Panic attacks and other fun
June 24, 2014 11:14 AM   Subscribe

I just had a panic attack at work over my resting heart rate. Questions about resting heart rate and panic attacks inside. (Snowflakes abound)

I have been working out over the last several weeks, probably 3-6 times a week. I've lost about 13% of my body weight through diet and exercise, and I feel good there.

I just checked my resting heart rate at work, which I do from time to time out of curiosity. Normally, it is ~55-65. It was 47. Then I read about Bradycardia, and promptly had a panic attack at work.

1.) Is my resting heart rate a concern? I had a panic attack in December (I was my old weight then) and they did an EKG at urgent care - normal. Should I see a doctor about my resting heart rate? I have not fainted, I have energy to workout, I have not had any chest pains. I have had a feeling of pressure in my eyes occassionally in the afternoons, but I chalk that up to staring at a computer all day.

2.) How have you dealt with panic attacks without medication? I am not thrilled with the idea of medication, but promise to be open to your thoughts and ideas.
posted by glaucon to Health & Fitness (22 answers total) 2 users marked this as a favorite
1. Doing cardio will lower your resting heart rate. It couldn't hurt to ask your doctor about it if you have insurance, perhaps during an otherwise routine checkup, but a drop in resting heart rate would not concern me.

2. I get away from people and I just watch a movie or something and maybe do deep breathing exercises, sort of thing. If I'm at work I go for a walk and try to breathe normally. I don't have panic attacks nearly as often as I used to, though, and if you find you have them with any frequency, this may also be something to talk to a doctor about.
posted by FAMOUS MONSTER at 11:20 AM on June 24, 2014

As you get more aerobically fit, your resting heart rate tends to drop. I wouldn't have thought that would happen over the course of just a few weeks, but personally I would see a low resting heart rate as cause for celebration, not concern. Here's what the Mayo Clinic has to say:
A resting heart rate slower than 60 beats a minute may be normal for some people, particularly for healthy young adults and trained athletes. For these people, bradycardia isn't considered a health problem.
posted by mskyle at 11:25 AM on June 24, 2014 [2 favorites]

I just want to point out that my (and I am not alone) panic attacks are obsessively focused on my heart rate. Yours may not have been caused by, but in fact your panic attack may be making you overly concerned about your heart rate. Then and right now.

Panic attacks are really too random to benefit from medication, with the exception of fast-acting treatments like sublingual or gelatin-strip forms of klonopin or similar. If you were having them frequently, you'd want to pursue an exam with an endocrinologist to rule out adrenal/pituitary/thyroid/pancreatic issues. Once a year is probably not frequent enough to concern an endocrinologist.

When I am having a panic attack, I need quiet, dim distraction. I usually watch tv so I can lay down. When I have one at work, I've had to have someone come get me and take me home.

Sometimes I will take a benadryl, because I also obsess that I'm having an allergy attack, and if that turned out to be the case the ER wouldn't mind and also it's basically like a tranquilizer dart for me.
posted by Lyn Never at 11:25 AM on June 24, 2014 [1 favorite]

No, you should not panic about your resting heart rate.

If you are consistently getting a resting heart rate in the forties, pop in to see the doctor.

Hearts can do all kinds of funny stuff, especially when anxiety is a factor, with no underlying issue at all.

My dad has always had a really low pulse, around 50. As he's aged, he's gotten into real, serious brachycardia - waking rate in the thirties. This is a problem because he feels really sluggish in the mornings. But he has nothing wrong with his heart - at least according to the various specialists he's seen and tests he's taken.

On dealing with anxiety: You shouldn't check your pulse at work! That's a terrible idea! For one thing, when you have a relatively low pulse rate, it's easy to miss a few beats and freak out. Absent significant symptoms in the moment, you shouldn't consult Dr. Google. Almost everything that presents with subclinical symptoms will get worst-but-treatable if it's serious, and you'll drive yourself mad otherwise.

