Many physical illnesses can produce nervousness in individuals who are not emotionally troubled. Certain other physical disorders -- those discussed in this section -- can cause a cluster of symptoms that resemble those of panic.

Physical Causes of Multiple Symptoms

The predominant cardiovascular disorder that can produce multiple symptoms is hypertension, caused by a narrowing of the arteries. As your heart pumps blood through your body, it exerts a certain amount of pressure on the arterial walls. If these passageways become constricted for some reason, it requires greater force to maintain a steady flow of blood. The entire circulatory system is then under strain, and hypertension is the diagnosis. This, as mentioned earlier, is often a symptomless disease, but you might notice such symptoms as palpitations, nervousness, dizziness, and fatigue, as well as a general sense of ill health.

Mitral valve prolapse is a common condition found in approximately 5 to 15 percent of the adult population. In this disturbance a valve leaflet within the heart balloons into the left upper chamber (the left atrium) of the heart during contraction. About half of all people with mitral valve prolapse will complain of heart palpitation sometime in their life. Other possible symptoms are rapid heartbeat, shortness of breath, dizziness, and an increased awareness of the heart's action. This is a rather minor cardiac problem, but people can erroneously blame it as the sole cause of panic attacks. More often, though, it is the patient's fearful preoccupation with the action of his heart that produces panic. You will find a more extensive discussion of mitral valve prolapse in Chapter 6 of the self-help book Don't Panic.

Location of mitral valve and change in appearance after ballooning.

There is growing evidence that hormonal changes can dramatically affect a person's physical disposition and mood. For instance, approximately 50 percent of women experiencing menopause report some major physical and/or emotional changes. Another 25 percent have uncomfortable, even distressing, symptoms that can include intense moments of palpitations, sweating, hot flashes, and anxiety. Premenstrual syndrome identifies a complex of symptoms, including panic, occurring in the days just before menstruation. You will learn more about premenstrual syndrome in Chapter 5 of the self-help book Don't Panic.