How to effectively manage health anxiety?

Question

Hello doctor,

I hope you can help me with my anxiety. I am a 35-year-old female with severe health anxiety, panic disorder, and agoraphobia. I had been doing well until this past month when I got sick and had a fever. During that time, my heart rate was elevated, and I became extremely anxious about it. I ended up buying a pulse oximeter to monitor it. Looking back, I think that might not have been the best decision. For example, when I am up moving around the house, and cleaning, my heart rate can reach 130 beats per minute. When I walk into a place that triggers my anxiety, it can go up to 140 beats per minute, and I feel it. This just makes me more scared.

I want to start walking with my mom, but I am afraid that doing so will increase my heart rate, which worries me. I feel stuck in this cycle of fearing my heart. For reassurance, my blood pressure generally runs at 107/75 mmHg, and my resting heart rate is around 70 beats per minute. I weigh 134 pounds and am 5 feet 3 inches tall. Seven years ago, when my anxiety first began, I had an echocardiogram and wore a 30-day Holter monitor. Everything was normal except for some PVCs (premature ventricular contractions). I also had a stress test without contrast, which was fine.

I have always been afraid to exercise because I am worried it will increase my heart rate, and I fear it could lead to a heart attack or cardiac arrest. Could you please give me some reassurance? I have also realized that I can replicate chest pain by pressing on the area, which helps me understand that it is not a heart attack.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have carefully reviewed your medical history. Based on your clinical symptoms and the medical tests you have undergone, I would explain the following: The recent increase in your heart rate is likely due to your elevated body temperature and the systemic inflammatory response. Dehydration may also be contributing to this, but the primary cause of your racing heart rate is your excessive anxiety, which needs to be addressed. The first step is to stop using the oximeter. It would be helpful to relax and spend time outdoors in nature. Yoga and aerobic exercise can be beneficial in this regard.

I hope this advice has been helpful to you.

Answer 2

Hello,

Welcome back to icliniq.com.

It is true that heart rate is a dynamic parameter and can change over time. It typically increases with physical activity, and psychological stress can further exacerbate it. In young individuals, the heart rate may rise even higher during physical activity. Based on your cardiac test results, I see no reason for concern as everything appears normal. It is difficult to replicate chest pain if it is of ischemic origin. Generally, ischemic pain is a dull, unpleasant feeling that cannot be altered by pressing on the area or changing body position. You are not at any obvious risk for a cardiac or cerebral issue. Just relax and try not to worry too much about it.

Regards.