I have a lot of anxiety but don't take medication - I don't like the idea myself. I did a lot of therapy to bring some underlying stuff to the surface, and that mostly resolved things - I still get anxious as hell, sometimes over really stupid things, but it's much, much more manageable and no longer dominates my life.

My best mental trick is that now I can compartmentalize - I can say to myself "I'll deal with that when it becomes a problem" and move on.
posted by Frowner at 11:28 AM on June 24, 2014

Friendly disagreement with Lyn Never there -- benzodiazepines of various kinds act very quickly, and come in quick-acting formulations, so there are actually medications that can be very helpful for panic attacks; some people find that they pre-empt panic attacks, in fact, just by being there, because the, er, meta-panic is eliminated.

It's also possible, if panic attacks are frequent, to medicate for chronic anxiety.

Medication is certainly orthagonal to lifestyle changes and cognitive-behavioral approaches as well. Neither requires the other; both can be helpful and they can be particularly helpful in combination.
posted by chesty_a_arthur at 11:30 AM on June 24, 2014 [4 favorites]

Frowner has two amazing pieces of advice that I always try to adhere to when my panic and/or hypochondria strike:

1) Please avoid Dr. Google. Also Dr Web, MD. Trust your OWN doctor. If you don't have one, find one that you trust and knows your issues and will take those into account.

2) "I'll deal with that when it become a problem." This is perfect. I often repeat to myself "That which I greatly feared never came to pass." It's a nice little mantra.

I have Xanax which I take, on average about 3 or 4 per year for real emergencies, when I can't get my body nor my thoughts under control.

You are doing THE RIGHT DAMN thing by getting healthy physically. Good on ya and keep moving forward with a positive attitude.
posted by John Kennedy Toole Box at 11:32 AM on June 24, 2014 [5 favorites]

chesty_a_arthur, that's why I said "with the exception of fast-acting treatments like sublingual or gelatin-strip forms of klonopin or similar".

Ongoing daily medication for anxiety is not the first best choice for yearly panic attacks. You can have medicated anxiety disorder and still have panic attacks as a result of biological stress factors.
posted by Lyn Never at 11:40 AM on June 24, 2014 [1 favorite]

The obvious first: CHECK WITH YOUR DOCTOR.
But you know this.

But, as others have said, weight loss and exercise will lower your resting heart rate, as well as your blood pressure. This is a good thing.

I was on 2 medications, and after dropping about 30 pounds, my blood pressure was TOO low, and my resting heart rate dropped from 70 - 80 down to 50-60. I stopped one med and my BP is now normal, and my resting heart rate is usually below 60, even when standing. I'm hoping to stop my other med soon, now that I've lost another 15 lbs.

So, when you see your low heart rate, tell yourself you are doing the right thing! If you continue to have panic attacks, see a doc, of course. But it sounds like you are doing great!
posted by The Deej at 11:44 AM on June 24, 2014

Oh, on the "managing anxiety" front: I have things that I try not to read or look at (certain health articles, mostly) because they trigger anxiety. I allow myself to be low-information about certain health issues, even ones I have, because I don't want to fall down the google-hole - and people have been effectively treated for [non-emergency conditions] back before they had PubMed and could second guess their doctors.

I also have some anti-anxiety media - I have a shelf of familiar books at home that are for reading myself to sleep if I'm anxious, and I have relaxing music for work.

Also, if you're not at work and you're feeling tense, singing along to something or doing a little vigorous exercise can chase some of this stuff away.

