Panic Disorder and Heart Attack – the story of a young South Asian man

Aditya is a 34 year old Indian male with a wife and a son who is two years old. He and his wife immigrated from India 3 years ago and settled into an apartment in a diverse neighborhood in the United States. On his 34th birthday, he ended up in the hospital. The doctor asked his wife for his history and she began to tell him:

Aditya was born a healthy baby boy to his parents, Kusum and Narayan, who had hoped he would be a boy. He had terrible stranger anxiety as an infant, but grew out of it as expected and became a social child. He enjoyed playing with other children and was very close to his older sisters. When his younger brother was born, when Aditya was 4 years old, he was thrilled and wished to be a part of Mani’s care, giving him bottles and helping to change his diaper.

As a teenager, Aditya withdrew more from people and did not have too many friends. In fact, he preferred to be alone most of the time. Growing up in a large city in South India with a father who was an engineer and a mother who was a dance teacher, Aditya found it difficult to stay away from people other than hiding out in his room. He was a very intelligent boy and succeeded in academics as did his two older sisters, Vidhya and Mamta, and his younger brother, Mani.

One day after he returned from high school, when he was 15 years old, Mani asked him to come outside and play cricket with his friends. Aditya refused but when his mother heard she also joined in encouraging Aditya to go outside. He began to feel pressured and became very enraged.

“Don’t tell me what to do!” screamed Aditya. “I don’t want to go outside!” He ran into the room he shared with this brother and slammed the door.

His father was home and saw this altercation. When his mother tried to follow him, his father said, “Leave him alone. You’ll baby him if you always ask him why he’s upset. Let him cool off on his own.” His mother hesitatingly turned around and went back to her chores.

What his parents and siblings didn’t know is that Aditya was hiding from people to avoid being embarrassed. On average, about three times per week, with no easily identifiable reason, he would start to feel like he was choking. His chest would tighten, his hands would start shaking and he would get the chills despite sweating all over his body.

Sometimes he would feel this way in class, during which time his classmates would laugh, thinking that he was pretending he was afraid of the exam or thinking that he was trying to get attention. The bullies at school started making fun of him and soon other boys joined in. The problem became so bad that he eventually started skipping classes to study on his own. He would only show up for exams and would pass them with flying colors. Because his academics were so high, his teachers nor his classmates thought anything of his absence from classes.

Other times, he would feel these symptoms even if he was playing outside by himself without peers around. Still other times it would happen at his cousin’s house or at the doctor’s office, despite always getting a clean bill of health. There did not seem to be a pattern to what triggered his symptoms.

He was so worried about what people would think that he hid the symptoms even from his family. Particularly, he was afraid his father would think he was “girly” or a “sissy”, something he thought often about Aditya.

For years his symptoms continued with similar frequency and similar unpredictability. Still he graduated from a prestigious engineering university in India, got married and immigrated to the United States days after their wedding.

About two weeks after their wedding and their move to a new country, Ritu and Aditya were watching a movie at home when he started sweating. His breath rate increased, as did his heart rate, and he felt like he was suffocating. She became very worried but did not know what to do to help. After about 3 minutes when the symptoms had passed she asked him about what had happened. He confided in her that he had felt this way for approximately 15 years but had not told anyone.

“It’s going to be fine,” he reassured her. “I’ve lived with this for so long and I’ve been fine.” She insisted he see a doctor, but he reminded her that his physical exams always came back clean and that he was too young to have a serious problem.

She dropped the subject with reservation, but dedicated herself to trying to figure out a pattern to his symptoms so she can mention them to his doctor at his next physical exam. For three years she watched him suffer with his symptoms without any explanation or trigger. Ritu finally made an appointment with his physician who conducted an EKG and a stress test. Both tests showed that his heart was healthy and his doctor simply asked him to reduce his salt intake if he wished in case he was retaining water. Ritu was dissatisfied with this explanation but had no other ideas of what else could be going on so she adhered to the doctor’s adivce without much change.

Six months later, on his 34th birthday, the two of them went to their favorite Malaysian restaurant near their house, while their neighbor watched their 2 year old son. At the restaurant, Aditya’s symptoms resurfaced for about 5 minutes while they were waiting for their food. After, he groaned in pain and clutched his left arm. Ritu became very scared and dialed 911.

Aditya had a moderate heart attack.

Ritu was shocked. He was in very good health, ate nutritiously, exercised well and was average weight. In addition, he was only 34 years old!

From the history of his symptoms and the many tests that they ran, the doctor at the hospital concluded that he had been suffering from panic disorder since he was 15 years old. He sat with Ritu and Aditya and explained that anxiety disorders such as panic disorder have been shown to significantly increase a cardiac event, such as heart attacks and strokes. He mentioned to them, very seriously, that panic disorder, if left untreated, could lead to a more serious heart attack in the future and possibly even death. He also reminded them that South Asians are at a higher risk for cardiovascular disease, which makes treating the panic disorder even more crucial.

They became convinced to take this disorder seriously so the hospital helped Aditya find a good South Asian therapist as well as a psychiatrist to help manage his anti-anxiety medication until his symptoms improved.

This is just one example of the presentation of symptoms of panic disorder in South Asians. Please click here for more information about panic disorder and its numerous other symptoms.

This story is purely fictional and is not intended to represent a real family. Any similarities between this family and a real life family are purely coincidental.