I recently had a stress echocardiogram which thankfully came

Patient

Q: I recently had a stress echocardiogram which thankfully came back normal. Prior to this I was exhibiting Angina like symptoms (although I'm only 43). My symptoms were quite strange. It started off with balance issues (which were ongoing for about 2 years), then this year the symptoms escalated/evolved.

Initially my Doctor thought it might be an issue with my Blood Pressue, (causing the balance problems), but when the shortness of breath and chest pains kicked in, it was uncertain.

Now that the Stress Test has come back negative, I'm wondering whether the issue still lies with my Blood Pressure? Normally my BP is on the lower side, (ranging from 90-110 on average). But at the height of my Ill phase, I had a couple episodes where I became hypertensive. I went from 90/71 to 141/124 within fithteen minutes, then the following morning 192/143 to 105/66, within 5 minutes.

I've noticed on my stress test that my starting BP was 107/71 and ended at 163/96, after 9 minutes.

I read somewhere that the Diastolic shouldn't change that much during exercise? Is a level of 96 a problem? Could it be that my blood pressure is an issue?

Symptoms:  Started off with balance problems for about 2 years. In February I started to experience shortness of breath. Symptoms at this stage were always fleeting. In June/July I had an ongoing episode where i was Ill every day for 3 weeks. The breathless episodes were lasting 2-3 hours, combined with varying pains/sensations in my chest and the problems with my balance continued.
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Doctor

A:   Hello,
Thanks for writing to us.
I have read your case and can understand your situation.
looking at your stress echo and other cardiac reports , it is less likely that you have any cardiac issue .

The spectrum of symptoms described by you like sudden high Blood pressure, chest pain, breathlessness, balance issue (dizziness) appears to fit into criteria of anxiety disorder mainly panic attacks.


A full-blown panic attack includes a combination of the following signs and symptoms:
Shortness of breath or hyperventilation
Heart palpitations or a racing heart
Chest pain or discomfort
Trembling or shaking
Choking feeling
Feeling unreal or detached from your surroundings
Sweating
Nausea or upset stomach
Feeling dizzy, light-headed, or faint
Numbness or tingling sensations
Hot or cold flashes
Fear of dying, losing control, or going crazy

Panic attacks or other anxiety disorders closely simulate cardiac disorder with difference lying in pathology seen in ECHO in later one.

Anxiety /panic attacks can be treated by pharmacotherapy and psychotherapy.
Pharmacotherapy involves use of anxiolytics like SSRI (Escitalopram, Fluoxetine etc.) and benzodiazepines ( clonazepam, lorazepam)
Psychotherapy involves Cognitive behaviour therapy and Exposure therapy.
It is advisable for you to see your doctor who may start you with above mentioned medications.
Hope this helps.
Feel free to write back.
Regards

Comments / Follow Ups

Patient: Hi There,

Many thanks for your swift response.
In answer to my initial question, was my Diastolic rate of 96 normal or hypertensive during the test?
It's doubtful that im suffering panic attacks as initially i was having balance issues. The balance problems lasted for 2-3 years, but as the symptoms were fleeting and sporadic I avoided going to the Doctor.

Things only escalated in June when the other symptoms kicked in. I was ill consecutively for 3-4 weeks (every day). I often found that the symptoms would start after eating (when the heart was doing more work to aid digestion). It's a bit of an anomaly.

The symptoms dissipated at the end of July and I've been relatively well since then, however I'm still extremely fatigued and get a feint burning sensation in my chest at times. Im also suffering from excessive sweating (this started in May). It's as if everything is a big effort and my body struggles to keep up.
Doctor: Hello,
Thanks for writing back.
The balance issues, fatiguability, excessive sweating, burning sensation and pain in chest can be attributed to anxiety disorder not necessarily panic disorder( thats a possibility)
After eating a big meal, the body has a tendency to slow down. Sometimes this is referred to as a food coma. When you have panic attacks and anxiety, any change in how you feel - like lightheadedness - can be an anxiety trigger. You may not even realize you're becoming fatigued or light headed, but your body knows and that leads to more anxiety.
Moreover, anxiety causes the body to digest food poorly, which in turn causes more indigestion.
The problems related to heart symptoms would be less likely sporadic and fleeting and more of continuous type.
Diastolic 96 occasionally or during the test only is of not much significance unless you have diastolic above 94 regularly.

However, to rule out other organic pathologies you can get following tests done:
Complete blood picture, Random blood sugar,
Thyroid profile, Serum creatinine, Serum B12, Electrocardiogram, Chest X Ray

Hope this helps. Feel free to write back.
Patient: Thank you again.. I'll ask my Doctor to check my Thyroid as this hasn't been done. I had a chest X-ray and bloods in June, but they were all fine.
Hopefully I'll get it resolved soon!
All the best
Doctor: Hello
Thanks for writing back
Feel free to write back
Regards

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