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Sinus tach, PVC's and anxiety relation
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Sinus tach, PVC's and anxiety relation

Greetings to the good doctors and thanks for reviewing this. I am male, 49, non smoker, non drinker. Since the summer of 2002, I have had episodes of PVC's. About half of the time, they are accompanied by bouts of sinus tachycardia. The PVC's were caught on the EKG as was the tach during a visit to the E-R. Lab tests are normal. My echocardiogram was also normal. My cardiologist claims that my PVC's are unifocal and nothing to worry about. Ditto for the sinus tach because my nerves are shot and my life is in a state of high anxiety. My PVC's seem to be aggravated by leaning forward, especially if my stomach is bloated, which frequently is the case.

1) Meds are Inderal 20mg up to four times a day. Xanax 0.5mg PRN.
Does that combo sound appropriate?

2) Even though my cardio doc dismisses my problem, my EKG printouts are stamped "ABNORMAL". Do I need to be concerned about this? I have heard folks comment on machine generated opinions and that they really need human interpretation.

3) My PVC's sometimes occur as bigeminy or the rare couplet. Are these complicating factors?

4) Is there significant risk for this situation to deteriorate in to something more sinister?

I'm miserable and feel pretty broken down. Any comments or suggestions are most welcome. Thank you!

PS: Sorry to burden the forum another PVC question.
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Hi MRBH,

It is hard to tell what precipitates PVCs/PACs, but in some people stress does seem to be a factor.  Regarding position, when lying on your left side or leaning forward, gravity pulls your heart closer to your chest wall, making any subtle change easier to notice.

1) Meds are Inderal 20mg up to four times a day. Xanax 0.5mg PRN.  Does that combo sound appropriate?

There are many ways to catch a skunk and this is certainly one way.  My bend would be to use a once a day beta blocker to make dosing more convenient for you.  Atenolol is cheap and works well.  If you don't tolerate atenolol, metoprolol twice a day is worth a shot.  If the propranolol is working, I wouldn't change anything.

In general I do not use benzodiazepines like xanax.  They are habit forming and can lead to other problems.  I will sometimes use them as a bridge through a tough time or as a bridge until another antianxiety medication kicks in -- like the SSRI class including zoloft and paxil.  One of these may be worth a try -- could be as or more helpful than the beta blocker if anxiety / depression is a key issue.

2) Even though my cardio doc dismisses my problem, my EKG printouts are stamped "ABNORMAL". Do I need to be concerned about this? I have heard folks comment on machine generated opinions and that they really need human interpretation.

I would not trust the machine reading without a physician interpreting it as well.  Without seeing the EKG I obviously cannot render an opinion.


3) My PVC's sometimes occur as bigeminy or the rare couplet. Are these complicating factors?

With a normal echo and holter monitor, short of other confounders like syncope (passing out), I would not think too much about it.

4) Is there significant risk for this situation to deteriorate in to something more sinister?

As long as your EKG is read as normal, normal echo and holter, I would not expect a sinister transition.  The problem is the fear of PVCs is sometimes worse than the PVCs themselves.

I hope you feel better soon.







20 Comments
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I hope the answer you get from the doc here is satisfactory to you. I just wanted to let you know that you are not alone, and that I have a similar experience to yours. Dealing with the PVC's is exasperating. I feel like going to the ER about two or three time a month and I think that they are going to start meeting me with "Your usual room, sir?" Well, I have learned how not to do that. But it is surely hard having all of the symptoms of serious problems (perhaps minus the severity...) and getting told "don't worry, be happy". But that is exactly what I have been trying to do. Exercise helps me. I have also been fortunate to lose some weight the past few months which has increased my own self esteem and heightened my resolve to deal with this successfully.

Good luck to you. You are not alone.

Art S.
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Thank you.

It is really tough to stifle all the torment sometimes. I'm sure many folks are plagued in exactly the same way.

