Tachycardia, palpitations, anxiety and hormones

[scareddee]

Hello,

Thank you for taking my questions and for providing this very valuable service.

I am a woman who turned 49 years old yesterday.  I have a ten year history of panic and GAD that waxes and wanes.  Cardiac symptoms, such as tachycardia and "skipped" beats occur when it's high.  I have had two echocardiograms, the first showed MVP(mild, but medicate for dental work), the second didn't.  These were both performed several years ago.  I had a normal holter monitor test last April.  I did have some symptoms, but was told holter was "normal."  I did not ask any specifics.

I have been having increasing bouts of tachycardia and palpitations again.  I am also struggling again with my anxiety and I'm in the middle of an awful perimenopause.  I am sometimes anemic and have had problems in the past with low potassium.  Lab values for each of these was normal last month when I had them retested.

My questions for you are: 1.  How much do changing hormones and anxiety-produced adrenaline factor in to periodic tachycardia and palpitations?  2.  Is there any way I can tell if anxiety is precipitating the palps or if the palps are precipitating the anxiety?  3.  Would more testing be in order and if so, which tests would be helpful?  4.  Is it better to medicate for the anxiety or the cardiac symptoms?  (I have had success in the past with klonopin and had no problems coming off.  I have had terrible side effects with SSRI's and also with beta blockers.  I am willing to give the beta blockers another chance if that is the best route to go.)

Thank you very much.

[Cleveland Clinic]

scareddee,

thanks for the post. cute name.

1. How much do changing hormones and anxiety-produced adrenaline factor in to periodic tachycardia and palpitations?

For some women, hormonal fluctuations can have significant effect on their palpitations. Anxiety can also play a big role.

2. Is there any way I can tell if anxiety is precipitating the palps or if the palps are precipitating the anxiety?

If the anxiety is getting worse I would imagine that it is probably the main component here.

3. Would more testing be in order and if so, which tests would be helpful?

I probably wouldn't pursue too much more testing if your previous test were normal.

4. Is it better to medicate for the anxiety or the cardiac symptoms? (I have had success in the past with klonopin and had no problems coming off. I have had terrible side effects with SSRI's and also with beta blockers. I am willing to give the beta blockers another chance if that is the best route to go.)

Again I proably would focus mor on the anxiety component. It would be important for your cardiologist and whoever you see for your anxiety communicate their findings.

good luck

[CollegeGirl143]

since you know that your tachycardia and palps are caused by your enxiety, i think the best way to go would be seeking counseling and some kind of anti anxiety medication (not a benzo)... klonopin and drugs like it are only temporary masks. Also maybe seek treatment for premenopausal symptoms. Treating your cardiac symtpoms rather than your anxiety disorder thats causing the symptom wont make u any better, just offer a temporary cover up

[anacyde]

Hormones have been playing 90% of the role in my palpitations since the birth of my son 11 months ago.  It can be extremely frustrating.  

I have frequent exercise-induced PACs and my cardiologist seems to think it's adrenaline.  Like you, I have a history of anxiety.  It seems many people here do, which makes me think it's very likely adrenaline plays a very big role in our ectopic frequency.

[Rachel's mom]

I feel for you as I am experiencing very similar hormonal reactions.  I started having tachycardia during my period last january and continued every month until i started a beta blocker during my period.  That has completely stopped the tachy but i had a very bad bout of pvcs/pacs last month...worse than i have ever had in my life while on the beta..i was surprised.  If it happens again this month i will look into swithcing beta blockers as i am suspicous it had something to do with the meds.

You read on here about alot of women having symtoms of more severity during their cycle and menopause...makes menapause even more scary.  I am almost tempted to do a low dose birthcontrol pill to even out my hormones.  Anyone try that?  Good luck and i hope you feel better soon.  Judianne

[anacyde]

I've heard of women taking low dose BC pills for this reason and having really good results actually.  I'm just too scared of the risks of the pill, no matter what.

The beta blockers you're on, are you taking them only at specific times during your cycle?  If so, maybe that would be an option for me to bring up to my cardiologist next time I see him.

Btw:  I'm Rachel's mom too, lol, that's my daughter's name :)

[NurseKagome]

The birth control pill (low does oral route) is pretty darn safe. The only big warnings are if you are a smoker, it can really increase your chances of bloodclot or stroke. But otherwise it has been around for quite sometime and posses little threat, otherwise I would think it wouldn't be so popular and you really only hear about bad side effects with smokers. I guess it could be an option for you. Don't read up on any drug and consider ALL of the side effects, I mean if you look up a simple drug like Advil or Tylenol they have some very bad sounding side effects, also VERY rare. :) Hope this helps.

Nurse Kagome

[Rachel's mom]

Yes, my cardiologist has me taking 25 mg of atenenol just during my period.  i go on for 5 days then off till my next cycle...has worked for me as i said but last month horrible pvc...so we will see.  Low dose pill sounds safe according to the comments here i think it could really help with the perimenapause im about to go into...can you stay on it thru menapause??  Say hi to your rachel...mine is 3 years old.  Geez no wonder im flipping and skipping im chasing a 3 year old around all day...haha.

