Arrhythmia

Becky asks:

My MC’s ex-boyfriend to come back with not-so-good-but-not-outright-

bad intentions to try to force her to take him back. He’s been leading a high-stress life-style (Dental School, top of his class, used to be an cyclist but stopped exercising, angry about no perfect job post school, turned-mean, etc.) and then she leaves him because he’s so awful and after almost 9 years of waiting to get married and live happily ever after, he tell her he doesn’t know if he really wants to be with her. Okay. That’s the back story on him.

Basically, he shows up in the throws of a nervous breakdown/panic attack that looks a lot like a heart attack. And that’s my question: Can a panic attack have similar/same symptoms of a heart attack? I want him to be hospitalized at least over night, so it needs to be bad enough to have to be monitored for 24+ hours, but not bad enough to kill him or leave him there long-term.

Jordyn Says:

As far as the scene, it can work medically. I think instead of a panic attack– you should go with an arrhythmia called SVT (supraventricular tachycardia.) I’ve included some links for you. At its simplest, SVT is a super fast heart beat. For an adult– it would be a sustained, unwavering heartbeat over 180 beats/min.

http://www.mayoclinic.com/health/tachycardia/DS00929/DSECTION=causes

http://www.cnn.com/HEALTH/library/heart-arrhythmias/DS00290.html

http://www.webmd.com/heart-disease/tc/supraventricular-tachycardia-overview

The reason to change it to this type of medical condition is if the medical team determines he had a panic attack– he will not be observed overnight. However, if he had an arrhythmia for which he was hemodynamically unstable (low blood pressure)– then observing overnight is warranted– particularly if they converted him out and he went back into it.

When you have SVT– it can feel like you’re having a heart attack. Many of the symptoms can be the same. Chest pain. Pain down the left arm. Jaw pain. Difficulty breathing. Low blood pressure. Sweating (diaphoresis). Pale, cool, clammy skin.

I don’t know if this is the direction you want to go but would be my suggestion.

Last post, I discussed the issue of heart palpitations and how, in isolation, they can be benign and not representative of heart disease.

The line in this particular published novel that did get my ire up is shortened as follows: “Any experience terrifying enough to cause a panic attack, in extreme circumstances, causes an arrhythmia. That’s a heart attack.”

Really? No. There’s a lot medically wrong with this sentence.

First, in very general terms, a heart attack is caused from lack of oxygen to the heart muscle, generally from a clot in an artery that feeds blood to the heart– your coronary arteries. When the heart muscle is not getting oxygen, it becomes irritable. One interesting thing about your heart is that each cell can generate an electrical current that will contract heart muscle. It generally does not do this due to the over-riding normal pacemaker. However, when oxygen is cut-off and the heart cells become irritable, they can begin to fire outside the normal conduction system.

When this happens, the medical team begins to see aberrant beats. But see, the heart attack itself generally causes the arrhythmia, not the other way around.

Let’s stay on track with this character. A healthy, college age woman. The incidence of actual heart disease is going to be low. What causes chest pain during a panic attack? Generally, the heart rate may be faster than usual. However, the truly rapid heart beat of SVT (more on that later) I would say is rare and would point away from the mind and more to the conduction system in the heart.

The last thing to consider is that people who have true heart arrhythmias, may have structurally fine hearts. Meaning the muscle, valves, and coronary arteries are good. Just the conduction system is a little funky.

My advice for authors– don’t make blanket medical statements. Just like they taught you in school– sentences that have all, every, etc… are likely the wrong answer.