Anxiety and panic attacks are links in the same chain.

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– Increased anxiety is one of the most common manifestations of post-COVID. But even before the pandemic, there were predictions that the number of people with such conditions would increase. By 2030, every third person in the world is expected to have seizures or constant anxiety – says a cardiologist, arrhythmologist, rehabilitation specialist, medical science candidate Maria Chaikkovskaya. – Anxiety and panic attacks are links in the same chain. All this is associated with chronic stress. And the pandemic (plus the current political situation in the world.-Ed.), naturally adds to our concerns.

Cardiologist, arrhythmologist, rehabilitation specialist, candidate of medical sciences Maria Chaikovskaya.

A picture: Personal archive

Stress is the background for panic attacks (PA), the expert explains. And he clarifies: “In an absolutely healthy person with no predisposition and an unfavorable background, PA cannot occur suddenly.” But who among us is sure that he is absolutely healthy and not underexposed? Yes, and more than enough stress background. So I asked Dr. Tchaikovsky to answer the most troubling questions about panic attacks. How dangerous are they to health? Why isn’t there enough air during an attack and a wave of horror covers? And above all: how can you help yourself?


– The most important thing to realize is that a panic attack, however unlikely it may seem during an attack, is physiologically safe for the body. Yes, yes, PA alone does not cause a heart attack or stroke, the cardiologist reassures.

Moreover, although this condition seems sudden to us, preparation for an attack is gradual, says Maria Chaikovsky.

– We collect a baggage of events that the brain interprets as negative (pushed on the subway, cut off by car, bad weather, verbally abused.-Ed.). And eventually the central nervous system gives a violent response – a panic attack begins.


The most common symptoms of PA

– Cardio palm.

– Feeling that the heart is beating with incredible force, as if it were in the throat.

– Pain or discomfort in the area of ​​the heart.

– Dizziness.

– Choking, shortness of breath.

– An attack of fear or intense fear.

– Feeling the unreality of what is happening.

There are many symptoms associated with panic attacks. Their combinations give up to several hundred variants of the clinical picture, says the doctor.


– Maria, why does a panic attack often cause a feeling of lack of air? And also the feeling that there is literally going to be an explosion in my head.

– All this is a reaction to stress. We are evolutionarily adapted to respond to stressful situations in a fight-or-flight fashion. The brain prepares the body for more muscle work. To do this, you need to increase the oxygen flow. Therefore, the heart begins to pump the blood stronger and faster – the heart rate increases. The breathing also accelerates so that the working muscles receive more oxygen. On the other hand, in the event that an injury occurs so that the person does not bleed to death, the blood vessels constrict.

In fact, we stay where we are! Muscles don’t work. It appears that the cardiovascular and respiratory systems are inactive. At the same time, a person intensively exhales carbon dioxide and gets into the body less than it needs. And CO2 is very important for physiology. On the one hand, it widens the blood vessels and reduces the pressure. On the other hand, carbon dioxide is necessary for the acid balance of our internal environment. With its lack, the balance shifts to the alkaline side. Due to this, hemoglobin, which transports oxygen, despite frequent breathing and active intake of air, does not give it to the tissues, but takes it away during transport. This is how a paradox arises: a person breathes very intensively, and internal organs receive less oxygen.

– Is this condition not harmful to health?

– Not. There’s nothing really dangerous about this. Our bodies are designed with a large margin of safety. A panic attack lasts no more than 20-30 minutes, during which time critical changes cannot occur (except when people already have severe heart disease – coronary artery disease).


Even if panic attacks aren’t fatal, they ruin our lives, the doctor confirms. At the very least, it scares, disturbs, violates, or completely destroys plans. How do you get rid of PA?

– A very important principle is not to give your fear and anxiety any additional ground, – Maria Chaikovsky remarks. – Afraid of the symptoms a person reinforces the unfavorable background and aggravates the condition. If you don’t get involved, take the panic attack for granted, it has come and will pass – this is the road to victory.

Sounds reassuring. But how do you achieve this in practice? But here everything is not so simple. In modern medicine, there are three approaches to treating panic attacks (officially called “panic disorders”), says our expert. And each method has its pros and cons.

1. Drug therapy.

What’s the point: this is the appointment of antidepressants and other drugs to help immediately at the time of the attack (if necessary, depending on the symptoms).

Advantages: a person does not have to do anything, just swallow pills; There are cheap drugs.

Disadvantages: often there are side effects; antidepressants have a cumulative effect and start working at best after a few weeks.

2. Psychotherapy.

Benefits: No need to take psychotropic drugs.

Cons: Expensive, not covered by CHI insurance; specialists who provide the necessary assistance are not always and not available everywhere.

3. Rehabilitation Techniques.

What’s the point: This method involves several workouts, explains Maria Chaikovskaya. First of all, breathing exercises (they are individually selected by a rehabilitation doctor) and various ways to teach self-control and self-regulation of a person’s condition. Examples of such techniques can be found on Chaikovskaya’s YouTube and Telegram channels.

Benefits: no need to take psychotropic drugs; long-term effect.

Cons: Not covered by CHI insurance (you must take courses with a rehabilitation physician at your own expense).


What to do in the moment?

– Maria, the first thought during an attack is to take validol under the tongue or valerian. Will it help?

– Such drugs have no physiological effect in a panic attack. They can only work on the placebo principle (that is, if the patient is deeply convinced that the pill will help. – ed.). In general, if a person does not have any serious concomitant illnesses, doing nothing is the best first aid option for PA. Just wait for the end of the attack and try to draw attention to something.

If you are very concerned about a strong heartbeat, the doctor may prescribe medications that reduce the pulse. And if there is such a wave of fear and anxiety that there is no strength to endure, prescription drugs of the benzodiazepine class can be prescribed. They quickly stop such a situation. But it is not recommended to take them all the time.

– There is a life hack on the internet: put a bag on your nose and inhale the carbon dioxide you exhale to restore balance in the body.

– I absolutely do not recommend this. There are cases when after such manipulation, people not only did not get better, but there was also an increase in adverse symptoms. In general, the best option is to take a course in individually selected exercises from a doctor (rehabilitation doctor, psychotherapist, neurologist). And do them at the very beginning of the attack to stop the development of a panic attack.


How to distinguish PA from real pain in the heart?

– During panic attacks, people often complain of discomfort and pain in the chest, in the region of the heart. This symptom is called “cardialgia”. It poses no danger to the cardiovascular system, Maria Chaikovskaya reassures. – But the real heart pain – angina pectoris – is a really alarming symptom that requires medical attention.

At the request of “KP”, the doctor listed the main distinguishing features.

– Age.

Angina pectoris: as a rule after 45 years in men and after 55 years in women.

Cardialgia: Common in 20-35 year olds.

Conditions of pain.

Angina: usually with exertion; passes in peace.

Cardialgia: unrelated to physical activity, often occurs at rest. And if a person starts to move, it passes faster.

Pain expensive.

Angina pectoris: not for long. It often disappears within 5 minutes after the load is stopped.

Cardialgia: Can hurt, whine for hours.

The nature of the pain.

Angina Pectoris: Pressure or burning in the center of the chest or on the left side.

Cardialgia: pain, tingling, “as if there is a stake in the chest”, etc.

! Important: if pain in the heart occurs in a person over 45 years old (men) and 55 years old (women) and at the same time it is burning or pressing, you should call an ambulance. So that doctors rule out a dangerous aggravation of heart disease.

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