[Carrie41]

Anyone have any success with any meds for anxiety about your heart?  I take 20 mg celexa (I just upped my dose a month ago because I was so stressed about my heart).  It does not to be donig the trick.  I still am freaking out everytime my heart skips.  Happened 10 times yesterday and I am on edge contantly.  I am going to see my doctor next week to ask if I should be taking some other sort of anxiety meds but I would like to know what has worked well for others regarding obessing about your heart.  Any suggestions??

[yoshi74]

Hey...I think it is so interesting that there are so many people that have pvc'/pac's during their cycle but doc's seem to say there are no correlation...at least that is what my doc said....I am convinced there has to be...I have them all of the time but they are WAY more profound that time of the month. This month has been really bad though. I am on my cycle now and I have been having palps left and right..even in my sleep...my cramps are pretty bad...and I am chasing around a 3 year old as well....aaahhhhh!!  Have you or anyone else ever been told that your cycle doesn't have anything to do with palps??...

[kitcurious]

Maybe it has something to do with people perceiving them not the number people actually have. Are there any studies on it?

[fearfactor]

Hi, all - my palps are DEFINITELY cycle-related.  They are worst at ovulation and PMS.  During my pregnancy, they almost completely went away - what a wonderful blessing!  :)  Now, since I have had my baby, they're back at times but thankfully not as bad as before.  My doctor recommended low-dose BC pills because she agrees they're hormone-related and the pill would even this out.  I'm a little scared but am thinking of going ahead and trying it.  I will let you all know how it works.  I have taken BC pills before - Yasmin - and my anxiety was HORRIBLE and I was having bad panic attacks and palpitations so I'm definitely NOT trying that one!  It is a bit different from other BC pills, though!

[CollegeGirl143]

i took birth control for.. well.. birth control purposes, but they made me feel so awful and intensified my svt and palps so bad i stopped.. I tried a low dose version of the same pill and no difference, so i just dont take the pills anymore, but everyone reacts to medication differently and ive heard of bc helping cycle related palps. Personally, ive seen more success with taking beta blockers during that time of month, or ovulation, if that time of the month bothers you more.

[anacyde]

Haha my Rachel is three also!  How weird :)

I'll have to ask my doctor next time I go if I could do something similar.  He had mentioned BBs before, but since my symptoms are not constant, I've always said I'd prefer not to.

[tickertock]

I agree with Al Dente's comments, I myself take atenolol 100mg daily in divided doses , I rarely have PVCs anymore, "knock on wood". While beta blockers are not for everyone and may even aggravate PVCs that occur at a lower heartrates, even though it is my understanding that beta blockers have been linked to an increase in glucose intolerance or even mild/borderline diabetes, the benefits of beta blockers have been well established, life would be difficult for me without them.If you can tolerate them and they work for you the benefits of taking them far outweigh the mild changes in blood sugar than can be controlled by diet, exercise  or even an added medication if necessary.Beta blockers have proven to be invaluable in the treatment of CAD, MI's ,reducing the incidences of arrhythmias, helping with anxiety & adrenaline induced tachycardia and PVCs.It is my understanding that even in CHF, beta blockers have proven tobe most helpful, greatly improving heart function and quality of life. My personal opinions and observations only from all the information I have gathered from being on a beta blocker myself.

[tickertock]

For most beta blocker's alone are not the first line drug or best medication at controlling HBP, for some a low dose beta blocker or high dose beta blocker does the trick with hypertension, like you stated it's all trial and error. I used to suffer from mild hypertension , not terribly elevated, but stubborn, I tried cozaar only, barely moved it, tried atenolol only, barely moved it, though it was only around 135-145/ 85-95, the the combo of atenolol & cozaar was added, dropped to around 120-130/80-85, due to my last echo showing mild hypertrophy of interventricular septum, HCTZ 12.5mg was added for ultimate BP control, cardio said he wanted to see BP around the 110-100/60-70 range, so far I would say it probably averages 105/65 most of the time. The key for me is the combination therapy of the beta, ARB, and diuretic. Like you stated it's all trial and error and perserverance, working with your doc or cardio to see what works for you.

Cheers and I hope you're feeling better.Your imput is much appreciated on this forum.

[kitcurious]

I think it depends on what you are treating. For a person with good health and structurally normal heart I find it unconscionable for a doctor to risk giving them a very real illness to treat perceived symptoms of a non-existent one.

