Management Of Chest Pain 5 - Example for Conny

In the previous section were concerns and bodily reactions discussed. If the bodily reactions give a strong anxiety reaction can lead to panic attacks. First, the background for why panic occurs is illustrated with an example.

While walking peacefully in the woods suddenly a moose running towards you. You responds instantly to leap to safety. This is an entirely appropriate response to a threat.

For you to be able to react swiftly happens automatically a series of reactions in the body when the brain perceives a situation as dangerous.

The alarm goes off!

The reactions in the body enabling you to either flee or fight and is often called the "flight or fight" responses. In a dangerous situation, these reactions are useful and potentially lifesaving.

It takes a series of reactions in the body when the brain perceives that you are in a dangerous situation.

The most important are:

• The heart beat faster and harder to get more blood to the muscles in the body
• Breathing faster to provide more oxygen to the blood
• The blood is redistributed from the digestive system and skin to the major muscle groups
• You start to sweat to cool the body

The reactions that occur are controlled by the autonomic nervous system. Autonomy means self and this nervous system is not voluntary. We may have little impact on this part of the nervous system itself.

The autonomic nervous system consists of two main components that work together:

• The parasympathetic system
• The sympathetic system

When the body is at rest, it is mainly the parasympathetic system is activated. This part of the autonomic nervous system activates including digestion and reduces heart rate and blood pressure.

The sympathetic system is the body's emergency system and activated when needed. When this system is activated, including adrenaline secreted which in turn stimulates the sympathetic system further. It is this system that activates the "fight or flight" reactions.

When the alarm goes off in a dangerous situation, this is an entirely appropriate and necessary response. Everything that happens in the body is reasonable in relation to fight or flee.

The problem arises from the false alarm, ie to obtain the activation of the alarm system in the body when there is a real danger one can escape or fight. It is in such situations, panic can occur.

When the alarm goes without that there is a real danger one can escape or fight, there is the same activation of the sympathetic nervous system as if it were a real danger. The adrenaline pumping, hearts beating and breathing quickly.

There is plenty of oxygen and energy available that is not being used, in addition, all the major muscles in readiness.
This leads to the following:

• There is a short term imbalance of oxygen and carbon dioxide in the blood.
• The produced mass excess energy that is not used and causes sweating
• The muscles tense up without being used

When you breathe quickly and superficially it becomes much oxygen in the blood. In addition, aired it out much karbonioksid (CO2). Carbon dioxide (carbonic acid) is acidic and is used in soft drinks. When there is little of this in the blood is blood pH up.

This causes a variety of symptoms such as:

• Dizziness
• Blurred vision
• Feeling "Unreal"
• Tingling / numbness that usually start around the mouth and moving around

Feeling of not getting enough air or choking sensation is common. At high breathing rate and imbalance in blood will blodgjennomstømmningen to brain changes. This causes the brain signals that one should breathe even faster even though it really is a lot of oxygen in the blood!

There are altered blood flow to the brain due to imbalance in the blood that cause dizziness, blurred vision and light-headedness.

These changes in blood / blood flow is temporary and completely harmless, but gives a range of unpleasant symptoms.

Rapid breathing causes referred to an imbalance in the blood.

By rapid and shallow breathing we use the upper part of the chest to breathe, and not lower as in normal breathing. These muscles are smaller and are quickly exhausted. This results in pain in this musklaturen.

Rapid and shallow breathing over a period of time thus chest pain!

In addition to shallow breathing will also general tension in muscles may contribute to breast pain.

• Cold sweat - little blood to the skin in combination with sweating gives sweating on cold skin
• Dryness of mouth - saliva on hold when the alarm is on
• Dilated pupils - pupils expanded to look better, but may be giving blurred vision

Most reactions caused by false alarms can be experienced very frightening. This again reinforces the panic reaction.

There are two main points that are particularly important:

• The bodily reactions to false alarms is unpleasant but natural and harmless
• The sympathetic system and the parasympathetic system work together. It means that after a certain time, the parasympathetic system downregulate the alarm automatically! Thus it is not physically possible to have a panic over a long time. Panic can not develop into a dangerous level, the parasympathetic system prevents this.

It is also worth noting that after a panic attack, there will be some second nalin and other substances in the blood that takes time to break down. Therefore, it is common to feel turned a certain time after the panic has calmed down.

Panic can be triggered by either an external event that is perceived as threatening or a bodily reaction as experienced frightening.

This leads to:

• Negative thoughts or catastrophic thoughts
• Feelings of anxiety / fear
• Bodily reactions

The order can vary, but the point is that points 1-3 mutually reinforce each other and lead to a vicious cycle that can spiral out of control, and create panic.

Typical catastrophizing thoughts in a panic attack:

• There is something wrong with my heart
• I have a heart attack
• I swoon
• I suffocate
• I lose control
• I'm going to die
• I'm about to go crazy

Triggering situation: My heart beats fast and hard

Disaster Thought: There is something wrong with my heart

Feeling: Anxiety rises

Bodily reaction: The heart beats even faster and harder

Disaster: It's certainly something seriously wrong with my heart

Feeling: Even higher anxiety

Bodily reaction: The heart beats even faster, your breath is quick, tight throat and chest pain

Catastrophizing Thoughts: I have a heart attack, I'm going to die

The point is to illustrate how thoughts, feelings and bodily reactions can reinforce each other.

Try to think back to an anxiety situation you remember well, such as the one that led to hospitalization for chest pain.

It is difficult to make any sense of anxiety / fear directly.

What you can do is to challenge catastrophe mind and understand the physical reactions.

In addition, it is possible to force their slow your breathing during a panic attack.

Bodily reactions:

When the bodily reactions are:
Try to remind you that the reactions are natural and harmless, even if they are unpleasant.

Catastrophic thoughts:

Attempts to challenge the negative thoughts:
Are you absolutely sure that they are true? Could there be another explanation, such as anxiety attacks?

Breathing Exercise:

During panic attacks do as follows:

1. When you breathe in - count to 4
2. Hold your breath for breath for a count of 4
3. Exhale for a count of 4
4. Hold your breath on the exhale for a count of 4

The goal is to use 10 to 12 seconds on each breathing cycle to normalize oxygen / carbon dioxide is the imbalance in the blood.

After 10-15 minutes, many of the bodily reactions are reduced.

Continue with 30 minutes of daily physical activity. Two of the days will be a little higher intensity. One of the days will be moderate to high intensity. If you think the task is too easy, you can do the exercises at higher intensity.

Over the next seven days you shall make a daily activity:

4 of the days - make an activity light intensity
2 of the days - make one active with slightly higher intensity
One of these days - do an activity with moderate / high intensity
In moderate / high intensity will your heart beat fast and hard, you will be tired and quite sweaty. To achieve this, one can for example add more sessions during which one looks almost completely.

The goal of the sessions with lettgradig intensity is that you know that your heart beats, and gets a little sweaty and tired.
The goal of the sessions with slightly higher intensity is that you will know very well that the heart beats, sweat and moderately tired.
The aim of the session with moderate / high intensity is that you will know that your heart is beating fast and hard, get sweaty and tired properly

After you have made ​​the physical activity records this activity in the form.

We recommend that you return to activity form every day after you have done the activity to detect that you have done the activity.

Within a week you will be contacted and you will then gain access to the next section.

During the next week's task is to make a lettgradig activity four days, an activity with slightly higher intensity two days and a day of moderate / vigorous activity.

Duration of activities shall be at least 30 minutes.

There is a separate form to record the activity when you have completed it. You have been given a code for this form.