Brief Answer:
Panic attack treatment to be started under pyschiatrist supervision

Detailed Answer:
Hi
Firstly thanks for choosing XXXXXXX care magic for your query!
Have noted all your details , your symptoms are most likely because of panic attacks and high levels of anxiety.

A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes .
According to journals published by college of XXXXXXX psychiatry a panic attack episode should include at least four of the following symptoms:
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Paresthesia (numbness or tingling sensations)

And in the brief history you mentioned you have all the four symptoms i.e
Anxiety, dizziness, shortness of breath and palpitations.

Stress test and echo combined together are more then 85% sensitive to rule out cardiac ischemia, most common cause of ventricular premature beats is ischemia , however the second most common cause is anxiety , higher anxiety levels may cause pvc's .

You have not mentioned the number of pvc's recorded in your holter test ,and if any run of non sustained ventricular tachycardia was there or not .

Bisoprolol 1.25mg is a sub optimal dose , ask your cardiologist to gradually increase the dose to 5mg once daily.

Apart from bisoprolol you should start SSRI's .SSRI,s can help prevent anxiety and reduce the frequency and severity of panic attacks, they are also used for immediate relief during an attack.Frequently used selective serotonin reuptake inhibitors (SSRIs) are Prozac, Paxil, Celexa, Lexapro, and Zoloft.Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that work by increasing the level of a chemical called serotonin in your brain.Ask you doctor to start you on minimum possible dose and increase the dosage every third week.
Imipramine and clomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants aren't addictive.They can be added to SSRI's.
Benzodiazepenes like clonazepam should also be given to lower the levels o anxiety .
The therapy will be given for atleast three month before a change is observed , apart from medicines life style modification should be followed .Try to meditate, yoga , and exercise will help.

In case you have any other query i would be happy to help!

Advice
Attach holter report


Thanks
Dr Rishu Saxena
Cardiologist

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Brief Answer:
Take treatment for panic attacks and anxiety!

Detailed Answer:
Hi,
Have seen your holter reports , only singlet pvc's are there.No sustained or non sustained runs of ventricular tachycardia was there hence , Psychiatric consultation is must.
As stress test was also normal,chances of cardiac ischemia are quiet less.

Advice
Treatment of panic attacks and anxiety should be started under guidance of pychiatrist for at-least 1 month, continue bisolprolol (monitor your blood pressure every third day,it will not cause dizziness unless blood pressure is less then 100/60mm of hg) , secondly it will help to eliminate PVC's.
In fact i would advice you to increase the doses of bisoprolol to 5mg once daily (optimal doses).

Thank you,
Dr Rishu Saxena
( YYYY@YYYY )

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Brief Answer:
Start with 2.5mg daily for 7 days,follow up after that!

Detailed Answer:
Hi,
Increase the doses gradually,initially make it 2.5mg once a day for 7 days then make it 5mg once a day ,take IT for 21 days ;keep a record of your blood pressure every 3rd day.After then you can again follow up with me ;A increase or decrease in dose depends on the response of your body to the drug.

Its always advisable to stop a medicine by tapering it ,sudden withdrawal of medicine can cause withdrawal symptoms.

Consult a pyschiatrist ,increase bisoprolol to 2.5mg,follow up with me after 7 days!

Thanks!
Wish you a happy recovery.

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