This is not the first time he has experienced such a terrifying moment, each time feeling as if he is hovering on the brink of death. Fortunately, as he fumbles for his phone, the symptoms gradually ease. The next day, he recalls the doctor’s advice and makes an appointment with the psychiatric department.
This article discusses a symptom similar to a “heart attack” that is closely linked to psychological factors, with the frequency of attacks potentially being proportional to the level of fear. Today, we would like to share two case stories with you.
“Heart Attacks” Over and Over Again A month ago, Mr. A’s friend suddenly passed away due to an acute myocardial infarction at the age of 39. Soon, symptoms similar to a heart attack appeared on him.
Another time, he was alone in the car when he got stuck in traffic, and the same symptoms appeared again. After several such episodes, he began to fear taking elevators and driving; actions that were once routine now became things he could not bear. On one occasion, when an attack occurred at home, he dialed the 120 emergency number. Unexpectedly, among the various tests in the emergency department,except for the ECG showing tachycardia, no other tests found significant abnormalities. The second patient, Ms. B, a 43-year-old woman, also found herself in such a predicament. She described her feelings as: “It feels like something is pressing on my chest, my heart is beating very fast, as if it’s about to jump out, but at the same time, it’s tightly gripped by something.” Three months ago, she began to experience symptoms similar to heart disease; each attack was very sudden, accompanied by chest pain, palpitations, and even a sensation of suffocation. As a teacher, her symptoms sometimes occurred in the classroom. However,despite multiple visits and examinations, no significant problems were found.
In the psychiatric department, both Mr. A and Ms. B received a diagnosis of More specifically, the symptoms they previously experienced, similar to heart attacks, actually belong to the manifestations of “panic attacks”
Mr. A’s Story
Mr. A is a businessman whose career is thriving, and his family is harmonious and happy. Overall, his life has been stable.The only change that caused him grief before he experienced “heart disease” symptoms was the sudden death of his friend. When he first heard the news of his friend’s sudden death, he was shocked and saddened, but more accurately, a deep sense of fear enveloped him. He and his friend had worked together for many years, often attending business dinners together, where they were surrounded by smoke and alcohol. After the incident, he realized that smoking and drinking may have sown the seeds of danger for their health long ago. He searched online for the causes of heart attacks and read about the various negative impacts of nicotine and alcohol. Since then, whenever he saw cigarettes or received invitations to social events, he would think of his friend’s misfortune.
But he questioned,can paying attention to health issues actually trigger symptoms similar to sudden death? If there’s no problem with the heart, can mental factors induce manifestations similar to a heart attack? Actually, “panic attacks” share many similarities with the symptoms of a heart attack; they are also known as “acute anxiety attacks,” which is a sudden onset of intense panic, When anxiety is activated, the brain’s “fight or flight” emergency system is overly Recurrent panic attacks can exacerbate the anxiety and insecurity in a patient’s heart, leading to catastrophic thoughts, such as, “Am I going to die? Will no one find me and help when I have an attack?” This results in more anxiety, causing a vicious cycle and thus forming “panic disorder”. Furthermore, when a patient experiences a panic attack in a specific situation, this situation becomes associated with intense fear and forms a fearful memory in the brain.
Since then, a fear of sudden death has enveloped Mr. A, who is the same age as the deceased.
Once while taking an elevator, he felt the space was unusually cramped and suffocating, and a strong sense of unease suddenly hit him.
Then, he felt palpitations, cold sweats, shortness of breath, and numbness in his feet.
He quickly got off the elevator, which allowed his heartbeat to gradually stabilize.
He was very worried that these symptoms might be an “alarm signal” for a heart attack, but the doctor not only recommended further evaluation of cardiovascular risk but also suggested he “rule out psychological factors”.
“anxiety disorder”, which is commonly referred to as “anxiety”.
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usually peaking within a few minutes, with mechanisms involving the interaction of multiple neurotransmitter systems and brain regions in the brain.
triggered, and the sympathetic nervous system responds rapidly, releasing a large amount of stress hormones such as adrenaline and noradrenaline, leading to physiological responses such as increased heart rate, rapid breathing, increased sweating, and muscle tension.
In similar situations in the future, this fearful memory may be reactivated, leading to a series of physiological responses.
For example, a patient may have had a panic attack while taking an elevator, and subsequently, every time they take an elevator, it may trigger similar symptoms.
At the same time, the doctor also advised him to engage in group exercises five times a week, half an hour each time.
He could play table tennis, ride bicycles with friends, jog, swim, etc. These aerobic exercises help relieve anxiety. The doctor also specially reminded him that the heart rate would also increase normally during exercise, and he should not consider the normal increase in heart rate as a precursor to “heart disease”.
