Can panic attacks cause chest pain and palpitations?

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Panic attacks and high levels of anxiety are most likely the cause of your symptoms. A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes. According to journals published by the College of American Psychiatry, a panic attack episode should include at least four of the following symptoms:

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesia (numbness or tingling sensations).

In the brief history that you have mentioned four symptoms including anxiety, dizziness, shortness of breath, and palpitations are present. Stress tests and echocardiogram combined are more than 85 % sensitive to rule out cardiac ischemia which is the most common cause of extra heartbeats (PVCs). However, the second most common cause is anxiety, higher anxiety levels may cause PVCs (premature ventricular contractions). You have not mentioned the number of PVCs recorded in your Holter test. I would suggest the following.

1. Bisoprolol (Bisoprolol Fumarate) 1.25 mg is a suboptimal dose, you can consult with your cardiologist to gradually increase the dose to 5 mg once daily.
2. SSRIs (selective serotonin reuptake inhibitors) can help prevent anxiety and reduce the frequency and severity of panic attacks. They are also used for immediate relief during an attack. Frequently used SSRIs are Prozac (Fluoxetine Hydrochloride), Paxil (Paroxetine Hydrochloride), Celexa (Citalopram), Lexapro (Escitalopram), and Zoloft (Sertraline). I would suggest you talk to your doctor to start you on the minimum possible dose and increase the dosage every third week.
3. Imipramine and Clomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants are not addictive. They can be taken along with SSRIs.
4. Benzodiazepines like Clonazepam can also be used to lower the levels of anxiety. Consult with your specialist doctor, talk to them, and then take the medications as prescribed by them.

Therapy will be given for three months before a change is observed. Apart from medications, lifestyle modifications should be followed. Exercise, meditation, and yoga will also help.

Thank you.