Is it arrhythmia or panic attack (the chicken or the egg story)?
Diane H, a 54 year old business woman, attended the clinic complaining of a racing heart, dizziness, difficulty in breathing, tingling in the hands, “butterflies” in the stomach and hot flushes. At the time she attended the clinic she was free of symptoms but they were occurring on a regular basis which made her feel there was something seriously wrong with the heart or head.
When she visited the doctor, again, the symptoms disappeared and even though he attached her to a heart monitor and took her blood pressure there was nothing significant to pass comment.
Her job was quite stressful and it was this that the doctor thought triggered the panic attacks and the associated cardiac arrhythmia.
Diane was prescribed amitriptyline by her doctor to help with the panic attacks as he considered her problem was more psychological than cardiac.
The frequency of the panic attacks increased whilst taking the drugs and therefore came to see me for a second opinion.
Comment:
Her symptoms are consistent with compromise of the vagal nerve. This nerve leaves the base of the skull between the carotid artery and jugular vein and travels virtually the whole length of the body sending nerve signals to the heart, lungs, abdomen and digestive tract.
On examination Diane displayed left sacroiliac ligament laxity, pelvic instability, leg length inequality, muscle spasm running from the left sacroiliac joint to the base of the skull and muscle spasm in the left buttock.
sacro-iliac joint dysfunction
muscle spasm running the whole length of the spine
twitch response on palpation
neural compromise to the hands
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The ligamentous instability of the left sacroiliac joint caused a compensatory muscle spasm in the left buttock and the spine. This compromised the vagus nerve which controls the heart, the lungs and the gastrointestinal tract. The functional scoliosis caused by the leg length difference compromised the neck and the nerves that supply the hands.
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