When Panic Is Really A Heart Attack

As a psychotherapist, I often think of phenomena in my own life from a psychological perspective... And as a fairly fit, trim, former runner/skier/hiker type of person, I rarely assume an ailment is a serious physical condition. My numbers are all low—BP, LDL, TRIG, CHOL. etc.

So, let me tell you a story about hubris. My own hubris and lack of appreciation for the powerful, yet fragile organ called my heart. I tell it as a tale of warning and hope.

Last month a very close relative died suddenly and tragically. The shock was unimaginable. Yet I carried on as I do, making arrangements, calming this, soothing that. I wrote my own words of remembrance, family members convened, we all cried and reminisced and sat in horrified bewilderment.

The night before the funeral I couldn't find my wallet. A minor, in the scheme of things catastrophe, but a crisis nonetheless, which I could focus on and “do” something about—or not. Immediately I felt my heart in my throat—that hot rush of adrenaline sear my ears in a pulsating sweat. I ran to my car and there it was under the seat. I breathed a sigh of relief, yet my heart pounded on. My breathing was tight. A panic attack, I said, as my chest turned inward, twisting like a knot. Breathe, focus on the breath, I told myself as I had countless clients before me. It's not a heart attack, you will be fine, don't hyperventilate or you may pass out..

So, breathe I did, and several hours later the pressing, slightly crushing sensation in my chest subsided and I fell asleep. I made it through the funeral and the reception and the drive back home without further incident.

When I returned to work the next day I visualized scenes from the days prior, and the same pressured feeling returned, accompanied by a vague, but noticeable ache in my left arm—and I had a different thought. Maybe I really am having a heart attack! A quick google search indicated, as a woman with vague pains, that I should call my doctor ASAP. From there it all unfolded. Indeed I was having an abnormal EKG, and troponin enzymes were being released into my bloodstream, indicating some degree of heart muscle damage, albeit minor.

The condition is called stress-induced cardiomyopathy, ”takotsubo”, or “Broken Heart Syndrome”, an uncommon reaction by post-menopausal women to a sudden upsurge of adrenalin, oftentimes during the aftermath of the loss of a loved one. Otherwise healthy arteries can become temporarily blocked, causing a loss of oxygen to the heart. In my case I am very lucky—no serious damage, and with medications I am protected from it happening again.

The lesson is this: I have a heart that is both emotional and physical. Emotional can be physical and physical can be emotional. They are inextricably intertwined, and can sometimes even break.

Let me hope that by reading this account, all supposed panic disorder symptoms be taken seriously, and all medical conditions be ruled out before assuming a psychological condition. Let this be an additional warning about any and all physical presentations of distress—and not assume it is “just in one's head”, particularly if you already are a psychiatric patient and feel the stigma from the medical community that sometimes exists about the validity of a true organic condition.