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Suggest Treatment For Irregular Heart Rate, Anxiety And Bradycardia

Posted on Mon, 29 Jun 2015

Question: Hi doctor i had all my cardiac tests done by 2 cardiologists in the past year. The most recent was 4 months ago where my echocardiogram showed a structurally normal heart. I also passed my stress tests and my 48 hour holter showed 400 pacs and 15 pvcs. I am worried because my heart rate feels very irregular. For example the beats are not spaced our evenly sometimes they will be a few slower beats and then some faster ones but never repetitive. My holter showed always in sinus rhythm with some slight bradycardia 26 % of the time. I do not knopw if this is a problem but my cardiologist says it is completely normal. He says my etopic beats are due to anxiety as i do suffer from anxiety. My lowest heart rate was during sleep at 41bpm and the highest was 163 bpm. Can anxiety really be the culprit for this irregular heart beat. I also have some acid reflux. I am really worried because when i check my pulse it does not seem normal to me. I called my cardiologist last week but he insists my heart is healthy and i do not need a follow up until maybe next year

Answered by Dr. Benard Shehu (56 minutes later)

Brief Answer:
Following advice.

Detailed Answer:
Hi XXXX!
Once again I read your query and understood your concerns.

All your cardiac examinations were normal and you shouldn't worry about those palpitations as long as your rhythm was sinusal (normal) and only pacs and pvcs were recorded.

Those findings are very common in patients with anxiety disorders and acid reflux. Moreover the alterations in HR especially tachycardia is a common findings in patients with anxiety disorders.

Pacs, pvcs and HR alterations are felt as irregular pulse (on pulse palpation). You shouldn'tworry about that because no other arrhythmia were detected on holter.

My opinion is that you should stay relaxed and keep going with BCT and to treat acid reflux. This will help you to relieve your symptoms.

Wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (52 minutes later)

Hi doctor today I had a meeting with someone about taking over their restaurant. I felt very anxious driving to the meeting as it is a very good opportunity for me. When I got there I started to feel lightheaded and a little numb on my face. I checked my pulse and it was difficult to find as I felt numb and my pulse was weak and slow. I kept on with the meeting and it passed after a minute. Then my heart rate felt faster over 100. I did not eat before the meeting and I felt a few etopic beats while driving there. What can this be? I'm very worried

Answered by Dr. Benard Shehu (15 hours later)

Brief Answer:
Following advice.

Detailed Answer:
Hi back,

You shouldn't worry about the lightheaded, numbness feeling. It's caused by a combination of low blood sugar (hypoglycaemia because you didn't eat before meeting) and anxiety.

As long as you eat something sweet before themeeting and you tryto get calm and relaxed everything it's going to be ok.

Hope this was of help!
Wish you luck with the new business!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (3 hours later)

Doctor thank you for clarifying this. I have one more question to ask you before I close the discussion. I know most things come down to anxiety however I have been having episodes where I will just be sitting at my computer working where I start to feel a weird feeling in my body. Like an agitation. Then I check my pulse and it is irregular. Fast and slow beats. Is this a symptom of a fib or another arythmia? Also how can I tell if it's afib without an ecg? I've never had afib on a holter or any test but these symptoms are strange to me. Also they pass after 2-3 minutes. Is this common of an arythmia or is it just pacs?

Answered by Dr. Benard Shehu (50 minutes later)

Brief Answer:
Following advice.

Detailed Answer:
Hi back,

What you are experiencing are more likely to be frequent PACs and PVCs, as long as your holter never recorded atrial fibrillation.

The frequent PACs, PVCs and ventricular pauses that follow are misinterpreted from untrained people (especially on pulse palpation) as irregular rhythm.

In those cases i would recommend to avoid checking the pulse because misinterpretation increase your anxiety and worsening your symptoms.

Wish you health!
Dr. Shehu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Benard Shehu (4 minutes later)

Ok doctor thank you. If it is frequent pvcs is that dangerous for me? My Holter usually showed pacs and very few pvcs. Only 15 pvc in 48 hours but 400 pacs. Is it more likely pacs that I am experiencing?

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer:
Following advice...

Detailed Answer:
Hi back,

Both Pacs and Pvcs are harmless in a normal functioning heart and shouldn't worry about them. You may experience within the two minutes that you palpate the pulse both Pacs and pvcs and this is why you misinterpret your pulse as arrhythmia.

Wish you health!
Dr. Shehu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar