except my platelet count was slightly low at 135L.

I had a nuclear stress test last year which came back normal. We've done a full blood work up as early as this year.

Even though everything has been tested, it doesn't seem to stop the physical feelings when I get under stress for long periods of time. Given this additional info and the fact that today, I felt much better with no nausea or bad feelings, would you still recommend going in?

I know I'm being a difficult patient, but I have reacted to these feelings before and every time they have been false alarms or related to anxiety. I didn't have any chest pains of any kind or even discomfort and I know that isn't necessarily required during a heart attack, at least in my head that makes this more likely to be anxiety related.

I appreciate the other tips and I will be trying some meditation. I've stopped smoking 6 years ago and rarely drink anymore. I obviously need to lose some weight and eat better.

I absolutely suck at taking time for myself both at work and at home. I have journaled in the past and it has helped.

I guess what I hear you saying is that there really is no way to tell the difference between a medical emergency and a severe panic attack without running tests?
Answered by Dr. Aparna Kohli 2 hours later
Given this additional information, I would not recommend going in. I dont think you're being difficult and each of your questions is well justified.
Also with the symptoms that you said you had, it would be almost impossible to distinguish between a heart attack and an anxiety attack.
If you think you cant spare time for yourself or your work, think of it the other way. A relaxed mind means better productivity. A better friends network would mean better connections ( and we are not even talking about the laughter and the fun yet)
I know its a slightly weird way of thinking but if it allows you to make a small change, go ahead.
I hope I have helped. I would be glad to answer any more questions that you might have.
Warm regards
Above answer was peer-reviewed by
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