[tickertock]

Good health can be hard to define, all medications have drawbacks and side effects,if you read all the possible side effects of medication I think we would all throw them in the waste basket, headaches can be debilitating when no physical organic cause can be found. When perceived symptoms are so bad that they disrupt one's daily living I can't see that as "good health" despite the lack of evidence for a physical organic disease process, this is where the risk benefit ratio of prescribing medications come in. In my opinion sometime it can be "unconscionable" not to prescribe an helpful medication to relieve the patient symptoms despite the lack of evidence for physical cause once the drugs prescribed are not potentially life threatening in themselves.My personal opinion only and even though I take several medications I'm not a advocate  of a doctor just writing a precription for the sake making the patient feel that at least something is being done for them.

[kitcurious]

Doctors sometimes prescribe BB's to patients who are not ill to attempt to calm them. They lessen the sensation of the beat and a highly sensitive/anxious response to the workings of the body seems to be the core of the complaint. I get it, though I think people with anxiety tend to still have the anxiety in some form even on the drug.

Since the Brits downgraded them to 4th-line use due to their being less efficacious than other drugs for HTN and for what they say is an "unacceptable" risk of inducing diabetes, I doubt my concerns there are unfounded.

I further will not be surprised if many (especially new ) patients will be advised to forgo them, unless medically necessary. I have seen that suggested by at least one doctor on this very site.

My GP was going to give me a dose before a knee surgery. I later read an artcile about a study that showed pre-operative use of beta blockers in low risk patients actually increased the risk of poor outcome, not reduced it.

They are a fine class of drugs for certain things. I simply would not take them if I was a healthy person.

I have no hesitancy about taking medication. If I had a fever, I would take a Tylenol even though it can effect the liver if taken in excess. I take my prohpylactic antibiotic before my dental appointments even though the chance of endocarditis is low and the side-effects on my stomach of the antibiotic are real. So that characterization is not apt.

My son had over a thousand PVCs on his Holter and the doctor told us she would not recommend medication. This indicates to me that medication is indeed not medically indicated except under certain conditions like structural abnormality, symptoms of cardiomyopathy or a dangerous rhythm etc. She also was listening to his heart, heard the ectopics and said "Relax a minute"... they stopped. She spends a lot of time with her patients, listens closely and explains things quite thoroughly.

I would not entirely trust a doctor who pulled the Rx pad out of their pocket too quickly, especially if they had just told me I was perfectly healthy in the area they are prescribing for.


It is entirely reasonable to question the use of drugs when you read post after post suggesting to people with normal test results that they may want to get onto them, or discussing the merits of one over another.


Everyone is entitled to their opinion and to take whatever Rx's they can get if they want them. That doesn't make those Rx's necessarily the best choice in every insatnce, but it is their right to make that choice if it is offered. It's their body.

[CollegeGirl143]

i agree with taking the side of caution.. While beta and calcium channel blockers are considered very safe, their can be some serious side effects.. Personally i do not agree with physicians handing out beta and calcium channel blockers like candy to help with anxiety. The disease should be indentified and treated, not the symptom. If the symptom is making life unlivable and MUST be treated, the anxiety should most certainly be being treated as well.. I once had an EP who told me beta blockers where so safe, politicians take them to keep their heart rates down before speeches. When i asked him why a person would medicate their heart instead of say, seeking some kind of counsel or taking a class in public speaking to learn to keep yourself calm, he couldnt answer me. Point blank, and i think most physicians would agree, using medication as a band aid and a cover up when you can work for and gain the cure, usually isnt good medicine.

[woodruff]

When there's a deep but treatable cause beneath the symptoms, say anxiety in its relation to pvcs, I do agree that going to the root of things is better treatment than putting a bandaid like xanax on it.  In the long term, I think the patient is better off.

Still, I myself know musicians who take beta blockers before a solo performance.   Competitive marksmen sometimes do the same thing:  The drug slows their hearts enough that they can squeeze the trigger between beats.  Presto, no weapon wobble!  

Re Tylenol for fever:  It does make a body feel more comfortable, but my husband the physiologist is of the opinion that the couple of extra degrees a nice fever gives you is a significant weapon against the bug that has invaded you.  He thinks it's prudent to endure the fever for the edge it provides.

[Carey01]

I've never taken a BB -- I have heard good and bad.  Just like any medication.  I find it sooooooooooooo hardto believe these skips are benign.  I have high blood pressure which is pretty controlled with medicine.  Does anyone know if that puts me at a higher risk with the PAC'S/PVC's??
I hate them and they SCARE THE HECK out of me!

[JAGERSMOM]

Hi, Very interesting info on this thread!  I am just starting to realize that my tach is showing a pattern, started a beta blocker 2 months ago and it is helping. But the last 3 months I have slight tach (100) and by bp goes up on the first day of my cycle. I also feel my feet sweat- weird.  My doc blew that off.  College girl- my doc told me the same story about public speaking and beta blockers...

Anyway, before the beta blockers the tach would get into the 130's and 140's for 24 hours or so. So I think the beta blocker helps.  Ran my hands under freezing water for a couple of minutes last night, and it really helped the tach. Thanks to whoever gave that tip!!

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