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What causes palpitations when suffering from anxiety and panic disorder?

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General & Family Physician
Practicing since : 2008
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I am a 4o years old female. Weight 39 Kg and Height is 167 cm. I have history of breast cancer in 2010 (IDC) I took chemo, and radiation on the right side after modified radical mastectomy. I have a sever generalized anxiety disorder, panic attacks and OCD. I had been complaining from heart palpitations after my diagnosis and has been admitted to ER several times. It comes and goes. Some times it lasts for days and sometimes it disappears or happens few during the day. I had a holter monitor in 2012 and came back normal. I did like 8 echos at various cardiologists and came back normal with only a very mild TR. The last one was done a month ago. Also every time I have palpitations I rush to do an EKG and it says sinus tacychardia, and sometimes normal sinus rhythm. Some times the beats are 80 to 90 but VERY strong I feel my heart is coming out of my chest. and sometimes it beats too fast
I also complain from bloating and discomfort in my abdomen, I feel 2 people are stretching it from the side, and I feel it hard to the touch. I also feel constant dull pressure in the center of my chest where the breastbone is. It even causes me to take a full deep breath to feel relieved. My appetite is poor and I really prefer soup and warm food as it makes me more comfortable.
I saw a Doctor and did physical exam, he said my colon is full of gas because it is empty and I don't eat enough food. As well when he presses the upper part of my stomach right under the breast bones where the rib-cage splits it hurt me.
I also did an ultrasound for the abdomen and all where good (liver, kidney, pancreas, gallbladder) The endometrial thickness is 1.5 cm
I did a complete blood test:
CBC all is normal and my Hb is 84. But the lymphocytes are 56% although I don't have an infection at all. I did Liver function, Renal function, and urine general and all came Good. The doctor said no need to worry about Lymphocytes as long as there is no clinical finding.
I did a recent chest X-ray which was yesterday and it came back normal showing nothing in the lungs or heart.
My questions are
1. Sometimes palpitations happen when I am at rest and for no apparent reason and it really freaks me out. So do I use maneuver techniques or take meds (beta blockers) although I am hypo tension 90/60.
2. What is the cause of the chest discomfort and tightness I feel. (Like I am wearing a tight bra) the discomfort comes and goes, but it happens every day. I think but no sure it is a little bit relieved when I eat. But again it comes back after a few hours.
3. I am experiencing right side of the back pain/strain could this be related to surgery or chest pain.
4. Could my chest pain be an impending heart attack or Angina
5. Is the X-ray and ultra-sound an adequate tool for diagnosis.
6. My sugar level H1 is 6% am I a candidate for diabetes. Although I have a history of hypoglycemia.
7. I take Zolam for anxiety on and off - on need basis. I was told to use SSRIs but as I am taking baby dose aspirin I am afraid from drug interaction

Posted Sun, 3 Aug 2014 in Abdominal Pain
 
 
Answered by Dr. Raju A.T 8 hours later
Brief Answer:
Answers are below

Detailed Answer:
Hi,

Thanks for your query.

1. Sometimes palpitations happen when I am at rest and for no apparent reason and it really freaks me out. So do I use maneuver techniques or take meds (beta blockers) although I am hypo tension 90/60.

--Since you are hypotensive taking medications could be risky as they can reduce the blood pressure some more.

2. What is the cause of the chest discomfort and tightness I feel. (Like I am wearing a tight bra) the discomfort comes and goes, but it happens every day. I think but no sure it is a little bit relieved when I eat. But again it comes back after a few hours.

--Gastritis, this could be secondary to anxiety you have.

3. I am experiencing right side of the back pain/strain could this be related to surgery or chest pain.

--Right side back pain in the upper back is most often due to gastritis or pancreatitis.

4. Could my chest pain be an impending heart attack or Angina

--Yes, it can be. Only a stress test like treadmill test can confirm.

5. Is the X-ray and ultra-sound an adequate tool for diagnosis.

--No, for your problems both are not adequate.

6. My sugar level H1 is 6% am I a candidate for diabetes. Although I have a history of hypoglycemia.

--No, need not worry. get a fasting, post prandial blood sugars and HBA1c estimation done. These in group can give a better idea on your glycemic control.

7. I take Zolam for anxiety on and off - on need basis. I was told to use SSRIs but as I am taking baby dose aspirin I am afraid from drug interaction

--Zolam is a bit safe. Continue the same with moderate dose.


Hope, I answered your queries

Wish you good health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: What causes palpitations when suffering from anxiety and panic disorder? 4 hours later
1. My HBA1C is 6%, I did the fasting and i think it was 5.6 or something. We have history of diabetes in the family. My sisters and one brother. although my parents did not have it. so am i a candidate for diabetes.
2. my ultrasound was normal, so what makes you think of pancreatic?
3. how do I differentiate between angina, heart attack and gastritis? I need to know, so I don't panic or over worry myself when I have symptoms. The discomfort does not happen on exercise, it happens when I am even at work, or watching TV.
4. I use to walk for half an hour 3 days a week, but towards the end of the walk I start feeling pain in my right chest area, where I had the surgery. Is this Angina?
5. What do you recommend for gastritis, I have oprazol, and rabemac at home, I need a fast effective one
6. Is my endometrial thickness OK 1.5cm, is it due to tamoxefine?
7. Any other tests or recommendations you suggest
 
 
Answered by Dr. Raju A.T 16 hours later
Brief Answer:
Below are the answers

Detailed Answer:
Hi,

Thanks for writing back.

1. My HBA1C is 6%, I did the fasting and i think it was 5.6 or something. We have history of diabetes in the family. My sisters and one brother. although my parents did not have it. so am i a candidate for diabetes.

--Get a GTT done . it can identify a prediabetic. HBA1c gives an idea about your sugar levels for last three months

2. my ultrasound was normal, so what makes you think of pancreatic?

--The pain presentation. The pain radiating to the back is usually seen in pancreatitis.

3. how do I differentiate between angina, heart attack and gastritis? I need to know, so I don't panic or over worry myself when I have symptoms. The discomfort does not happen on exercise, it happens when I am even at work, or watching TV.

--Pain during exercise associated with breathlessness, sweating, increase heart rate is angina or heart attack. Gastritis do not have these associated features.

4. I use to walk for half an hour 3 days a week, but towards the end of the walk I start feeling pain in my right chest area, where I had the surgery. Is this Angina?

--could be
5. What do you recommend for gastritis, I have oprazol, and rabemac at home, I need a fast effective one

--Pantoprazole is best. You can take Rabemac.

6. Is my endometrial thickness OK 1.5cm, is it due to tamoxefine?

--Yes.

7. Any other tests or recommendations you suggest

-- Endoscopy of the upper gastrointestinal tract.

regards,
Above answer was peer-reviewed by
 
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