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Heart Disease (Expert Forum)
Heart stress under anesthesia
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Heart stress under anesthesia
by wxci, Dec 10, 2004 12:00AM
I'm a 44 yo male, with a long history of panic and anxiety and subsequent dependence on prescribed benzos like xanax. It took me years to taper off of these benzos due to terrible rebound anxiety, chest pains, PVCs, and tachycardia. My doctor and I tried propranolol for a couple of years as an anxiolytic, but I started developing more and more PVCs, including nocturnal ones. Now, after ceasing all medications for months I have a few PVCs now and then but I've learned not to let them bother me. No caffeine, smoking etc and healthy lifestyle including jogging and good diet. If I have any alcohol or sedative like benadryl, for a couple nights after when I wake up I have a couple minutes of tachycardia until I rise to full consciousness. Event monitor showed a few PACs/PVCs and sinus tachycardia up to 160 max. Dr isnt concerned.
Under general anesthesia or twilight anesthesia, might PVCs or sinus tachycardia upon awakening cause complications for the surgeon? Is the physiological stress of surgery added to pre-existing "touchy" heart (as my dr calls it) dangerous? I'm concerned that a cocktail of anesthesia drugs including scopolamine & versed might make my heart rate unstable, cause a panic attack, and freak the operating team out.
Under general anesthesia or twilight anesthesia, might PVCs or sinus tachycardia upon awakening cause complications for the surgeon? Is the physiological stress of surgery added to pre-existing "touchy" heart (as my dr calls it) dangerous? I'm concerned that a cocktail of anesthesia drugs including scopolamine & versed might make my heart rate unstable, cause a panic attack, and freak the operating team out.
Doctor's Answer
by CCF-M.D.-MJM, Dec 10, 2004 12:00AM
Hello,
I understand your concerns. There are two seperate issues here. The first is regarding panic attacks. While they make you feel like you are going to die, you will not die from a panic attack. If there are complications from surgery, it would more likely manifest as a fast heart rate and low blood pressure. I panic attack would cause high blood pressure and tachycardia. They should be able to distinguish the two. Don't forget, that they are giving sedatives that act by the same mechanism as xanax.....you should be relaxed.
I don't know what your surgery is. You should have a preoperative risk assessment prior to surgery. your doctor will decide whether you represent low, intermediate, or high risk for complications. It is always possible to have heart problems with surgery, it will not stem from a panic attack or anxiety.
Good luck with your surgery and thanks for posting.
I understand your concerns. There are two seperate issues here. The first is regarding panic attacks. While they make you feel like you are going to die, you will not die from a panic attack. If there are complications from surgery, it would more likely manifest as a fast heart rate and low blood pressure. I panic attack would cause high blood pressure and tachycardia. They should be able to distinguish the two. Don't forget, that they are giving sedatives that act by the same mechanism as xanax.....you should be relaxed.
I don't know what your surgery is. You should have a preoperative risk assessment prior to surgery. your doctor will decide whether you represent low, intermediate, or high risk for complications. It is always possible to have heart problems with surgery, it will not stem from a panic attack or anxiety.
Good luck with your surgery and thanks for posting.
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My PVCs increases dramatically after eating when I am having a bad epiosode of them. In general after eating , blood is pulled from the heart to the stomach to aid in digesting the food , this usually causes an increase in heartrate or tachycardia in most persons, for some the pulse is slowed after eating,If the eating causes an increase in heartrate and the PVCs disappear then the PVCs are probably vagally mediated to start with , if the PVCs increases after eating and the heartrate is faster they are probably sympathetically driven, if your heartrate decreases after eating and the PVCs increase, the PVCs are probably vagally mediated also.
PVCs that are reduced by exercise and an increase in heartrate are usually vagally mediated PVCs, PVCs that are occur with exercise and a afster heartrate are usually sympathetic driven.
Just a quick thought. I understand your perspective regarding PVC's. At times, however, it helps some of to talk and share about our issues, it makes the burden lighter. Hope that makes sense.
Uptown
TO Everyone, I sincerely feel for those that have severe heart disease and heart problems, in most PVCs are almost an intolerable nuisance that why we complain about them so much.
I myself have a chronic connective tissue disease , so I know what suffering is like, somedays I feel so painful and stiff , I would almost rather a couple PVCs for those days.
