Can smoking and coffee cause panic symptoms in a person?

Question

Hi doctor,

I am a 27-year-old male. For the last month I have been feeling odd after smoking or drinking coffee. One day after a smoke break in the office, I suddenly felt odd, and my head was spinning with a feeling like I was going to faint or something bad was going to happen to me.

Then I sat with these feelings alone for two hours and did my ECG (electrocardiogram), which was normal. Then I was almost normal for the day and did my job. Then, three weeks later, I woke up and had strong coffee with one smoke and immediately felt odd with an almost similar feeling to last time.

I rushed to the doctor; my pulse was elevated to 125 beats per minute. I did my ECG again, and it was again normal. Then I also went back to almost normal after two hours. My resting pulse is around 80 usually, with blood pressure around 80 to 115 mm of Hg (millimeters of mercury).

I have been smoking five to seven cigarettes a day for five years and sometimes drink very, very strong coffee. Now I smoke. Even with one cigarette a day or a drink of weak coffee, I do not feel good.

Even got my troponin test, which is also perfect. No diabetes and no medication. No surgical history. Why is this happening lately?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern and will definitely help you with it

I am sorry you are going through this because those episodes can feel genuinely frightening, especially when they come suddenly and create a sense that something terrible is about to happen.

The pattern you describe strongly suggests your body has become unusually sensitive to nicotine and caffeine stimulation. Both cigarettes and strong coffee can sharply increase adrenaline levels, heart rate, blood pressure fluctuations, dizziness, shakiness, and feelings of panic or impending doom, even in people who previously tolerated them well.

Sometimes, after a strong nicotine or caffeine reaction, the brain becomes hyperaware of body sensations, and future smoking or coffee can trigger the same cycle much more easily. A pulse of 125 beats per minute during these episodes with normal ECGs (electrocardiogram) and normal troponin is reassuring against a heart attack, especially at your age, but it does not make the experience feel any less intense.

Anxiety or panic attacks can also present exactly this way, with dizziness, rapid pulse, derealization, fear, chest discomfort, and feeling faint, and nicotine plus caffeine are very common triggers.

Dehydration, poor sleep, stress, empty-stomach caffeine intake, gastritis, or low blood sugar can make the reactions stronger as well. Since even small amounts now trigger symptoms, your body is essentially telling you it is not tolerating these stimulants well anymore.

It would be wise to stop smoking completely and avoid strong coffee for now and see whether the episodes settle over the coming weeks.

Gradually many people feel significantly better once nicotine and excessive caffeine are removed. Still, if you ever develop true chest pain, fainting, severe shortness of breath, an irregular heartbeat, neurologic symptoms, or episodes occurring without caffeine or smoking triggers, you should get further evaluation.

This includes a Holter monitor or thyroid testing to rule out rhythm problems or other medical causes.

I hope this is clear, and if you have any questions, do not hesitate to ask.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.