joojee

In my opinion, a true, classic panic attack is a severe autonomic nervous system reaction, probably some sort of cardiovascular event, that is triggered often, but not always, by an acute feeling of anxiety. The panic attack (and this is such an awful, confusing name for it) is the physical event. The anxiety is the trigger. They are not the same event, and don't always even happen together. During a true panic attack a person does not have racing thoughts of anxiety about anything other than what is happening to their body - which is much more significant than a lot of people think. Fears of losing control - the autonomic nervous system has gone haywire. Fear of losing control in this situation is actually a rational thought. You HAVE lost control. Sense of dying - this is not unique to panic attack. The same thing is reported in people having heart attacks, going into shock, and probably other medical emergencies. Those with panic attacks are battling the same 'it's all in your head' that POTS sufferers do. There are other conditions also often, but not always, triggered by anxiety. Takotsubo cardiomyopathy. Paroxysmal hypertention (Page's Syndrome, psueudopheochromocytoma). These conditions are taken seriously only because they can be observed and measured - ballooning left ventricle, elevated troponin, elevated dopamine sulfate, etc. And yes to the poster above, you CAN have an autonomic fear/defense response without feeling any kind of anxiety. According to Joseph Ledoux, a leading neuroscientist in the area of fear/defense systems in the brain, there are 2 related but not identical pathways in the brain that carry messages of anxiety. One results in 'feelings', the other goes straight to the autonomic nervous system and results in physical manifestations (heart rate, etc). Not only are these pathways not identical, they can occur independently of each other. Some people can feel very anxious but not have any physical manifestations, and it is also possible for your body to have a strong fear/defense reaction without you feeling any sort of fear or anxiety.

I wonder if this has any connection to what happens in Burning Mouth Syndrome

I would just like to toss in some info re 'fight or flight'. Joseph LeDoux of NYU (a neuroscientist studying fear/anxiety/defense mechanisms) offers some fascinating insights into the autonomic 'fear/defense' mechanism. The key point I find interesting, is that this autonomic response is related to but not identical to the 'emotional' sense of anxiety. In other words, you can have a 'fear' or 'fight or flight' purely physical autonomic response without feeling at all stressed or fearful emotionally. Given how powerful the autonomic response system is in altering body functions (hemodynamics, heart rate, fluid balance, etc), this is quite interesting. If you look at the issues of stress cardiomyopathy (also called takotsubo cardiomyopathy), paroxysmal hypertension (Page's Syndrome, pseudopheochromocytoma) and who knows what else - doctors seem to attribute the cause as probably being 'emotional' - yet a significant percentage of patients cannot identify any emotional triggers - probably because they DON'T feel any emotional trigger. This is not to suggest a person needs talk therapy if this is the case - LeDoux, if I am correct, states the part of the brain that interacts with the amygdala during the autonomic response does not have the wiring to be influenced by the 'conscious' parts of the brain. An interesting item - stress cardiomyopathy - happens almost exlusively in menopausal women.

There is something called 'stress cardiomyopathy' you may want to ask your doctor about. This type of issue is supposedly caused by some type of psychological stress - but a lot of patients don't experience this psychological anxiety symptom so feeling 'stressed' is not an absolute prerequisite. With this issue they need to look at your left ventricle because the other tests may come out normal. Also, catecholamine levels tend to be much higher with this - did they test your blood catecholamine levels?

Did you ever find any answers from the doctors about the high dopamine sulfate? I've found high dopamine sulfate levels come up in different issues related to heart and hemodynamics in the literature. Dr. Otto Kuchel published a few interesting items on this.