How to Distinguish Heart Disease Symptoms From Panic Attacks
DEAR DR. ROACH: How can you tell with at least a moderate degree of certainty that you might really have a heart or blood pressure problem, as opposed to just having an anxiety attack that is less serious? — D.S.
ANSWER: A panic attack is an abrupt change in mental state. They are usually unexpected, sometimes with or without identifiable triggers. Symptoms of a panic attack vary from person to person, but among the most common are feelings of heart palpitations; sweating; trembling or shaking; shortness of breath; chest pain or discomfort; dizziness; numbness or a “pins and needles” feeling; abdominal pain or nausea; feeling abnormally hot or cold; feeling detached from oneself or from reality; and a fear of dying, losing control or “going crazy.”
Most of us have had some of these feelings from time to time, and some of these symptoms are identical to ones of heart disease, specifically of angina pectoris — the classic symptom of poor blood flow to the heart. There are many conditions, both medical and psychiatric, that can cause these symptoms as well, so acquiring a moderate degree of certainty isn’t always easy.
A very careful history exam helps. With chest pain due to heart disease, for example, symptoms are commonly brought on by exertion; whereas with a panic disorder, there might not be a trigger, or it may be triggered by psychological stress. Some people have highly specific triggers, such as open spaces or needles. Some people can trigger a panic attack just by worrying that they are going to have one.
The time course of the symptoms can be very helpful. With a panic attack, the attack starts, and chest discomfort (for example) will then occur. In people with heart disease, chest discomfort starts, and then people will get anxious.
I had a wise cardiology professor who told me to always consider heart disease even if a person’s history is suggestive of a panic attack. I generally check their blood pressure and order an electrocardiogram, blood testing (including thyroid tests) and sometimes other tests when considering the diagnosis of a panic attack.
There is very effective treatment available for people with panic disorder (people with recurrent unexpected panic attacks that lead to avoidant behaviors), both through therapy and medication. But your question implies that being pretty sure of the diagnosis is wise before dismissing the possibility of cardiac disease or other medical diseases.
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DEAR DR. ROACH: I’m sure you’ve answered this question before, but how important do you think the digital rectal exam is for a 70-year-old man with normal findings in his PSA tests? My previous doctor who retired would routinely do them during my annual physical, but my current doctor said it’s my choice. So, I’ve opted not to have it done. Thoughts? — Anon.
ANSWER: The PSA test is much better at diagnosing than a finger is. There are cases where a clinician felt a tumor that would have been missed by the PSA test, so there is some small benefit to the digital rectal exam. But the benefit is quite modest.
There are men who have come to expect that part of the exam and feel unsatisfied without it, just as there are some men who absolutely refuse it. So, a wise clinician gives the patient the choice after explaining the small benefit and nonexistent risk.
Dr. Roach regrets that he is unable to answer
individual questions, but will incorporate them
in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
© 2023 North America Synd., Inc.
All Rights Reserved
Holiday Food Safety Hacks
Food is a big part of holiday celebrations. When food sits out at room temperature for long periods of time, the door is open to uninvited guests—bacteria that cause foodborne illness. Every year 48 million people (1 in 6) become ill from foodborne illness! Follow these safe food handling tips to prevent illness from ruining your holidays!
• Keep hot food HOT and cold food COLD: Hot food needs to be held at 140°F or higher. Use slow cookers and warming trays. Cold food needs to be held at 40°F or lower. Nest dishes in bowls of ice. Otherwise, use small serving trays and replace them as needed along with new utensils.
• Handle food safely: Always wash your hands before handling food and clean all surfaces. Use different utensils for each food item.
• Follow the two-hour rule: Perishable foods should not sit at room temperature for more than two hours.
This is a good reminder to either eat or freeze leftovers within three to four days. To handle leftovers safely, use the following guidelines:
1. Store leftovers in small shallow containers for fast cooling.
2. Eat or freeze leftovers within four days.
3. Use labels or masking tape and a black marker to write dates on food for the refrigerator or freezer. If you label leftovers in the refrigerator with the ‘four-day throw away’ date, you will see right away the last day you can safely eat them.
4. Use Food Safety Charts, www.foodsafety.gov, to learn how long food can be safely stored in the refrigerator or freezer.
For more information on food safety and cooking temperatures, visit the FSIS website at www.fsis.usda.gov or call the USDA Meat and Poultry Hotline at 1-888-674-6854. Open Monday – Friday from 10 a.m. to 6 p.m. ET.