To better days...
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dear everybody
somehow I have same symptoms, sometimes i feel dizzy but when i check my pulse it is normal as always for example it is 60 or little more or less.but sometimes it beats faster till 90-100 without any activity, at this period of beats i feel something happens in my chest, it is not pain or ? and after a short time (1 or 2 secs)i feel a heavy pulse and after that every thing goes ok but some anxiety.If casually through this event I check my pulse I feel an interrupt or skipping pulse.It makes me crazy.Also sometimes i feel pain in my chest bones dr.s siad they are due to ur anxiety.
I did echo which was ok and 24 hrs holter i had a period of 43 bpm during sleep at night and a 2.14 secs rest in hearts beat plus 2 rests less than 2 secs.
whats going on me? what are skips in my heart with odd feeling?
I am 27 yr/male ,173 cm and 73 kgs casually sport(soccer)
please help me
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salis110 - Go see a doctor.

The doctors who graciously take the time to answer questions don't appear to monitor the "patient to patient" comments in this area of the board. None of us are doctors. We are only qualified to a) tell you we have similar symptoms and b) provide support. But you need to take the step to go see the doctor on your own. Most of the posts I have read here are from folks who don't have a serious medical problem - just some difficult and exasperating symptoms to deal with. But sometimes there is something more serious going on. Go see a doc on your own, my friend. And good luck to you.

Art S.
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I know how you feel.  I used to have pvc's practically nonstop and still do occasionally.  Thes were helped tremendously by the addition of Diovan to my blood pressure meds because they keep my potassium normal.  But my trouble is sinus tach now. I had it before the diovan.  Personally I believe the taking of Celebrex for two years started this.  I wake up from a sound sleep with my heart pounding and going wildly fast for me because I also take beta blockers which usually keeps my pulse very slow(about50 or less) When I wake up like this my Bp is very high sometimes over 200/110. After taking a 100 mg Lopressor it will finally settle down in about an hour. Have went to ER in ambulance several times feeling very sick but always sent home in 2 to 3 hours. Had all kinds of tests. No help anywhere.  Have thyroid problems and on Levoxyl for this.  Also just recenly diagnosed as diabetic.  Have blood work abnormal, but noone  can give me an answer for it either.  We have a big medical center in my town.  You would think I could get some answers, It is very depressing but I just live my life day by day and try not to worry and just hope I will be able to make it safely through the next episode.  I have tried to post a question here to no avail, but this helped just telling about it, sorry it was so long.  Good luck to all of you.
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Hi,

My name is Megan and I am 21 and have been suffering from ectopic beats for about 4 months. they have basically reduced me to a complete mess. I am anxious all the time and they really depress me.  It's so hard. My boyfriend just broke up with me and so not only am I anxious about my heart but I'm also devastated about the brake up. He'd been away for 3 months and I kep thinking that maybe once he got back my heart would go back to normal...stupid, I know. I guess now I just want some advice about how to deal with all of this. Is there anytjing I can do which could reduce my anxiety about the papls as well as maybe help with the saddness of the break up? Any advice form anyone about how to deal with these ectopic beats would be much appreciated...and also how you deal with them when you suffer other stresses in life. I just want to feel that I'm not the only one I guess. Cheers.
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You are not the only one.  I am a 37 year old male and have had problems over the past three years, off and on, with PACs, PVCs and four instances of Afib (only one required medication to decrease the heart rate).  Scary as heck but you learn to deal with it.  I find it comforting coming to this site and reading the posts of everyone.  It makes me feel better to see that I am not alone.  I always think that I am the only one when I am having an episode late at night and cannot sleep.  My wife and kids sound asleep.  The biggest thing to work on is decreasing the stress you have in your life.  I can almost always tell when I am going to have a problem with irregular beats....when my stress level has been increased for a week or more.  I was diagnosed with an thoracic aortic aneurysm in January.  Since then, I have been a basket case and have had several episodes of irregular beats.  Exercise, easy listening music and a positive outlook on things are what I try to counteract everything.  Hang in there...you are not alone.
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Megan,

Sorry to hear about the tough time you are having. Have you seen a doctor about the ectopics? If so, do you know what kind of ectopics you are having? Are you otherwise healthy?

I have dealt with ectopics for many years. They can definitely rule your life if you let them.  Over the years I have identified many ectopic triggers and eliminated them. The fact is that essentially everyone gets ectopics, but only a subset of people are symptomatic (and symtpoms vary a lot).  

Take care ...
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Dear Jeff,

Thanks for the advice. I have seen a cardiologist and all that he said was that I had ectopic beats and that they were benign. I wasn't even aware of these PVC and PAC things before I visited this website...I didn't realise they could be different types of ectopic beats. Which one is worse?

I found the cardiologist very cold and uncaring. I just wanted to know what was happening to me and all he said was "it'll pass"....but it hasn't.

I know there is a correlation with stress/anxiety but I'd like to know if you start to get the ectopics at the same time as when you're anxious, or whether the anxiety just builds up and the ectopics are a result of it. For example, if you're stresed for a week do you get the palps, or do you get them at the first sign of being anxious? I guess it's different for different people but I'd like people to tell me how the anxiety affects them. I know that caffeine makes it worse but I refuse to give up chocolate. And I dont understand how alcohol can make them worse when alcohol is a depressent and caffeine is a stimulant.

Thanks guys....grrrrr...those bloody palps!!! Why can't Dr. Phil do a show on them..someone mentioned here that Oprah should.
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Megan,

Provided you have an otherwise structurally and functionally normal heart one type of ectopic is essentially no worse than the other.  What tests did your doctor perform?

Caffeine and alcohol are without question two of the biggest causes of ectopics, so if this is what causes your ectopics you will have to balance up your need for these substances against your anxiety over the ectopics they might cause.  I personally hope you can get through life without having to eliminate too many things from your diet. I had no trouble giving up alchohol and caffeine as I am far healthier overall without them. That said, I have had ectopics for 20 years (starting when I was very young) and I have eliminated many foods and things that I have found to be triggers, but the price for this is quality of life which is why I said I hope you can deal with this without having to eliminate too many things.  Stree is definitely one of the other big causes of ectopics.  To answer your question from my own experiences, stress affects me in two ways: If I have a very very stressful day I will get far more ectopics as I go sleep that night; whereas if I have low grade stress for a long period (say a month), then I do not get an increase in the number ectopics at night during the stressful period, but once the stressful period is over I then get an increase in the number of ectopics at night for a couple of weeks.

I am not a doctor (just a veteran sufferer), so my comments above are based upon my experiences and research.  I find many doctors do have the attitude that your doctor exhibited. One reason for that is that I guess they are trying to convey to you there lack of concern for your condition hoping that you will just get on with your life.  The problem is that unless you experience frequency symptomatic ectopics you can never understand why it causes anxiety in sufferers.  That is why this site is a good resource for you.  There are also more compassionate doctors out there if you find that your doctors attitude is unacceptable.

Maybe in your case if this all started with the breakup they will subside as you get that out of your system.  There are always drugs that you can take to suppress the ectopics beats and or symptoms.  They work well for some people.

May your over-reactive cardiac cells chill out ...



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Wow I was searching around on the internet when I found this site and already I feel so much relief!!  Like Megan, I too am young, only 25.  I do not have any kids, do not take drugs or drink.  I have about 2-3 palps every other day, usually worse when I'm tired, sick or have PMS.  I have eliminated caffiene and have been eating better.  I've had these since I was 19 but 3 weeks ago while on a walk I had some palps that caused me more than the usual discomfort so I went to the doc.  I've been to the ER many times with these with always the same result, "your fine, EKG is normal and so are your lab tests."  However I am a nurse now so decided to once more face possible humilitation after being told I'm basically nuts.  My new doc is great, he gave me the benefit of the doubt and put me on a 31 day heart monitor, and also did an echo.  He told me if there was an abnormal event detected he would call me.  I have had about 12 recorded events and no phone call, and already I feel less anxious.  But today I've had them frequently and am back to my old worries, despite what I know now.  I really want someone to give me advice on how they deal.  I can't help but get depressed about them, I watch TV and think, "I wish I could do those fun things, but my heart would probably skip and then I would get upset."  However after reading these posts I am reassured, I do not feel so isolated.  Thank-you to strangers I don't even know!!
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Dear Lindy and Jeff,

I know exactly what you're going through lindy. Sometimes I think I shouldn't do certain things (like go to the gym) because I think it'll bring on palps, even though exercising used to make me feel better. I avoid doing many things because I think it'll bring on palps...I cant even go to places anymore where I've had bad palps beacuse it increases my anxiety so much. But sometimes I think, no, stuff it, I dont care if my heart goes crazy, I'm not going to let it rule my life! And I go out and try to keep myself busy. Is your job very stressful?

I was put on beta blockers which did nothing and am now on a drug called tambaccor...or flecainade...for irregular heart beat. I dont like the idea of becoming dependent on a drug however. Anyways...at least we all know what each other is going through. This forum is so helpful. Relaxing, staying off the caffeine/alcohol, exercising and a psoitive state of mind are the key components to help control the palps. I do hate them soo much however.
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Wow ... my understanding is flecainide is a pretty powerful drug and not without long term affects (especially given you are so young). I did not think many doctors prescribed this for ectopics in someone your age. Just my understanding ...
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Hi  I am too young, I am 23 and I have had heart flutters and then a heard heart pound feeling for about 3 years that I can remember but recently they are happeing more offten, I have got an doc appoitment here in about a week, and I am really scared cause I do get axiety and this just makes it sooo much worse, what are these feeling caused by?? any info would help

Melissa
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can someone please help....i had relatively few palps for about a month and now they're back and I dont know what to do anymore...can anything help me?? It's so depressing I jsut dont know what to do...how do i get through these hard times?
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Hi Meg, I know you are young, and when I read that you were unwilling to give up the chocolate I had a laugh to myself because a year ago I said I wouldn't give up coffee, alcohol, or cholcolate.  No way was I going to let this 'beast' rule my life.  Since then I've been in the ER 3 times with tachycardia and PVC/PAC.  It happened last a week ago, I felt like the ER staff thought I had a 'psyche' problem.  I felt very alone.  But, I left the coffee, alcohol and chocolate behind.  I made the choice because my 'disorder' is becoming incapacitating.  Be strong and confident, deal with this head on.
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Thanks so much everyone!!!!  One thing I have realized...my palps started when I started nursing school.  Now I'm a nurse, and on rough days I have bad palps.  I finally got my heart monitor results, and, SURPRISE!  begign PVC's with some SVT at times.  Its been a LOOONNNGGG month for me, but I'm learning so much more about this condition and its symptoms.  I want to ask the women one question, are they worse with cycle fluctuations?  And for EVERYONE, what makes it so bad is the feeling of isolation we get when we have these and nobody else has any idea we are suffering.  BUT, we, obviously, are NOT alone!!!!  The new thing that has helped me deal besides this forum and other internet chat rooms is my new found faith.  When you are not so terrified of death, your not so terrified of anything!!!  We are here to live and do what we can.  When its over...well, we all have different ideas about when its over, and if you don't I reccommend church or spiritual readings or something of that nature!!!
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lindy, I am right there with you. I often think I wish I could do certain things and then dont because I am afraid of pvcs. After awhile of that, i wasnt going anywhere. I now try to stay on my daily course of action. If I was going to the store or the movies, I still go, even if I am haveing a bad day. The best part is after the event is over, i realize" I made it" Some days are worse then others and YES I have an extreme correlation with hormones. I get them badly around my ovulation, and rihgt before and during my period. THe days when I dont have any seem so great that I forget that it has only been a 2 week period generally that I dont have any. I use those 2 weeks to the max. I try my hardest not to let it get me down, but it does sometimes. THis forum is the best thing and I think about it at night when I dont have access to a computer. I look on here at work and I feel much better. Good luck
cam
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Who else has found that exercise CAUSES anxiety? Sure, it used to be that all I nneded to relieve an anxiety attack was run, run in place, or do almost any exercise. Now, it's the opposite. All I have to do is run five minutes and I start feeling PVCs and anxiety in general. And, usually, if I take a xanax an hour before running, no problem. Does it follow that PVCs Are anxiety, or vice versa?
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A related discussion, RU12 was started.
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