Could my rapid heartbeat and tingling be due to anxiety?

Question

Hello doctor,

I am 58 years old and have hydrocephalus. I was prescribed Metoprolol by my doctor to help with pressure-related headaches, especially related to air travel. I am seeing the neurologist again in about two weeks. For the last 15 years, my condition has been unchanged, but I have been battling a lot of anxiety over the past two weeks.

I was very anxious during yesterday's flight. While walking through the airport to go through customs, I noticed my breathing became very fast. I felt queasy and shaky, and the fingers on my left hand were tingly. I do not recall having pain in my jaw or left arm.

I took another half dose of Metoprolol, and then it settled down in about 10 to 20 minutes. While we were waiting for our shuttle, I sat down. I was also carrying a very heavy backpack that weighed 15.43 pounds.

I have never experienced this before and am feeling a bit weak this morning. I have a smart watch on, and a few times during the flight, my heart rate was relatively high. I do generally get palpitations, but they are not too bad. I do not recall hearing my heartbeat in my head. I did not have chest pain.

I know I have been extremely anxious over the past two weeks. I checked the ECG on my smart watch, and it shows a normal sinus rhythm.

I am wondering if this could just be anxiety. I do not generally get panic attacks, so I am wondering what this could be.

What symptoms should I watch out for?
Do you think I need to see a doctor?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

First of all, I encourage you to continue visiting your neurology care provider for hydrocephalus (a condition characterized by an abnormal buildup of cerebrospinal fluid (CSF) within the brain's ventricles) as planned. Consider visiting earlier if you need help regarding headaches or hydrocephalus management.

Regarding the symptoms you are describing, they sound like a very high level of anxiety to me. Since you have recorded an ECG (electrocardiogram) and mentioned that it was normal, this should provide reassurance. It would have been better if you could have shared your rhythm strips with me so I could review them.

I also suggest a 24-hour Holter monitor to assess the burden of a fast heart rate throughout the day. This would also help detect any ectopic beats, if present, and assist in titrating your medication.

For now, you are on the correct dose of Metoprolol, and your pulse rate of 73 beats per minute, as you have mentioned, is in an ideal range. Severe anxiety can sometimes, in addition to increasing heart rate, also raise blood pressure that is otherwise normal. This type of blood pressure elevation is termed situational and usually requires only management of anxiety.

Common symptoms of anxiety include feeling overwhelmed, fear that something bad will happen, irritability, restlessness, fast heartbeat, chest tightness or sometimes pain, shortness of breath, numbness or tingling in the hands, feet, and lips, abdominal cramps or gastrointestinal disturbances, nausea, lack of sleep, and headaches, among others.

Please remember that cardiac symptoms are more alarming, such as chest pain radiating to the shoulder, jaw, or left arm, associated with chest heaviness, perspiration, nausea, and sometimes vomiting. Such chest pain typically increases with exertion and decreases with rest. There may also be associated shortness of breath, lightheadedness, or fainting.

I have reviewed the laboratory reports (attachment removed to protect the patient’s identity) you shared, and you have a slightly deranged lipid profile, for which I recommend lifestyle management only, including weight reduction, regular exercise, and a healthy diet. A weight of 214 lbs (97 kg) also needs attention. Your vital signs are otherwise within the ideal range.

Are there any recent laboratory reports available, including a basic metabolic panel and thyroid profile?

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have gone through your query and understand your concern.

I am glad to see that the laboratory reports you have shared are all within normal limits. You are taking very good care of yourself, and I wish you the very best in health.

Tablets containing Chlordiazepoxide and Clidinium, and Lorazepam do not have any significant or clinically important interactions. However, using both medications together can cause increased sedation. You can stop taking Lorazepam today and start the tablet containing Chlordiazepoxide and Clidinium tomorrow.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I have gone through your query and understand your concern.

The ache in your arm associated with anxiety does not correspond to a cardiac issue. If it were due to a cardiac cause, the ache would also occur and worsen with exertion and be relieved by rest. Cardiac issues are usually associated with chest pain, as described above, along with nausea, chest heaviness, and shortness of breath.

Expired medication should never be used. You should immediately discard the bottle, ensuring that nobody else can use it. If you need the medication, please consult a doctor locally or continue with Lorazepam as needed for now.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

You are always welcome. Have a very good day. Take good care of yourself.

Thank you.