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Suggest Treatment For Panic Attacks Due To Anxiety
Question: Sir, my son is of 24 years old and has completed M Tech. At present he is in search of job. He is somewhat sensitive and caring to parents and sister. When he came to home two months back he observed both me and my wife fell on sick due to over anxiety of mine and spondylitis to my wife. he felt so anxiety and started searching net for solutions to our problems. He developed over anxiety and panic attacks started. without our knowledge he consulted a government doctor (an young MD) who administered rantac injection and advised to see a psychiatrist. On that night at about 12.30 midnight he felt heavy pain and tightness in his chest area and over anxiety roaming here and there restlessly. He felt it as heart stroke . we rushed him to an MD in our town. he immediately took ECG. The ECG result is normal and the doctor prescribed Inderal-40 two times a day @half tablet each time and lorsaid P8 for 4 days. But my son, though doctor told him that there is no problem with heart, started thinking that he is having some trouble in heart. every day at night he receives palpitations , pain in left side of chest area and tingling affect in left hand. Further to worsen the situation, he could not go for jogging due to pain in chest and fatigue even for one round i.e.800 mts. prior to this health condition he used to make 6 rounds without much discomfort or fatigue.he experiences pain in chest area, if he speaks loud he gets pain in chest area (left side), if he jogs he experiences pain, anxiety and fatigue. This is happening for the last 2months (only after we fell sick and he observed it). Prior to this, his health is very very good and never knew fear for anything. He never cared for fever or some other ailments. after this episode he developed fear and anxiety even for small in conveniences occur at heart area. But he is susceptible to cold easily when climate changes. so he started fearing strongly that his heart is becoming weak. after 15 days of this episode he developed stomach pain due to gas trouble and we took him to the gastro enterologist. He ruled out heart problem at this early age and he prescribed medicines for gas trouble and anti anxiety medicines. though the condition is some what improved, palpitations become regular and pain in ribs and chest area is common. recently one week back he went to university for his certificates and stayed there for 3 days taking outside food. after returning from university again gas trouble palpitations and anxiety started at higher level. Again we went for ECG and the result is 'normal' and we have taken to a Government doctor who is MS and he prescribed Escitalopram 5mg,
clonazepam 0.5 mg and pantaprozole for 10 days.
Now I request that based on this history please inform me whether my son has heart trouble or panic attacks due to anxiety? what should I do ? should I go for the medicines cited above Or should I take him to a cardiologist. I am not having good opinion on corporate hospitals as my father in law was misguided by those people. Kindly suggest me for further action
Regards,
XXXX
clonazepam 0.5 mg and pantaprozole for 10 days.
Now I request that based on this history please inform me whether my son has heart trouble or panic attacks due to anxiety? what should I do ? should I go for the medicines cited above Or should I take him to a cardiologist. I am not having good opinion on corporate hospitals as my father in law was misguided by those people. Kindly suggest me for further action
Regards,
XXXX
Brief Answer:
please see details below
Detailed Answer:
Dear Sir
1. Historically , a very pertinent point is that how much he is able to walk/ exercise/ run/ use stairs without getting breathless or developing pain chest? if he is able to do so up to a significant level of effort, at any time, likelihood of his symptoms being due to anxiety is high. but basic principle of medicine is "Always rule out organic disease first".
2. My pick on this condition will be that he must be seen by a good ethical cardiologist first. Once he is examined well, the cardiologist can directly subject him to exercise stress test (or after performing ECHO). The stress test will not only rule out anginal heart disease but will also assure him of his exercise capacity. There will be an objective documentary evidence that will be convincing to his mind.
3. There after you can see a clinical psychologist , rather than a psychiatirst. If the clinical psychologist thinks that he really requires psychiatirc intervention, only then he should consult a psychitrist. Else there is a possibility that a psychologist can treat him well.
4. Sir there is a difference between possibility and fact. For a given patient fact is much more important than possibility. Hence organic disease must be ruled out, which I do not think will take much for a seasoned cardiologist.
Feel Free to discuss further.
Sincerely
Sukhvinder
please see details below
Detailed Answer:
Dear Sir
1. Historically , a very pertinent point is that how much he is able to walk/ exercise/ run/ use stairs without getting breathless or developing pain chest? if he is able to do so up to a significant level of effort, at any time, likelihood of his symptoms being due to anxiety is high. but basic principle of medicine is "Always rule out organic disease first".
2. My pick on this condition will be that he must be seen by a good ethical cardiologist first. Once he is examined well, the cardiologist can directly subject him to exercise stress test (or after performing ECHO). The stress test will not only rule out anginal heart disease but will also assure him of his exercise capacity. There will be an objective documentary evidence that will be convincing to his mind.
3. There after you can see a clinical psychologist , rather than a psychiatirst. If the clinical psychologist thinks that he really requires psychiatirc intervention, only then he should consult a psychitrist. Else there is a possibility that a psychologist can treat him well.
4. Sir there is a difference between possibility and fact. For a given patient fact is much more important than possibility. Hence organic disease must be ruled out, which I do not think will take much for a seasoned cardiologist.
Feel Free to discuss further.
Sincerely
Sukhvinder
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Above answer was peer-reviewed by :
Dr. Raju A.T
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