Anxiety or real Cardiac Issues ?

[shahriar599]

I am a 53 yr old Male, with a bad family history ( father died of CHF, all his brothers have had Heart Attacks due to blocked arteries. About three year sago I had some Heart palpitations, got about one episode per year ( I know its not much)....but quite scary. I reported this as possible 'Sinus Tachycardia' or SVT.....but never has been proven via Holter. Also did angiograms and showed some atherosclerosis/mild blockage of some heart arteries etc.....but not enough to Stent. I've been on Beta Blockers ( 25 mg Metaprolol Tartrate) for about three years, somewhat tolerated the drug. Used to exercise about 3-4 times a week. But this year, I found out that I also Type Diabetic ( as was my Dad & brother)....I was 'marginally' diabetic i.e. Blood Glucose 109 & A1C = 6.9. AFter trying diet & exercise, although my levels remained the same, my GP put me on 500 mg Metformin. Maybe coincidental, but since taking this drug in combo with my B-blockers, I have developed pretty bad anxitey, sometime inot panic attacks, also experiencing very slow heart rates 65-55 ( that is really slow for me). As a result, I just don't feel exercising, or even getting up to do a 1/2 mile walk ( that is real bad news for someone with some blockage). Its sending me over the edge........really impacting my life. Should I stop the Metformin ( I know I cant stop the B-blocker ). Shoudl I talk to my Cardiologist or GP for how I feel ? I am not sure if something else ( liek allergies etc) is causing my slow heart beat. I also work for a Pacemaker company, and I tend to over-analyze my situation quite  a bit i.e. look at my own EKG's ( which looks quite normal).

[Ken1945]

Actually I had similar a couple of years ago and wore a monitor for a month. When I felt something I pushed a button and the information easily went over the phone to the company. After 30 days - nothing. About 2 years later I felt palpations again and had the monitor on for 30 days. When I went to the Dr. I was in A-Fib at 170 BPM. He sent me right over to the ER. I get symptoms too which are difficult to deal with. Try to keep the anxiety down. If 2  doctors told you that you are OK, then you probably are. My doctor recommended meditation which is helping me sleep better. If I didn't have to pee every 2 hours I would sleep even better  ;-)  Goggle Celexa to learn about the drug and its side effects.

[shahriar599]

I saw my Cardio for my yearly check up yesterday and told him about my PVC's ( which, by the way...are diminshing somewhat after my GP increased my Toprol from 25 mg rto 37.5 mg per day i.e. 1 1/2 tablets). Basically both my docs told me ..." knock it off....".....you are OK, just deal with the PVC's. Its anxiety, and we can give you anxiety meds like Celexa etc. I think they might be right,.....but its real tough for me when they occur. It feels almost like a long sinus pause an dthen a large kick to my chest - even when I cam exercising. Thanks for all the comments here.....I guess I will just have to learn to live with them. If it gets too tough .....I'll just get on the anxiety Meds).

[rilesnic]

Sorry to hear about your bad day. I'm glad you went to your doctor and he/she knows what's going on and how you're feeling. That's the best thing you can do, always let them know of any changes or if you have a bad episode. I take 12.5 of atenolol because I can't tolerate the entire 25mg. I wish I could though, because I see a decrease in my PVC's when I take more of it, it just completely washes me out. Yes, eating is a major PVC set off for me as well. Sometimes I dread eating if I'm having a bad heart day. I've asked my doc about this and he said it's true about the whole swimming thing...you're not supposed to go in for 30 minutes or so after you eat because your heart starts pumping more blood to aid in digestion (taking blood away from your limbs) which makes your heart speed up. My doc told me this is the same reason I feel them after I eat. Also, the vagal nerve runs through that entire area (stomach, heart, esophagus) and can be irritated by a full stomach,which can increase PVC's, so eating slower or smaller portions (maybe more throughout the day instead of a full meal at one sitting) may help. I've also found that carbohydrates, MSG, caffeine (including chocolate), and alcohol will increase my PVC's after eating. MSG has landed me in the ER twice so I completely avoid it. Drink plenty of water and try to exercise (with your doc's ok) and that may help to lessen some of the symptoms. Exercising will help to lessen the anxiety as well. Hope this makes sense and helps some. Feel better!

[shahriar599]

Well guess what ? I had an 'episode' yesterday.....this was the fourth in four years ( not much I know). But basically,...I had a 'giant' PVC followed by train of rapid bpms...went upto around 120...didnt feel good at all ! Totally shook me up.....but lasted only minutes. I know I've been getting PVC's lately but this was the first one borderlining a Tachycardia episode. So, went to my Doc today...sure enough....he upp'd my Beta blockers (Metaprolol 25 mg) to 37.5 mg. I hope I can tolerate this dosage. I heard that some patients are on 300 mg....Yikes ! I hope I dont have to take anxiety meds....so far, so good. But PVC's gives me that anxious feeling and perpetuates itself to more of them. Strangest thing.....I always PVC's when I am eating.

