Arrhtthmia and Paxil?

[John__0__0]

   Dear CCF;
        My Stepfather was once a department head at CCF, I know that CCF is
  up to date on the latest info so here is my story.
        History; I am a 40 year old white male, 6', 205 lbs. I am a smoker,
  2 to 3 packs a day for 20 years now, I drink about a six pack of beer each
  day, Blood tests ok, chest xray clear, Liver function normal. I had a Thalium
  stress test two years ago after my first Panic attack, which I thought was a
  heart attack. After a year of suffering these attacks and seeing many doctors
  my GP sent me to a Psychiatrist who put me on Lorazepam 4mg per day, which
  stopped the attacks, after 18 months on the Lorazepam he added Paxil to the
  mix, after about 5 weeks at 10mg per day, I started getting PAC's which again
  sent me to the ER at 2AM. The ER Doc said my EKG was normal, but further
  monitoring dit show a couple PAC's which he said were benign and although
  uncomfortable they were harmless, and not a sign of Cardiovascular disease.
  My BP runs around 140 over 90 and my pulse around 100. I can seem to go for days
  without PAC's then boom, I feel a few. I was wondering if the Paxil has been known
  known to produce PAC's and if so will they continue as long as I am on the drug, or
  could it be a short term side effect. When I got my first panic attack I felt
  a rush come over my body centered in my chest, I got to the ER just seconds
  after the attack subsided and all tests were normal. But I had flu like fatigue
  symptoms which lasted for 6 weeks after that first attack. and each subsequent
  panic attack would leave me sick for at least a week. No MD I have seen has
  ever heard of such a lasting effect from a Panic attack before, have you ever seen
  this in a patient??? I deeply appreciate any advice you can give. I would
  ask my stepfather but since I am not a calf or monkey looking for an artificial
  heart, I will pass!
                                                      Thank you,
                                                               John Brisbin
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Dear John:
Paxil is known to cause palpitations in a small number of patients.  As far as antidepressant medications go, it belongs to a very safe class of drugs with respect to the heart.  However, if your palpitations are worse on Paxil, it may be responsible.  A portable 24 - 48 hour EKG monitor would be able to determine just how many PACs you are having.  It would be unwise to stop the Paxil without first consulting with your psychiatrist.
I am not aware of panic attacks causing such prolonged symptoms, other than when there is an underlying major depression.  However, you should address this issue with your psychiatrist.
Also, I must comment on your smoking and excessive drinking.  At your current levels, you will almost certainly develop significant medical problems, cardiac and otherwise.  In addition, in some people alcohol, tobacco, and caffeine can cause PACs.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.