With over 35 years of operation, the hotline has answered over 2 million calls. Often the first question callers ask is, “Are you a real person?” The hotline is one of the rare services where a live person answers callers specific questions one-on-one!
Each season brings with it a certain set of hazards that we must contend with and winter is no different. Cold temperatures, slippery roads and sidewalks and strenuous activities are all things that we must be mindful of. And as we get older, the cold temperatures increase those hazards. Here are some dangers to be mindful of and tips on how to avoid them.
According to the American Heart Association, the risk of a heart attack during snow shoveling may increase for some due to the colder temperatures and physical exertion increases on the heart. When shoveling take breaks. Pay attention to how your body is feeling. Eating a large meal before or directly after shoveling can also put extra strain on the heart. If you have preexisting medical conditions consult with your doctor to see if shoveling snow is advised. Use a smaller shovel or invest in a snow blower.
While outside also be aware of the potential for hypothermia. As we age, the body’s mechanism that regulates temperature deteriorates. Dress in layers of warm clothing. Wear gloves and a hat. Much of the body’s heat can be lost through the head. Wearing a hat will help stop that loss.
Be mindful of ice and snow. The older we get the sensation in our feet decreases as well as the mobility. These factors increase the potential of slipping or tripping on the ice and snow. Allow enough time to get where you are going so you are not rushed or hurrying. Use extra caution when walking or getting in and out of vehicles. And use handrails or handholds as much as possible.
Lastly, do not be afraid to ask for HELP. Hire the neighbor kid to shovel your snow. Have your groceries, medications or meals delivered right to your door. And if you don’t need it today, stay in and wait for a day with nicer weather before venturing outside.
If you have any questions or would like further information I can be reached at 563-589-4195 or at Dpaulson@cityofdubuque.org.
• OK, I’ll say it: I love tradition, but sometimes I want to mix it up for Thanksgiving dinner. I keep the main dishes the same as they always are, but I add my drama in the details. For instance, mix your choice of herbs into a stick of softened butter. Using a plastic baggie with the corner cut off or a decorating bag, pipe the herbed butter onto a butter dish. Refrigerate and enjoy the oohs and ahs. — JoAnn
• “For easier cooking, when making large holiday meals, simply choose two side dishes that can be oven cooked in the same amount of time at an average temperature. I like one or two that can be cooked in the microwave as well.” — E.U. in Texas
• “For a delightful twist on cranberry jelly, slice and sprinkle with orange zest. Dress up your mashed potatoes with a sprinkling of chopped fresh chives.” — via email
• The night before serving your large sit-down dinner, put all the serving pieces on the table, and all the dinnerware in the dining room. You don’t want to have one person trying to get plates and spoons when you are getting dinner on the table. — JoAnn
• “You know what works really well to keep hot casseroles hot when waiting for other sides to finish? A cooler. Line it with a towel and set your casseroles inside. Then, when they are on the table, stick the cooler back in the kitchen. You can throw the casserole dishes back in dirty after you pack away leftovers. Add some warm soapy water and they can even wait until the next day to get cleaned.” — M.B. in Georgia
• Don’t throw away that damaged garden hose. Here are three great uses: 1. Use as a weather strip along the bottom of your garage door. 2. Use sections to protect the blades on your ice skates. 3.Use as a safety edge on your saws in the shop. Cut to fit and slip it over the blade.
• “If a small screw keeps coming loose on something, remove it, paint it with clear nail polish and rescrew quickly. This often does the trick. Makes it more grippy.” — I.W. in Minnesota
• “To keep calendar entries straight, you can use a different color highlighter for types of events or for each family member — blue for appointments, or green for kids’ activities. A family calendar will help keep everyone in the loop.” — A reader
• “Those little soft cardboard sleeves that light bulbs come in are really great for mailing photos. If you fold them flat, you can slip your pics inside, and it goes right in the envelope. They’ll be nice and protected.” — D.L. in Georgia
• “If your curling broom is losing its spring, try trimming the bristles a little bit. This worked for me.” — R.D. in Canada (Tipsters: Curling is an ice sport.)
• Defog your mirror with shaving cream. Smear it over the entire surface and then wipe away with a clean towel. Keep cleaning until clear. It works for at least two weeks — NO FOG!
• Looking for a way to replace eggs in a recipe? Here are some substitutes: powdered egg substitute (Ener-G brand, for example), 2 tablespoons of arrowroot powder or cornstarch; 1 banana, mashed; a tablespoon of milled flaxseed with 3 tablespoons of water.
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