You will find it common among those with serious potentially life threatening heart problems to be aggressive toward others with "minor" problems like PVCs who complain frequently yet their symptoms pose no threat life. Those people tend to feel trapped and unfortunate, not all but some, and would welcome the nuisance of PVCs anyday.
I feel for them and understand where they are coming from, unless they are really rude to you and even when they are , it is best to wish them well and move on, they often refer to us as feeding off anxiety, well they for some reason tend to feed off of contentious debates" how sad for them" , they are only human and unfortunately that is the personality of some with a potential life threatening illnesses, they are past the anxiety stage, yet haven't made peace with what the final outcome might be. I know this sounds blunt, but it is a fact that needs to be stated.
I sincerely wish them the best with these serious conditions, but from now on I will refuse to get into contentious debates or exchanges with them and I would encourage everyone to do like wise, that way it will stop.
Best wishes.
Maybe if the doctors/cardiologists would come to a common agreement, maybe we would not be so scared of these PVC's. For example: I read in a magazine and on this board that PVC's during exercise can be fatal. When I asked my Cardiologist he brushed it off, when I got a second opinian again from a Cardilogist he said "do you believe everything you read". BOTH Cardiologists told me that PVC's during exercise are NOT dangerous. I get them at times when I go for my fast walks, sometimes real bad that I either return to my car or I keep on walking remembering what these TWO cardiologists told me. And btw. I was not told this 30 yrs ago or 10 yrs ago, but LESS THAN A YEAR ago. By two very good Cardilogists who work in a well known top Heart and Lung Hospital in our city. I also had these PVC's during a stress test, again was told "not to worry" only to read articles which some of them were written by CARDIOLOGISTS that PVC's can be fatal during exercise. Give me a break! Count your blessings that you don't have to go through this hell when your heart skips every other beat for a very long time. One time I had an EKG done it showed that I had a "previous heart attack" follow up EKG's didn't show a "previous heart attack". The explanation from TWO Cardiologists were "sometimes people who had a heart attack also have PVC's, the computerized EKG could not distinguish between benign PVC's or PVC's following a heart attack". With all this confusing stuff, and the doctors/cardiologists say one thing only to read in articles from medical journals the total opposite why shouldn't we worry about PVC's.??
Going by your post I guess you never had them, so count your blessings for I would not wish this on my biggest enemy. Yes, I consider myself lucky that I did not have a heart attack, a bypass surgery etc. but I do have a leaking heart valve which I don't worry about, but the confusing reports about PVC's make me nervous after all it has to do with your major organ if your ticker malfunction, that's it. Hastela vista!
You can never look at a persons problem and say that they shouldn't be worried or to what degree they should worry, if they are having panic attacks because of something in their life or experiencing feelings of absolute terror then that sure is a big deal to them.
Let's all realise that we're all different and not judge each other too harshly.
Take care all of you.
Before people should judge somebody and tell somebody how lucky they're that they don't have a serious illness they should realize that there might be a cause for this they don't know about. I don't think they'd tell a depressed person "get over it and be glad you don't have a serious physical illness" because depression is understood, for which I'm glad, all I expect that my situation is a problem for me, people don't even have to understand it, but please don't judge me for somebody you have clue about. BTW. I didn't mean you Barbie when I said "don't judge me" I meant people in general.
Just read your story and thought I might just tell you of my experiences.
Firstly I found that xanax and propanolol (and other beta blockers)worsened my palpitations - I took xanax for years. When I look back xanax changed my personality making me tired all the time and maybe a little miserable. I wouldn't take anti depressants for years because I thought they would trigger off my palpitations ...... WRONG!!!! After taking the plunge I have found that anti depressants have helped me so enormously - I'm not tired all the time and feel so much more positive and confident in every way, I'm still getting a few palpitations but I'm not brooding about them afterwards and letting them stop me live, I'm thinking "so I've got a heart that jumps about, it doesn't matter". So, forget xanax and perhaps try an anti-depressant, the one I am taking is seroxat - this anti-depressant was recommended to me by my heart specialist as being the one least likely to upset the heart.
2nd point of your post - arrythmia under anaesthetic. I have gone into tachycardia a few times just as it is starting to take effect, the reason being my heart does not like adrenalin and reacts to it, so ask for a non-adrenalin shot and you should be OK - I have since I have asked for it.
To finish, I do have a genuine fault with my heart that has been found (scar tissue in the atrium) but obviously my rather anxious nature has really helped to get the palpitations going and I feel sure that the anti-depressants have at least prevented this particular trigger. It goes to show just what our emotions can do to us.
Good luck, you're OK.
Best Wishes. Linda
I was glad to see your post. I tried to email you several times during the week, but was not able to. Could you please give me your email again. I sent to the email you offered in the comments last week, but could not get through. I have lived in the Carolinas all my life.
I have been to Duke heart Center, and wish you all the best there with your ablation. I have very minimal cardiac symptoms anymore. Let us know how everything turns out.
Uptown
Make no mistake about this... I HAVE HAD HUGE NUMBERS OF PVCS for at least 30 years if not more. I am just saying that in the context of everything else that has happened to me, PVCs were no big deal for me. It is like being tall, short or whatever...I just dealt with it and really never complained until I had some chest pain. They worked that up and found no disease at that time. Yes PVCs are annoying and can be uncomfortable and if there is a drug to fix it, take it or if an ablation can be done successfully, do it. I would choose the route of no drugs and maybe an ablation though often other sites pop up and nothing changes in the end. They are doing lots of research and I am sure there will be answers to all of this. Electrophysiology is a relatively new field. There are new approaches, new wires new equipment coming on the market every year so I don't think personally we are that far from having more answers to this age old problem.
I suffer from anxiety/panic and get PVC's, tachycardia and am becoming a 'cardiac cripple'. I have had an EKG (normal) and am waiting for an echo and a holter. I am not taking any meds, but I keep reading that one of the treatments recommended for anxiety is 'biofeedback'. Can anyone tell me what this is and what it involves? Thanks
Good Qusetion,
Biofeedback is learning to respond to what makes you or your body feel a certain way, what helps, what doesn't ect.
If you learn that certain things triggers PVCs, you can take steps to learn coping skills that will help improve symptoms.
If anxiety and over breathing triggers them you might learn breathing exercises to help.
If you suffer from them during exercise you might learn how to cope with anxiety knowing that exercise will trigger the thus reducing the frequency during exercise, maybe go alittle slower and longer, derive the same benefit and avoid the anxiety.
If you get them at rest, you might just get up and walk around the house or yard a bit, usually this provide some relief from the symptoms of PVCs.
If caffiene , alcohol or certain foods tends to trigger them , avoid the food.
Find someone the experiences what you are experiencing shares your thoughts, fears, and cocern, ask how they cope, thery might provide useful information and lessen your fears and anxiety.
Learn what helps your body and mind to cope with symptoms and improve them to tolerable lveles or diminish them altogether, this is what I understand biofeedback to be.
Lastly don't let a "benign" condition no matter how uncomfortable it may feel allow you to become a 'cardiac cripple", I was given that label once by a electrophysiologist/ EP cardiologist, a label I did not deserve, as i was not crippled by symptoms, the term "neurotic" would have suited me much more appropriately, Iwas never house bound or afraid to do things despite my alarming and uncomfortable symptoms due to PVCs and tachycardia.
Good luck, maybe someone else could throw in their understanding of biofeedback, this my understanding only , could be completely wrong.
Hope you feel better soon.
Maybe people like me bring on the PVC's more because we worry about it. Maybe some of it is psycho psymatic, it doesn't matter whether mental or physical, unless you've been in these person shoes (meaning having their anxiety) you have no idea. You have these PVC's and you don't worry about it, that is you. My husband pops meds with alcohol and doesn't worry about it and says "if I die I die, what the hell". Everybody is different. But he is the healthiest one in the family, because he doesn't care, and doesn't worry but he UNDERSTANDS what people like me and his sister (who suffers from frequent anxiety attacks and PVC's) are going through.
I would ignore these PVC's too if not one Cardiologist says "don't worry if you have them during exercise" then you read an article BY a Cardiologist that says "PVC's during exercise can be fatal".
I thought this board was for people to help each other and not criticize people and tell people what procedures to get without knowing what their doctors said, what kind of insurance they have etc.
I UNDERSTAND that people who are not in our shoes don't understand what we are going through anxiety wise but all I expect is that people realize and understand that it is a problem for me and people like me.
Like I said before I don't understand how an adult can be afraid of a needle, but I would never criticize these people for I UNDERSTAND that it is a problem for THEM.
I never had any luck with bio feedback, but I would be the last person to tell the person who posted above, and asked about bio feedback that bio feedback doesn't work. What works for one person might not for another one.
And last but not least people who already suffer from anxiety/panic attacks will worry about anything coming from the heart and that includes PVC's a lot more than somebody who doesn't have an anxiety condition. People like me HATE to be like that, don't want people to feel sorry for us, most of our friends and relatives don't even know about it.
The one thing with PVCs though is that when you feel one it is not only a constant reminder of your heart function going awry, it's very disrupting to your daily activities. Sometimes they feel like a small mule kicking you in the chest. Although they are benign (supposedly) it's still justifiably disturbing. Even if visual disturbances or uncontrollable limb movements were judged "benign" by doctors you wouldn't fault people for wanting relief from them and being disturbed by them. You wouldn't tell someone with chronic hiccups or heartburn or back pain "it's all in your head, get over it and be thankful you don't have a real problem." The correct distinction is between people's anxiety over PVCs, which seems to be more of an irrational mood disorder than a heart problem, as opposed to being disturbed by the sensation of the PVCs themselves.
By the way, it doesn't help anyone's anxiety over heart problems to see so many commercials on TV with EKG traces and voiceovers saying "you're having a heart attack, such and such aspirin is proven to save lives.. etc etc etc." In fact anytime an advertiser wants to induce excitement or fear, they use a sound effect of "lub-dub" going ever faster, or an EKG trace, or someone clutching their chest in pain. This goes for anything from commercials for statin drugs, to cars, to roller coasters. You might say "well just don't watch TV" which sounds like a good idea, but hardly practical. Ironically, when I used to have panic attacks a few years ago, the first thing doctors, psychiatristts, and therapists used to say was "when you feel yourself getting anxious go distract yourself, watch TV." Go figure.
Anyway, thanks for all your great posts and the best of luck to everyone!
I understand you completely, unfortunately I was medically retired from my job at the hospital where I worked last year,not because of PVCs, tachycardia and anxiety , but because of a painful connective disease called ankylosing spondylitis, luckily i got my full pension at 38 instead of having to wait til 55. Though I am not that physically disabled , but I was suffering from chronic pain and stiffness , also chronic fatigue and fibro myalgia syndrome secondary to the disease.I am still suffering from chronic costochondritis CFS and FM due to this AS, but i keep on the move.
Like you, most that I worked with never knew when I was having PVCs, when i mentioned to one or two persons on the job , they said Hank my I would never deam that you were having a problem like that and hiding it so well, working in the medical professional you have to put on a great exterior at times.
One big clue you had PVCs for 40 years, hell I am only 40 and nothing bad as happened to you yet,it probably never will at least not from the PVCs. I mostly have exercised induced PVCs though when I get my episodes I have them regardless of any particular trigger, I had them 6 months straight every day in thousands, I had an exercise stress test with PVCs during the test. Ignore the the doc that says PVCs will kill you if they happens during exercise, this is an "alarmist" and does not apply to persons like yourself and I and most on the forum.
They are some "docs" from the old school, no disrespect to them that has prescribed proarrhythmic drugs for persons with simple PVCs that ended in devastation, they still have the mentality of seeing a single PVC trigger V-fib in a patient that suffered a MI in the intensive and still can't get it out of their heads that this does not apply to the general population with PVCs and write these articles , no wonder there is so much anxiety regarding PVCs especially when you read conflicting articles everyday about them.
Take care.
Thanks again for your understanding.
I found out the more I worried about them the stronger they got. YES, I did have them skipping like every other beat for a long time. Its a living hell. I KNOW what you're going through. Once the doc has you checked out and found that there is nothing physical what causes these skippings i.e. low blood sugar, low or high potassium, a thyroid problem, once all this is ruled out (usually these are not the causes) and your heart checks out o.k. try to ignore them. I KNOW this is easier said than done. I've been there where you are 10 yrs ago it was HELL. After the tests and since the cardio told me there was nothing wrong with my heart except for a mild leakage (not suppose to cause the PVC's) I don't get into full anxiety when they start. I still HATE them, but just tell yourself NOTHING will happen to you, maybe this will help. 10 yrs ago I got one of these episodes while on a plane and of course I could not get out, the "what if" kicked in and I was a total basket case.
Good luck. Let me know what the doc said. Remember I UNDERSTAND what you're going through. I've been there and still am there at times.