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I have had anxiety for over 20 years and I always worry

Customer Question
I have had anxiety...

I have had anxiety for over 20 years and I always worry about my heart due to chest pain, pressure and shortness of breath. I went to the er last night they did a ekg, blood work including the heart work up like troponin levels. I had a nuclear stress test back in April of last year and that said it was fine. I’m a smoker, 53 year old female and I have elevated cholesterol.

Doctor's Assistant: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?

20 years, and nothing seems to help or make it worse.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I had Graves’ disease and took the rai back in 1997, have fibromyalgia and gastritis

Submitted: 1 month ago.Category: Medical
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Answered in 3 minutes by:
1/6/2018
Doctor: Dr. Sohaib, Doctor replied 1 month ago
Dr. Sohaib
Dr. Sohaib, Doctor
Category: Medical
Satisfied Customers: 5,110
Experience: MBBS, FCPS Experienced in all Medical Specialities
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Hello and thank you for the question.
I am Dr. Sohaib, a practicing Internal Medicine Consultant with over 13 years of experience and I will do my best to help you today.
Let me review your question for a minute and I will get back to you.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

What treatment have you taken for anxiety and panic attacks?

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Customer reply replied 1 month ago
I am on an anxiety medicine called alprozam.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

How much dose, and since how long?

How far this has been helpful to control your problem?

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Customer reply replied 1 month ago
Ive been on this medicine for a long time. But I don’t take it dail
Doctor: Dr. Sohaib, Doctor replied 1 month ago

Any other kind of medications tried? In the past?

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Customer reply replied 1 month ago
I have taken buspar and Prozac
Doctor: Dr. Sohaib, Doctor replied 1 month ago

And how frequently do you suffer from the panic/anxiety attacks while you are on this medicine? Any reduction in symptoms or frequency of attacks?

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Customer reply replied 1 month ago
I’ve even begged my cardiologist to do a heart cath but he wouldn’t.
Customer reply replied 1 month ago
It helps a little but it don’t take it away.
Customer reply replied 1 month ago
Is a nuclear stress test accurate?
Doctor: Dr. Sohaib, Doctor replied 1 month ago

Thank you.

Cardiac cath study is an invasive procedure and unless there is a very clear indication, no one can take the risk to proceed with it. Nuclear Stress studies are very accurate; especially the PET-CT scan (gadolinium based) is more superior than conventional Tallium based scan.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

But I think you focus should be more on Anxiety treatment instead of cardiac studies.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

And I believe you are sub-optimally treated for panic/anxiety disorder.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

Various clinical trials have shown that Buspirone has no effect in controlling panic attacks.

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Customer reply replied 1 month ago
I didnthave the cat scan just the nuclear stress test. They were going to do the cut but my heart rate was in the uper 80’s and they couldn’t do it.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

And Alprazolam is short acting agent and for it to be more efficacious, multiple doses have to be taken. Clonazepam is better option (long half life and less frequent dosing required).

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

So your anxiety should be controlled first, effectively, and then will come the further cardiac evaluation

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Customer reply replied 1 month ago
Well the cardiac issues is really my concern. I was in the er until 4am this morning.
Customer reply replied 1 month ago
I wouldn’t want to wait if it’s heart related. I’m so stressed over this.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

Okay, so you have had a cardiac work up done, negative. So this is not the heart. Its your anxiety.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

And PET-CT cant be done unless your anxiety is well controlled, as this will keep your heart rate high with which they can not initiate this study.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

Because during the study they have to induce ischemia also to evaluate the heart, and if the heart rate is too high, they can not proceed with this.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

Was it helpful?

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Customer reply replied 1 month ago
that’s what they told m, but my heart rate usually runs in the 80’s and I even take topral.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

May be the dose of Toprol has to be increased, along with anxiety treatment.

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Customer reply replied 1 month ago
My nuclear stress test said no ischemia.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

That's reassuring.

What is your exact question?

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Customer reply replied 1 month ago
It just seems like no one listens to me, my symptoms are real and I get woke up out of a sound sleep with chest pains. Sorry
Doctor: Dr. Sohaib, Doctor replied 1 month ago

I have already answered this concern of yours.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

We can not force a cardiologist to do cath studies. If he doesn't feel its necessary, its his responsibility and clinical judgement and we need to respect that.

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Customer reply replied 1 month ago
Sorry I wasted your time and my money. I really didn’t hae this money to spare but I just thought it would help me but it hasn’t.
Doctor: Dr. Sohaib, Doctor replied 1 month ago

Also you know that you have anxiety problem, which I still believe is uncontrolled, so once again I will suggest to get back to a psychiatrist and have this re-evaluated and treated soon.

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Doctor: Dr. Sohaib, Doctor replied 1 month ago

Thank you.

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