Also, webcomics! Seriously, a few hours of laughing can just break up anxiety and give you a boost that can last weeks. I personally recommend Noelle Stevenson's Broship of the Ring doodles, her Nimona comic (start from the beginning, things are high-drama right now), American Captain, A Redtail's Dream and Bad Machinery.
posted by Frowner at 11:44 AM on June 24, 2014

Like JKTB, I have Xanax always on my person (well, purse) and just having it if I need it relaxes me. I use it maybe 3 times a year. It works in about 15 minutes for me. I have other strategies for stopping an attack, mostly focusing on my breathing (counting to 7 while slowly inhaling, stop, count to 7 while slowly exhaling) because anxiety makes you tend to hyperventilate.
posted by chowflap at 11:45 AM on June 24, 2014

I am currently in nursing school and "normal" resting heart rate is 60-100 bpm, but there is a girl in my class whose heart rate is consistently around 48-50. My professor's only comment is, "wow, you must be really fit!" So no, I don't think a low heart rate alone is a problem.

I also have a history of panic attacks, and the way I deal with them is by figuring out what I am scared of about having a panic attack and talking myself out of it. I don't worry about my heart rate, so my techniques won't help you, but you need to ask yourself "what am I scared will happen if I panic?" If you're just worried about your heart rate, maybe that isn't the best approach, but it's one CBT approach.
posted by queens86 at 11:47 AM on June 24, 2014

A higher fitness level will do it and there are some physiological/genetic influences as well. My father has always had very low resting heart rate even without being super fit. Doctors and nurses who don't know him ask if he's a runner and when he's hooked up to monitors, he can trip the "low heart rate" alarms.
posted by quince at 12:06 PM on June 24, 2014


In short, you heart rate is nothing to worry about. Your anxiety, though, needs some attention. I have suffered various degrees of anxiety problems for a long time, and while lifestyle adjustments are absolutely necessary (good for you!), I really didn't get relief until I tried medication.
posted by Lutoslawski at 12:14 PM on June 24, 2014

It sounds like you have a history of panic attacks, so I would seriously encourage you to go talk to a therapist or psychiatrist about how to manage this better. Medication isn't the only option out there (although it is very effective for some people), you might benefit from cognitive behavioral therapy.

One thing I learned from CBT, which sounds kind of silly, is to write down the feelings you have in the moment. Then rate the severity of the feeling from 1-10. Then write down what thoughts you are having. Rating is kind of important here, it's part of learning how to teach yourself that the anxiety you are feeling is not the worst in the world and you can get through it.
posted by inertia at 12:19 PM on June 24, 2014

My resting heart rate is usually 48-50 sometimes its as high as 55. I even mentioned it to my doctor once who said not to worry about unless I saw symptoms, which I didn't.

I do take thyroid medication so it may be related to that. I also mention that because when I have my thyroid levels wrong the first thing I feel is a sort of pressure in my eyes. So maybe get your thyroid levels checked?
posted by vacapinta at 1:01 PM on June 24, 2014

I just checked my resting heart rate at work, which I do from time to time out of curiosity. Normally, it is ~55-65. It was 47. Then I read about Bradycardia, and promptly had a panic attack at work.
I have had a feeling of pressure in my eyes occassionally in the afternoons, but I chalk that up to staring at a computer all day.

I think you could have had a panic attack because carbon dioxide in your blood and accumulating lactic acid may have lowered the pH in your brain too far:
Panic Attacks as a Problem of pH

Now, a recent study from the laboratory of John Wemmie at the University of Iowa may have revealed an important new clue to the underlying cause of recurring panic attacks: It may, in effect, be a problem of pH -- of acidity at key junctures in the brain.
The Iowa paper also examined another element in the panic equation: Carbon dioxide. Carbon dioxide acts like an acid in the body and the brain. Several of the experiments described in the Iowa paper showed that inhaling elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice, and that some of these fear reactions required the presence of the acid-sensing protein in the amygdala.

These experiments are especially relevant to understanding panic disorder. One of the most consistent findings in patients with panic disorder is that they are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity. Most patients with panic disorder will experience a panic attack when they inhale air containing 35% carbon dioxide, while most healthy volunteers will not.
The panic attacks would serve to clear the lactic acid and lower the levels of carbon dioxide by increasing your heart rate and making you breathe faster.

