Question: Hi. I recently went to a cardiologist. I have had anxiety/panic/agoraphobia for about 17 years that is accompanied by tachycardia. While some heart palpitations are common with my panic attacks, under heavy stress or when doing intense exercise I have tachy of 220-240 bpm. It usually lasts for several minutes. During the episode I am unable to stand and short of breath and dizzy. I have told myself that it is a symptom of a panic attack, but my psychiatrist recommended I have a cardiac stress test. My cardiologist performed an ECG, which apparently was a bit abnormal. He believes it might be SVT. I take Inderal (propranolol) daily to mitigate tachy, which is usually quite effective. I have a trip to Europe planned for this week, but my cardiologist told me not to go until I have seen an EP to do an echo and have further diagnosis. I would like to know if it would still be possible to take my trip. The next appointment I can get with an EP is not for three weeks.

Hi. First, let me make a small correction that the doctor I saw was a family practice physician, not a cardiologist.

In answer to your question:
1) In the past 5 years I have taken propranolol in doses of 10mg as needed when I have, or anticipate, tachy associated with my panic attacks. It was prescribed by my psychiatrist.
2) I presently take 30mg each morning before I leave for work. In the past few years I have had several fast tachy episodes with only 10mg, but to my knowledge I have only had one tachy episode that could be >200 bpm for several minutes while taking 30mg of propranolol. It was about one month ago just as I was waking up in the morning. Generally with 30mg of propranolol I do not feel any tachy, even when anxious. Once or twice do I remember having a palpitation when taking 30mg of propranolol. They were very brief (a few seconds).
3) During heavy physical activity I can often trigger a fast tachy. Sometimes I have them at rest (usually very brief) but at rest is usually associated with panic/anxiety, except the one episode I mentioned in answer #2.

Other information:
I successfully used an SSRI (celexa) for several years to manage my anxiety, but now it is no longer effective. Over the past several months I have been trying other medications (SNRI's, etc.) with the help of a psychiatrist, but in order to manage my panic attacks I use 30mg of propranolol in the morning and 10mg in the evening, combined with a benzodiazepine such as Xanax or Klonopin each day. The most propranolol I have tried is 40 mg. I felt a bit odd when taking it, but not dizzy. It could have just been anxiety about taking more propranolol and knowing that it would reduce my heart rate

My BP is typically 120/70. My resting heart rate is usually 65-75 bpm. I had blood work done recently. Nothing was abnormal. Total cholesterol was 199, Triglycerides were 89, HDL was 60 and LDL was 121. TSH was normal (0.891). Sodium was 143, Potassium was 4.3, and Calcium was 9.3. I can provide additional blood work results if you would like. I am 180cm and currently weigh 104.5kg (overweight). I walk each day up 1-3 km, but avoid strenuous exercise. I work in an office. My job can be stressful and is mostly sedentary.

Please let me know if there is any other information you need.
Thank you