A few weeks later, the frequency and severity of Mr. A’s attacks did indeed ease.
He felt relieved, but he was still afraid to take elevators and drive alone. At this point, the doctor suggested that he have weekly psychological counseling, trying to improve his fear through “cognitive-behavioral therapy”.
Ms. B’s Story
“I have indeed felt unprecedented anxiety in the past few months, but I don’t think there’s anything that could make me this anxious…” Ms. B was puzzled about what was happening to her. She said that her work was going well, her family was harmonious, and she even “didn’t lack money at home”. Nothing special had happened before the symptoms appeared.
So she began psychodynamic therapy. One part of the therapy is called “free association,” where the therapist encourages her to speak her thoughts. In the first few sessions, she talked about her life experiences—both parents are university teachers, she has always been a top student, the “kid next door” in many people’s eyes; after graduation, she taught at the university and became a professor at 40; her husband is a successful businessman, and her child is well-behaved and studies hard…
It wasn’t until the sixth session that Ms. B first mentioned her “fear”—“I had a dream one day, in which my husband had a car accident, and I was so scared. Even thinking about it now, I’m a bit frightened.”
The therapist cautiously asked, “When you think of this dream, what images come to your mind?” Ms. B frowned and slowly said:“I don’t know if my husband in the dream is really… gone? I’m not sad, just scared, probably because I’m afraid of losing him.”
The therapist tentatively asked, “I heard you mention before that your husband is often not at home these past few months. Are you somewhat dissatisfied with him?” She was slightly taken aback, then softly replied:“Yes, but I think I should be considerate of him. He’s doing it for the family…”
Does the word “should” bind the true feelings? The therapist gently pursued, “Do you often let the idea of ‘should’ bind your true feelings, so much so that you can’t take care of your own inner feelings?” As soon as the words fell, Ms. B’s eyes instantly moistened, and tears welled up in her eyes.
“I’ve always been asked to consider other people’s feelings since I was a child, but I also have a lot of my own feelings!” Tears broke through, and she cried like a child.
The therapist gently comforted, “You long to be accompanied, understood, and considered. It’s normal to be dissatisfied and angry when you feel neglected, but you seem to never allow yourself to be angry.”
She nodded while wiping her tears, as if she had found resonance.
As the consultation was about to end, she said that after crying, she felt much more comfortable.
Ms. B’s panic attacks, as well as the dream she mentioned, are closely connected to the anger that has been suppressed deep within her heart. In her view, anger is a frightening emotion. Once released, it seems that she would no longer be an understanding person but would become mean and heartless. She worried that such a self would be disliked, so her anger was covered up by the labels of “should” and “empathetic”.
From a psychodynamic perspective, panic attacks are not always related to anger, but they are often closely related to those deep-seated conflicts that need to be unearthed and understood.
These conflicts are like undercurrents hidden deep in the soul, affecting individuals’ emotions, physical sensations, and behaviors.
How are they doing after receiving psychotherapy? Ms. B’s panic attacks gradually subsided after several months of psychodynamic therapy.
And Mr. A, who was afraid to take elevators and drive, received such treatment advice—
When he first tried it, he watched the elevator doors slowly open, his heart pounding. After entering the elevator, he tried to focus all his attention on his breathing.
The practice in the car was the same. At first, he could only stay in the car for a short time before fear would flood in. With each extended period of breathing training, he got closer to his fear, but also closer to overcoming it. Finally, by the eighth week, he told the therapist that he could calmly take the elevator and drive by himself, as if he had broken free from the “shackles” of panic disorder.
Perhaps, there are friends in front of the screen who are troubled by the above symptoms. Exploring the psychological factors behind physical symptoms is by no means a shameful thing. And walking into the psychiatric department does not mean that one has a “mental problem”. Our goal is to receive scientific diagnosis and treatment and to regain vitality and health.
Sometimes, physical discomfort may be caused by “small knots” in the heart. When encountering such unexplained, unclear symptoms, one can try intervention from a psychological level.
Gradually expose himself to elevators and driving situations every week, try to acknowledge and accept the fact of his anxiety and fear; at the same time, practice breathing exercises to lengthen and slow down his breath, focusing his attention on his breathing.
He silently recited the method given by the therapist: “Breathe in so that your lower abdomen swells, breathe out so that your lower abdomen relaxes…” Feeling the rise and fall of his abdomen with his breath, time seemed to
solidify. Until the elevator bell rang and the doors opened, he let out a long breath.
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