The feeling of pressure in your eyes could also be a sign of too much carbon dioxide:
SUMMARY The changes in intraocular pressure due to blood pH, Pco2, and Po2 alterations induced by hyperventilation and hypercapnea [abnormally high levels of carbon dioxide in the blood] in man undergoing routine general anaesthesia were studied.

It was shown that hypercapnea produces elevation of intraocular pressure, while hyperventilation lowers it. Acetazolamide pretreatment did not alter these IOP responses to Pco2, Po2, and blood pH changes.
It's interesting that you and Lyn Never (et. al) panic because your heart rates are too low; given the number of intoxicants that can kill you by depressing breathing and heart function, it may not be too much to guess that noticing your heart beating really slowly is inherently frightening for some people.
posted by jamjam at 1:39 PM on June 24, 2014 [1 favorite]

I am currently undergoing pharmaceutical and therapeutic treatment to deal with my anxiety, again, with some measure of hope. However, I just had a panic attack today, and these are things I utilize regardless of whether there's meds involved or not:

- I want to third, or fourth, or whatever not consulting Dr. Google or any of the like.
- I need to be away from people, I need to be laying down, preferably in a dark room. Essentially the same way you'd treat a migraine.
- I do a lot of self-talk. I used to try to rationalize the panic or anxiety away -- now I try to just accept that it's happening and assure myself that I'm going to be alright.
- I call my doctor.
posted by sm1tten at 2:41 PM on June 24, 2014

To clarify: I do not know my panic attack has started until my heart starts racing, but at that point I become obsessed with it, am both sure I'm having a heart attack and simultaneously thinking that I only *think* my heart is racing because my fingers are too adrenaline-jolted to take my own pulse. I'm only suggesting that there is a panic attack process already underway at that point, which may have been part of OPs sudden obsession with his heartrate.
posted by Lyn Never at 2:55 PM on June 24, 2014

This question has been thoroughly answered, but I'm just going to chime in and say that my resting heart rate is also 45-50. I get dizzy sometimes if I stand up too quickly (fairly low blood pressure) but other than that it's never been a problem.
posted by Kevtaro at 3:07 PM on June 24, 2014

Stop taking your own pulse and focus on something outside of your own body. There is nothing that will bring on a panic attack faster than encapsulating yourself in a thought bubble that only has you in it.

The problem with panic attacks is that, once you've had a bad one, the beginning of any future ones can trigger additional panic because you can then start to panic about having a panic attack. I handled this by telling myself that I was just thirsty and I needed water. I would then sip water and wait it out. I did this enough (I had lots of panic attacks in my early 20s) that eventually I trained myself to calm down by sipping water. Medication also helps. As does therapy and charity work. Oh, and prayer. Prayer, done right, can get you chill before the panic attack even starts.
posted by myselfasme at 6:56 PM on June 24, 2014

My resting heart rate dropped by nearly 10 beats a minute within a month of me starting regular running.

Mine was a LOT higher than yours to start with, though. But my husband has a similar RHR to yours, so it's definitely within a normal range.
posted by lollusc at 6:58 PM on June 24, 2014

I do take thyroid medication so it may be related to that. I also mention that because when I have my thyroid levels wrong the first thing I feel is a sort of pressure in my eyes. So maybe get your thyroid levels checked?

I think vacapinta's answer needs to be considered because hyperthyroid is known to be associated with panic attacks:
Hyperthyroid, on the other hand, is directly linked to panic attacks. In fact, panic attacks are often considered a symptom of this type of thyroid disease, and in rare cases it's considered a warning sign of possibly an undiagnosed thyroid problem.
But hyperthyroid causes higher resting heart rates in general (140+ bpm during a thyroid crisis), though it may well also cause elevated intraocular pressure and a feeling of pressure in the eyes to go with it; it's notorious for causing elevated CSF pressure, but I've looked in vain several times for a credible claim that it causes higher eye pressure.
posted by jamjam at 8:43 PM on June 24, 2014

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