Is your heart glad 2 C me or a panic attack in your pocket?

I do not watch much TV. I even cancelled my cable subscription for this reason and only watch a few channels I pick up over the air, once or twice a month. And in one of these occasion, I got to watch Dr Oz talking about misdiagnosing panic attacks.

In a previous article, I described my fight with irregular heart rhythm and how, lacking any better explanation, I pretty much gave up, even though I felt strongly that the cause was most likely physical in nature.

In my chance encounter with Dr Oz, I learned a number of potential causes of symptoms that could be misinterpreted as panic attacks – by lazy or less than knowledgeable practitioners. A panic attack is quite obvious, as you can see in the clips below. Here are the potential causes, as listed in the program.

1. Hypothyroidism

Called “cretinism” in infants, it is the disease state in humans and in vertebrates caused by insufficient production of thyroid hormones by the thyroid gland. This is a rather complicated disease that seems to affect women more so than men. Treatment is also complex. Here’s a table of symptoms, courtesy of wikipedia:

Causes About three percent of the general population is hypothyroid. Factors such as iodine deficiency or exposure to Iodine-131 (I-131) can increase that risk. There are a number of causes for hypothyroidism. Iodine deficiency is the most common cause of hypothyroidism worldwide. Early Poor muscle tone (muscle hypotonia) Fatigue Cold intolerance, increased sensitivity to cold Constipation Depression Muscle cramps and joint pain Carpal Tunnel Syndrome Goiter Thin, brittle fingernails Thin, brittle hair Paleness Osteoporosis Decreased sweating Dry, itchy skin Weight gain and water retention Bradycardia (low heart rate – fewer than sixty beats per minute) Late Slow speech and a hoarse, breaking voice – deepening of the voice can also be noticed, caused by Reinke's Edema. Dry puffy skin, especially on the face Thinning of the outer third of the eyebrows (sign of Hertoghe) Abnormal menstrual cycles Low basal body temperature

Uncommon Impaired memory Impaired cognitive function (brain fog) and inattentiveness A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and decreased contractility. Reactive (or post-prandial) hypoglycemia Sluggish reflexes Hair loss Anemia caused by impaired haemoglobin synthesis (decreased EPO levels), impaired intestinal iron and folate absorption or B12 deficiency from pernicious anemia Difficulty swallowing Shortness of breath with a shallow and slow respiratory pattern. Increased need for sleep Irritability and mood instability Yellowing of the skin due to impaired conversion of beta-carotene to vitamin A Impaired renal function with decreased glomerular filtration rate Elevated serum cholesterol Acute psychosis (myxedema madness) (a rare presentation of hypothyroidism) Decreased libido due to impairment of testicular testosterone synthesis Decreased sense of taste and smell (anosmia) Puffy face, hands and feet (late, less common symptoms) Gynecomastia

2. Adrenal tumor

This term is used in conjunction with benign neoplasms which are often causing the overproduction of hormones, as opposed to “cancer”, used solely for malignant tumors.

3. Mitral valve prolapse

The newer diagnostic criteria result in an estimated prevalence of 2-3%, compared to 38% of healthy teenage males with the old one. According to Dr Oz, one way to determine if further investigations are needed is to listen for a 3rd heartbeat, where there should be none. Here’s how wikipedia describes that:

Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common. The murmur is enhanced by maneuvers that increase total peripheral resistance (i.e., squatting, hand grip) because this causes more blood to flow back to the left side of the heart, where the mitral valve prolapse is.

The proper way to diagnose it is echocardiography. Surgery is seldom required and it is suggested that magnesium supplements may help reduce symptoms of MVP.

4. Acid reflux or Heartburn

Known as pyrosis, dyspepsia or acid indigestion, it is a burning sensation in the chest, behind the breastbone or in the epigastrium and it may sometimes rise and radiate throughout your neck, etc. It is sometimes confused with angina or ischemic heart disease. It is treated with antacids or antibiotics, if H. Pylori is present.

Though I have learned something I did not know in this show, I am still not ecstatic about the medical shows that seem to have taken over the TV networks lately (the Doctors, ER, House MD etc). Even Oprah was complaining that she got diagnosed with hot flashes when she actually had hypothyroidism. These shows seem to walk a fine line between encouraging self-diagnosis and providing the public with information that their practitioners does not have the time to give them. All in all, the effect is benefic, especially when you consider that family doctors have less and less time to devote to their patients.

Apart from what Dr Oz told us, abnormal heart beat may also be a sign of the following health problems: arrhythmia, atrial fibrilation, hypertension, hypterthyroidism, dilated cardiomyopathy, (congestive) heart failure, hypokalemia, anaphylaxis, amphetamine abuse, dehydration, caffeine overdose, hypoglycemia, pulmonary embolus, sepsis, Paroxysmal supraventricular tachycardia (PSVT), stroke, mononucleosis, hyperkalemia, animal bites or stings, aortic dissection, thyroid storm, aspiration pneumonia, heart attack, septic / hypovolemic  / cardiogenic shock, lobar intracerebral hemorrhage, etc

None of the above can be a substitute for a consultation with your family doctor or for doctor advice. Even when you don’t have a family doctor, as it is the case with more and more Canadians..

Sources / More info: oz-oprah, oz-1, pa-causes, pa-reasons, pa-turbulence, pa-pd, wiki-panic-attack, wiki-hypoth, wiki-adr, wiki-mvp, wiki-hb, wiki-auscultation, wiki-murmur, macleans-fam-dr-crisis, hl-ahb, yt-panic (ib)

Consumed Consumer, health, panic, heart, murmur, tachycardia, palpitations, diagnostic, misdiagnostic, misdiagnosis