Health Anxiety and An Actual Health Problem

I had a really big setback with my health anxiety, as well as my generalized anxiety, yesterday.

As background, I have always had bad health anxiety, in addition to all kinds of other anxiety and mood disorders.

I feel genuinely unwell a lot of the time - mostly gastrointestinal stuff, eg, frequent nausea and I also have IBS and get upper and lower digestive tract issues. I also get migraines and I have a lot of heart palpitations.

It's always been tricky to figure out whether it's my constant anxiety and stress causing me to feel unwell, or whether it's the fact that I so often feel unwell that is making me anxious.

A few years ago I was diagnosed with a heart arrhythmia called SVT. It's basically where your heart randomly starts beating super fast and you feel dizzy and light headed and it's definitely a very scary feeling. Of course it's very similar to what a panic attack feels like. I have gone to the ER with this several times and for years I was told it was a panic attack and given a Valium and sent home.

It was only when I got older that they fitted me with a heart rate monitor that you wear for long periods and that was how I got diagnosed with the arrhythmia.

This diagnosis really scared me a lot. Particularly the randomness of the bouts of SVT. It makes me feel like a ticking time bomb. With SVT your heart rate goes up really high. Mine has exceeded 200 beats per minute and that's not unusual. It's an incredibly uncomfortable feeling and in me it induces panic, which just makes it worse.

Anyhow, long story short, I've seen several cardiologists and also an electrophysiologist about this and they have all actually been very reassuring. In that they've told me that SVT is rarely life-threatening and even though it feels awful when your heart beats that fast, it isn't actually damaging your heart (as long as it goes back to normal, which it typically does after a few minutes).

There are 3 main ways you can manage SVT. The first way is, literally, do nothing. Just live with it and practice some vagal maneuvers when it happens. The second way is medication, eg beta blockers. And the third is catheter ablation, which is super invasive and the thought of it absolutely terrifies me.

For the last few years I've chosen option one, which is do nothing and try and live with it. At first I was constantly checking my heart rate on my watch. I can even do an EKG on the watch (not sure how accurate it is though). And then, gradually I was able to kind of let it go.I've really worked hard not to react to a bout of SVT with panic. I just try and let it run it's course. It's difficult but generally I've been doing ok with that. Typically when I get the SVT it's over within a few minutes.

Any time I try a new psychiatric medication I get really worried because any drug can effect your heart.

Sorry this is so long. I guess I just needed to get it all out. Anyhow, yesterday I had two really bad bouts of SVT and ended up asking my husband to take me to the ER around midnight last night. I've never had 2 bouts in a day and I was feeling really unwell and my heart rate wasn't going back down to normal.

At the ER the doctor was very nice and thorough and said my EKG was normal and my heart rate was only a little over 100 beats per minute so he wasn't worried (I told him my heart rate had been much higher about an hour previously and he said that's what happens with SVT). The doctor does think I need to start a beta blocker and he gave me a prescription and sent me home.

I have not taken the beta blocker because I'm scared of new drugs. Today my heart rate has been normal but I'm back to checking it compulsively. I went on a walk with my dogs and went up some hills to see if I still could. I felt a bit weak but it didn't make my heart rate soar, the way it did yesterday (it was going up a steep hill that triggered one of the bouts of SVT yesterday. I had to stop because I was going to pass out and my heart rate was at 195 beats per minute). Today, same hill, my heart beat normally.

But I feel so bad today. Depressed and also it's really triggered my anxiety. I feel like I can't trust my body. I already know I can't trust my mind. I was doing quite a bit better and today I just feel so full of despair again. I also really hate going to the ER. It's not a good place for someone with anxiety!! The staff were super nice last night but I was so freaked out being there again. I don't like hospitals generally. Now I'm thinking up all these worst case scenarios that I'm going to have to have some horrible procedure done and my anxiety has been so very high today. It's like half a step forward and then 100 steps back!!

Ive been on a beta blocker for most of my adult life. I kinda love it.

Good to know! The main concern I have is that my blood pressure typically runs low (when I'm not having a sustained bout of SVT or a big panic attack) and beta blockers lower blood pressure. I have also heard from people who take them that they can cause fatigue and depression, which are the last things I need.

I asked the doctor if I could take Metoprolol as needed and the doctor said I could give it a go but that I'd likely get better results if I took it every day.

Ironically, my heart rate also typically runs low - in the low 50s when I'm at rest. So that's another concern. I really need something I can take just when I'm having a bout of SVT. But there doesn't seem to be anything for that.

I may be wrong, but i kinda thought they just stop your heart rate and blood pressure from going up, like when you are exerting yourself. Like it blocks the ceiling rather than lowering the floor? I guess you could see if the lower rate is stable and acceptable, as well as controlling the high..

It definitely says it's contraindicated in people with low blood pressure and a low heart rate. But obviously my heart rate goes crazy high when I have these SVT episodes. And my blood pressure increases then too. The rest of the time though, both my bp and my hr are low. I did ask the cardiologist about this previously and I was advised that I should take my blood pressure and my heart rate prior to taking the beta blocker each day, and if they are below normal, then I shouldn't take the beta blocker.

Hi, I don’t have SVT but I do take a beta blocker daily for migraine prevention (propranolol 80mg SR) and I previously had a low resting heart rate, I was concerned a bit too about my HR going too low but I was getting so many severe migraines I was desperate for them to stop.

After 9 months on them my resting HR did come down on them, but no symptoms like dizziness or fainting, so my resting HR is typically in the 40s rather than 50s now. Exercising HR can’t get to the levels it previously did however and this has impacted on exercise performance I think, I don’t have the stamina I did. Anyhow that’s my experience with beta blockers FWIW, my bp is lower normal these days too btw.

Tbh the only thing that I don’t like about my beta blocker is the slight reduction in exercise stamina but I’m being picky really because I can still exercise well enough, and also a little weight gain which could also be my age. I have known people get other side effects with beta blockers though so I think I’m fairly lucky.

Hope this has given you a bit more info anyhow although realise beta blockers are varying types and also everyone is different.

That is really good to know. Thank you! How is your blood pressure? My blood pressure is typically around 96/64. Anything blow 90/60 is considered low and can cause problems like fainting etc. So I definitely wouldn't want my blood pressure to get too much lower. I already make sure to eat extra salt whenever I can. I guess compression stockings are another possibility.

Anyhow, that's really good to know that the beta blocker didn't make your heart rate drop too much lower. I think the 40s is fine.

I definitely worry about fatigue and I've heard a lot of people experience this side effect on beta blockers. That would be a deal breaker for me. The depression already makes it hard to motivate myself to do things and I really need medications that are energizing, not sedating (even though I have horrible anxiety, so you'd think I'd do well on sedating meds, but I hate them!)

I'm going to reach out to the cardiologist again. Thanks so much for sharing your experiences and I'm so glad the beta blocker helps you!

You’re welcome, your bp does seem quite low end of normal as it is, I think you’re right to have concerns. Before I took the beta blocker mine was around the 120/70 mark and last time I took it it was between 98/60 and 105/65 so it lowered but not worryingly so.

I haven’t personally experienced fatigue as a side effect but I would say I’ve got a degree of exercise intolerance. For example running uphill I would always keep going but these days I need to have a walk for part of it. All of my runs are that bit slower but I’m not a professional athlete so not a biggie.

Good luck and keep us posted!

Thank you! I emailed the cardiologist this morning.