[Mom2four85]

If you can, doing mild exercise may help with not only stress, anxiety, but it may help you prolong things like CAD since it's so prevalent in your family.  Easier said than done, but luckily for me I kept on with exercise even when i felt my arrhythmia's increase dramatically, I think that kept my heart strong and healthy for when my heart did stop.

Dr's are amazed when I tell them I walked 4-6 times a week and ran 3-5 times; while I was in Bigeminy. I felt my heart stop one night walking...did that stop me? no... I admit I'm a bit dense sometimes - heart stop, fainting and I got up and walked another 3 miles, not the smartest decision, but I was sure nothing was wrong with me.

You should have a full cardiac workup if you haven't, to see if you have any problems going on. Could it be your meds causing some problems?  I know my system is really sensitive and I can't take alot of the beta blockers; the only thing I've found that worked for me was Inderal.

Talk to your doctor about exercise and make sure you're ok to go ahead with it and then put some precautions in line like having a phone with you; 911 on speed dial etc like others do, but don't let pvc's stop you unless your dr says and start slow and listen to your body.

btw...as long as your heart is structurally normal and there's nothing wrong; your heart can handle runs of pvc's and VT; here's some info that may help: http://www.medhelp.org/user_journals/show/284968/Ventricular-Tachycardia-VT---Vtach?personal_page_id=861727  there's a woman that my cardiologist treats with 80,000 pvc's daily, she has no structural problems and he said she doesn't even feel most of them and no symptoms, made me feel bad complaining over my amount lol

I think people get scared over VT/VTach but it takes alot for the heart to stop.  Before ablation I had 50,000 pvc's daily possibly more but that's what it was on the day I had my Holter done, after ablation I'm down to 10,000 pvc's daily and VT runs, PAC's PSVT and some stuff like you with Bradycardia.  I had to have a pacemaker/icd implanted but I'm one of those rare cases and have other problems.

It may be helpful also to keep a journal of dates, times, symptoms if you have any and what you were doing at the time you have episodes.

[DeltaDawn23]

What Beta Blocker are you taking? I was on Toprol XR and it made me dizzy, and took by bp and hr down too much.  Another doc put me on Atenolol 25 mg. up to 2 per day and I take it in 1/4's throughout the day.  If my bp or hr is down, I wait to take the next dose.  The cardiologist told me the Atenolol does not cross the blood-brain barrier and would make me less dizzy and I do tolerate it better.  I also take Metformin 500 mg. per day and have anxiety attacks -- due to my Afib -- when I have an irregular beat I get dizzy but it passes.  I increase my meds and do breathing exercises to slow my hr down during those times.

Hope some of this helps.  Good luck.

[rilesnic]

Yes, PVC's can certainly be unnerving....I really don't know how many I have a day (I don't really want to know), and there are people on this forum in the 10,000's plus...it's truly unbelievable the amount people get and the number of people that suffer from these. I can tell you, your 10-20 per day are just as much a problem for you as those that have 10,000+. If they make you feel bad, and you're symptomatic with them, then just having one can be bothersome. Personally, I don't think I'll ever get used to them. They always catch me off guard and make me feel drained. Always let your cardio know if you see an increase in your palps. You can always give a shout out to the nurse and she/he will let the doc know and they can direct you from there. Mine cause me a lot of anxiety and panic too. The more I panic, the worse they get. As long as your heart is healthy and structurally normal, I believe the risk of VT is very minimal. PVC's are benign unless there are other underlying heart conditions. I hope you start feeling better soon. Wishing you good health and safe travels!

[shahriar599]

Thanks !!! I also forgot to mention....that I have been getting a fair amount of PVC's ( around 10-20 per day). Three years ago, I used to get a few pvc's a month but now, they are almost a daily occurrence. Its these pvc's which makes me think I am getting anxiety (or Panic) attacks, OR, there could be real underlying cardiac issues i.e. worsening my arrhythmia. People tell me that pvc's are benign, my GP said don't worry....some people get 10,000 pvc's a day.!! For me....they cause me panick....( I travel a lot, long flights across the country & International).....I always think that my pvc's will break into VT's.

[rilesnic]

With your extensive medical history (family heart issues, diabetes, blockage), I would definitely let the cardiologist know what's going on.

Sometimes low blood sugar makes you feel anxious and can trigger panic attacks (in some people), and since you're taking diabetic medication, there may be some things going on that the doctor can fix so that you can start feeling better again.

I would not stop any medication without first speaking with my doctor. I hope you start feeling better soon.