Brief Answer:
relaxation exercises will help.

Detailed Answer:
Hello dear
Welcome to HCM.

I have read your query and understand your concerns. You have been diagnosed with aortic regurgitation and now you get anxiety and panic attacks. Drugs which you take are remipril, metoprolol and ativan.

I have suggestions for you. These will help you to deal with anxiety and panic without medications:

1. Remember that emotions are like waves. They come and go. Similarly, panic attack is a wave that will settle down on its own in few minutes. Keep repeating this in your mind when you feel anxious. This will help you to stay calm.

2. Practice relaxation exercises like meditation and slow and deep breathing. These work very well to condition your mind to relax.

3. Some foods containing caffeine precipitate panic attacks like tea, coffee and chocolates. Avoid them. Increase green vegetables and fruits in your diet. These reduces oxidative stress of your brain due to anxiety.

4. Quit alcohol, smoking or any other drug of abuse, if you do take.

5. Psychological therapies like biofeedback, systematic desensitization and progressive muscle relaxation help a lot to relieve anxiety. A clinical psychologist will help you in this.

6. Omega3 fatty acid supplements are found to help in anxiety.

If these suggestions donot work to control your anxiety and panic, ativan (which you are using) and sertraline are safest choice anti-anxiety drugs in heart disease. But these are prescription drugs. Its better to consult a psychiatrist.

Hope this helps.

Any further queries are welcome.

Thanks.

Dr. Shubham Mehta, M.D.(Psychiatry).

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Brief Answer:
slow & deep breathing will help.

Detailed Answer:
Thanks for the follow-up post.

I can understand that its a difficult situation for you.

Right when you think you're going to have a panic attack, train yourself to slow down your breathing as follows:

-Breathe in for at least 5 seconds, hold for 3 seconds, and breathe out over 5 seconds.

-During breathing, keep a hand on the chest and it should stay still. Keep the other hand over your belly and it should raise with your breath. This is how you know the breath is deep enough.

-Continue these breaths until you feel relaxed.

-Make sure you're breathing in through your nose and either out through your nose or out through pursed lips like you're whistling.

-This will make panic far less severe and under control.

If this does not control your panic attack, take a tablet of ativan straight away.

However, keep practicing these breathing exercises daily even when you are normal to train yourself.

Also, visit a psychotherapist for biofeedback therapy and progressive muscle relaxation training.

Panic attacks usually donot cause damage to a normal heart. But since you are having aortic regurgitation, you have to keep some caution. I would also advise you to keep a regular follow-up with your cardiologist for your aortic regurgitation.

Anyhow, try to keep yourself calm. The more you will think about this, the more worried you will be.

Feel free to ask further.

I wish you good health.

Thanks.

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Brief Answer:
breathing exercises will control rapid heart rate as well.

Detailed Answer:
The breathing exercises which I have mentioned earlier will most certainly help you to abort panic attack. This will automatically control your palpitations also.

There are some other ways to control palpitations as well:

-Splashing cold water on your face or taking a cold shower can reset your normal heart rhythm.

or

-Another technique is to make a fist and blow into it like you are blowing up a balloon. This will stimulate vagus nerve and control your heartbeat.

or

-Sometimes simple coughing can help to control heart rate.

I usually advise my patients to take ativan 1mg (prescription drug) as soon as they feel that they are about to have a panic.

Sertraline (prescription drug) is usually started at dose of 25mg initially and to be taken daily. The dose is increased after two weeks to 50 mg, if there is no response to initial dose.

Its good to know that LVEF is normal. So you should not worry about panic attack causing cardiac arrest.

Hope this answers your query satisfactorily.

Thanks.

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Brief Answer:
Its safe to take ativan in afternoon.

Detailed Answer:
Welcome again.

Yes you can take ativan in afternoon also when you usually face panic attacks.

In my opinion, I would certainly start sertraline (in addition to psychological therapies) for you for 2 reasons:

1. Since you are having cardiac issues, a regular anti-anxiety drug is must to control panic attacks.
2. Sertraline is the safest choice among all as it cardiac-safe and has minimal drug interactions (keeping in mind the other drugs you take). As ativan has habit-forming tendencies, it must kept as reserve drug and to be taken only to abort an acute panic attack.

But as sertraline is a prescription drug, you can consult a nearby psychiatrist for this.

Hope this helps.

Take care.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Thanks.

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