Brief Answer:
Can be caused due to severe dyspepsia and gastritis.

Detailed Answer:
Hello and Thank you for choosing this forum to ask you query.

I an Dr Rishu a cardiologist.
Have seen all your details and i appreciate your concern.
As all your cardiac tests were normal the second possibilty was an attack of dyspepsia and GERD. Patient usually feels severe heart burn nausea and vomiting.
This may stimulate the autonomous nervous system causing increaed pulse and heart rate which can cause palpiation.
Before making any further comment kindly elaborate what were the test that were done on you.
Has stress test and echo been done?
Were cardiac trops checked?
what was your blood sugar?
Any medicines you are on?
Are you smoker diabetic or hypertensive?

please reply.
waiting!

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Brief Answer:
Most likely episode of panic attack.

Detailed Answer:
Hello again dear,
Have seen the reports.
I don't think that its related to cardiac event.
So the two possibilities left are-
1)Reflux and gastritis
2)Nervous problem [panic attack due to anxiety]

You are already on escitalopam this means that you are having issues with anxiety levels.
Most likely that was an episode of panic attack.
Panic attacks involve sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. Patient experiencing a panic attack may believe they are having a heart attack. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them.
Symptoms last for about 10 minutes, such as a fear for imminent death or losing control, chills, numbness of toes or fingers, stomach ache problem or nausea, head heaviness,trembling, dizziness, chest pain, shortness of breath and difficulty in breathing.Duration of your attack and symptoms exactly matches it.
I dont think its migraine.Rather every thing fits very well in panic attack.

So i would recommend you to consult a pysciatrist and pyschotherapist for treatment on lines of panic attack.


Psychotherapy- It is a type of counseling wherein trained professionals assist people by discussing strategies for comprehending and stabilizing this disorder.

Cognitive Behavioral Theory- Cognitive behavioral theory aims at identifying possible triggers of panic attacks and helps one recognize and change their thought patterns and behaviors that stimulate such behavior.

Both these options should be discussed.

Thanks

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Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
1)I woke up i felt to much pressure on my head and suddenly my ears turned extremely red with palpitations that are very fast heart rate-The ecg attached by you is in normal sinus rhythm with normal heart rate which indicates that there were no palpitations in real at that time.
2)This was again followed by dizziness and nausea with heart burn.

All the symptoms written by you are there in an episode of panic attack.

Migraine is usually associated with unilateral(half head) heaviness and pain.Only in 5% cases full head is involved.Secondly migraine is usually associated with repeat attacks. Thirdly Tachycardia,ear reddning etc are not features of migraine.

Final advice-
Can be GERD also however most probable cause seems to be panic attack episode.
Nature of attacks may be different.Presenting symptoms may be totally different in two attacks.
Thank you.

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Brief Answer:
follow up .

Detailed Answer:
Hi again,
Yes he should start you on Paroxetine initially at 25mg doses and should keep you on maintainence of 50mg per day for 6 months.Along with it anxiolytic like clonazepam should also be given along with it.

Thanks

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Brief Answer:
Follow up.

Detailed Answer:
Hello again,
Lets keep our fingers crossed till the results are there with you.
However my gut feeling says that its not thyroid.
Wish u luck.
Thanks.

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Brief Answer:
Follow up.

Detailed Answer:
Hello again,
I am sorry that thyroid came back as normal.
But don't worry have faith in your doctor and medicines and you will be fine soon.

No matter what you have followed earlier now discuss this plan with your pyschiatrist.

Starting Paroxetine 25mg for one week to be increased to 50 mg once daily maintainence dose for atleast 6 months.
Along with it initially Mirtazapone should be started at dose of 7.5 mg followed by a maintainence dose of 15 mg for atleast 6 months.In trials mirtazapine was found to be superior to all of the included selective serotonin reuptake inhibitors (SSRIs).

Along with it tertramethylfolate should be given once daily.It increases potency of paroxetine.

Please discuss this with your psychiatrist and inform me what he suggests.

Regards.

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Brief Answer:
Follow up.

Detailed Answer:
Hello again,

As per your query, I would like to inform you that dizziness, caused due to infection and inflammation of inner ear also termed as labyrinthitis. Some times pressure disturbance across middle ear due to blocked eustachian tube can also cause dizziness.

So yes, a physical examination by ENT specialist is a good idea.

Feel free to follow up.
Regards

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