anxiety

[JJonathon]

Reading all of these posts about anxiety mimicking cardio issues have one thing in common, they're scary.  About 20 years ago I started having panic attacks, which soon morphed in cardio symptoms.  Several events had a common ground, bridges and high overpasses when driving, or the after effect of a 5 or 6 beer evening once the anesthetic affects of the alcohol wore off.  Sometimes they were nearly debilitating. They were relieved somewhat by lighting up, but then were worse due to the effects of the nicotine & chemicals in the smoke.Then they became more frequent, sometimes several times per day, and sometimes were terrible night.  I was living alone and often wondered who would call 911 if I passed out.  Tried Paxil at a moderate dose for a couple years, didn't really do much for me except give me an "iffy stiffy".  After going through the brain shocks getting off the Paxil, I struggled for about 5 yrs.  Always seemed to worry if it was a heart attack, would it turn into cardiac arrest, would anyone be there to help me, etc.  Then I suffered an MI, it was the LAD descending artery  which is the major heart artery.  I thought it was a bad, bad panic attack,  Turns out I called 911, they wouldn't tell me if it was an MI.  They gave me 6 sprays of nitro, and morphine.  Transported me, I knew I was dying, my limbs were trembling deep inside, and I was cold, so cold.  About 20 minutes in the ER they determined the blockage was present and it's critical location, rushed me off to the cath lab for a stent.  I survived with only 5% reduction in ejection fraction, and have been pretty fit, eat better, and don't smoke.
   Now then, the panic attacks continued, I was sometimes more, sometimes lees scared than before, but I also know how close I came to dying, and with artery cardiac artery disease there could be another MI with no warning.  I take Effexor, it helps, but doesn't solve the  problem, went to counseling, that helps until the panic strikes again. It can happens in the most mundane and unexpected times and places.  After having the "Widow Maker" and surviving it,(only 5% survive)  it scares me as bad, even now with the meds.  Been to the ER twice since, sure it was an MI, doctors found nothing other than HR, BP, and my describable symptoms to indicate a MI.  Sometimes it takes a day or two to for the symptoms to pass and life to return to normal, sometimes 3-5 hours.  either way, it takes some good sleep for a couple nights and some naps to get completely over it.  My heart goes out to those who must life with this impairment.  Even in today's society, it is still something which one does not discuss openly, only those of us who are cursed by it truly understand how it impairs and even destroy quality of life for us.

[achillea]

As a longtime sufferer of panic attacks, I can agree that they are dreadful and can be totally disabling.  Mine come on every few years in what I call 'swarms'--a tendency towards them that can last months on end.  Neither I nor my shrink have ever found a trigger, other than perhaps a change of season, and there is some kind of instant association with PVCs.

Since you have had an MI, albeit (and thank goodness) a mild one, you have probably more reason to experience panic in a kind of post-traumatic way than I do, but since panic disorders do not respond to sweet reason alone, one's past is not the biggest part of the problem.

My own guess is that panic and anxiety disorder are genetic mistakes, and that if a sufferer were to quiz all the members of his family, he'd find out that he's not alone in his affliction.

The question, though, is how to treat.  I can tell you that it is possible, and that it will take a number of sessions with a real shrink, a person who went to med school and has a good acquaintance with pharmacology. However, these sessions are not the old school thing you might have read about in novels--the years of once a week on the couch, laying bare your soul, etc.

You mention that you have tried both Paxil and Effexor.  My own experience is that both of those are somewhat more stimulating than calming.  When it comes to medical treatment of panic, one medication does not fit all, and my shrink tried me on about four, as I recall, each one requiring a faithful two week trial.

Paxil made me jumpy.   Lexapro made me jumpy (and made chocolate taste like chalk). Celexa calmed me down to the point of snoozing, and that was so nice that I stayed on it for several years.  The downside was that I was so relaxed that it was hard to get anything done!  And Zoloft, in a pretty low dose, turned out to be the Magic Bullet, muting my cardiac awareness, which in turn actually quieted the number of ectopic beats I was getting.

During all these trials, my shrink stayed in close contact with me, monitoring the effects of the drugs and altering the dose or discontinuing the drug, as needed.

Upon finding the right drug and the right dose for me, my psychiatrist had me stay on the med for close to a year, enough time, as he put it, "to let my car alarm cool down."  After that period, he re-assessed me and slowly (VERY slowly in the case of SSRIs) reduced the dose.  At some point, I was taking nothing--and I was just fine.

However, a few years went by, and boom, one day (without warning, as you know) the panic was back.  I called the doc, he put me back on the regime, and this time, I responded more quickly and needed to be on the med for a shorter period of time.  I think that once a successful routine is found, the nervous system kind of 'learns' to respond faster.

Now, I understand that these attacks are part of my personality and I will almost certainly have them all my life, but having gone to the right doctor for treatment, I have a solid weapon against them, and they no longer scare me.

If you have not tried psychiatric treatment by a doc who specializes in anxiety, I strongly suggest it.  It could give you back your pleasure in life.

[JJonathon]

Sorry for the confusion.  EF loss was only 5%, is currently >50%
No CHF. Very good recovery, no restrictions other than cold weather ,20 deg F, must be careful and cover face.  pass Biennial Bruce protocol stress test w/ no problem.
The tests done when I had the MI indicated 5% of the muscle was damaged.
MI was 2006,  had angiogram 12/2012, no increase change from 2006, stent clean.
Biggest issued to me is panic is sudden and unexpected ,in  familiar surroundings (comfort zone), unfamiliar settings, everyday tasks for no reason (that I can understand), etc.  Had NO chest pain wen MI occurred, general body symptoms of panic closely mimmick those of the MI.  In fact went to hospital last year w/ symptoms.  That is when interventional cardiologist suggested angiogram, found nothing remarkable, protein marker for heart attack damage was not present, 12-lead was good, echo was good. Subsequent stress test was good.
  But, it's just plain scary - it's awfully hard on me as well as my wife.  Never know if it is the real thing when it occurs,  Need to get a handle on it.

[Flycaster305]

Have you had a BNP blood test to determine your heart damage?  This test is given to determine the level of heart failure you might have.  

Your post wasn't clear to me if you have a 5% EF, or your EF was 5% lower than the baseline.  5% is within the standard deviation factor.  

If you have had a blood test that determined your BNP level, let us know.  From what you post, it sounds like anxiety, but I'm not a health professional, but someone who has confirmed CHF.