Heart Rhythm or Anxiety... ?

[HypoWhat]

Let me being by saying I do have anxiety problems - 3 yrs now. I've had a similar episode before, but not this bad. I used to take 25 mg of Toprol XL while on Effexor, but had to stop when I stopped the Effexor bc my HR would get into the low 50’s while awake.

I've seen a couple cardiologists. Neither found anything physically wrong. Although, one - my current one - never ran any tests. He just knows I’ve had a stress echo somewhere else.

Well, lately, I’ve been having more PVC’s than I used to have (they have found those). Also, they’ve seen one triplet, too. At night my HR usually gets into the lower 50’s, but it’s been as low as 38. My HR was 55 when I had the triplet.

This weekend, I was feeling bad, I got anxious, and my heart went crazy! It started skipping really bad and racing. It felt like it was skipping because it was beating faster than possible. I called 911, and they told me to take my pulse. It was 192 bpm once it stopped skipping. My hands and feet turned really pale, too. I was terrified. When the ambulance got there, it was down to 150 – Sinus Tach. BP was 160/111; however, it’s normally only like this when I get anxious. They took me to the hospital, and my HR got down to mostly the 130’s but was all over the place though. It would slow down to 120 and then jump back to 145 within a second. They tried ativian, but my HR wouldn’t go below about 115, so they gave me Atenolol 50 mg. This is the second attack where the ER couldn’t get my HR to slow down.

Today, my HR is fine - 68, and my BP is normal. Do I take the Atenolol? Will my HR get really slow then? I’m so scared it will start skipping and racing again. Could anxiety really cause that bad of a reaction?  I called my cardiologist, and he was no help – kind of mean actually.

I know you don’t have my charts or anything, but I appreciate any advice/help. I’m 27 yrs old…mldly overweight (5’11 and 195). Other than the PVC’s and anxiety, mostly healthy. I don’t exercise tho bc of the PVC’s.

[mrworry40]

The doctor is right on the spot. I suffer from anxiety and benign pvc's as well. I once read a article stating that it is not a curse to have pvc's it is that you can feel them. normally pvc's trigger my anxiety so i came to this awesome site to help calm my nerves and try to do relaxing things. I hope this helps and always remember there is a lot of us out here just like you. Take care

[bobad]

Listen to what kat4 said, as she obviously has a good grasp on the matter.

I just want to add that your body is hard wired to create anxiety when something goes wrong. When you do something wrong... eat something a little poisonous, breathe something a little noxious... the body lets you know. It creates very unpleasant feelings so you are more likely to avoid the harmful situation in the future. That mechanism can go haywire. For example, one day I ate fresh pineapple, and later that night I came down with a bad case of influenza. Although I have no doubt the pineapple had nothing to do with it, I had a revulsion for pineapple for many years. I am 100% convinced the body is hard wired to produce anxiety that is designed to save your life. When your heart is acting up, your body takes over, trying to find something to blame it on and to avoid. Of course there is nothing, so it creates more anxiety. Just remember that you didn't create the anxiety, and don't feel guilty about it. For a good quality of life, anxiety needs treatment just as surely as the heart condition.  

Your instincts are good. Beta blockers on a HR of 60 is asking for trouble, and the doctor would not give them to you unless there is a *very strong* indication for them.

Good luck with your heart and the anxiety. Keep us up to date.

[kat4]

Hi,

Let me express my sympathy about the anxiety, because I have attacks as well.

If I were a doctor of any specialty, I would never, never dismiss someone with anxiety, any more than I would if they showed up bleeding.  How long does it take to reassure them again that their heart is basically okay and to tell them that the anxiety has to be treated.  Someday doctors will realize that this is as much an illness as any other.

I hope you go back to whichever doctor prescribed the Effexor and work with him or her about the anxiety issue, and also what you should do about the Atenolol or Toprol.

Be careful of Ativan, it can be addictive.

Try to exercise (maybe walking) if you can when it does not disturb your heart.  It is easy to compound your problems by getting way out of shape.  I know there is a tendency to hole up and be a couch potato when frightened, but it is then hard to get back into shape, and it adds to anxiety and depression.  Exercise will make you feel better emotionally.

[HypoWhat]

Thanks for the info.  I know I have anxiety, and it's just a pain.  I was really worried about whether I should take the Atenolol or not, with my HR normal today.  I don't want to play dr., but I'm thinking if my HR is in the 60's a beta blocker may not be a good idea.  

I'm seeing an endo who does want to rule out a pheo.  He's running a 24 hr urinary catecholamines test. They act suspicious b/c of the numbers and the elevated albumin.

I assume that will turn up normal as all of my other tests, and then it'll be time to go see the psychiatrist.

Thanks for your time.  :-)

[Michael J. McWilliams, M.D.]

Unfortunately anxiety can explain most of those symptoms.  The PVCs are probably unrelated to anxiety or they can be made worse by anxiety, but anxiety is rarely the sole cause of them.

When you heart rate gets up that high and they find sinus tachycardia, with the background information you have given, it sounds like a panic attack.  A 30 day event monitor would show the heart rhythm during these events, but it sounds like EMS found you in sinus tachycardia.  The up down rates you describe sounds like anxiety.  It often takes hours for heart rates to come down after that.  The adrenaline surge of a  panic attack can last for hours.

The reason your cardiologist got short or mean with you is because they have already told you that they think your heart is fine.  In general, we treat anxiety problems. Once we have looked at all the tests and decided the problem is mostly reactive (anxiety, panic) rather than primary cardiac, there isn't much we can do.  Anxiety issues are usually handled by the primary care doctors or through referrals to psychiatry.  I know this isn't an excuse, but I think it is why doctors sometimes seem short with patients.  We are good a "fixing" things but when the answer isn't a medication or ablation, we  sometimes get frustrated too.  Again, not an excuse but I think it explains the psychology to why doctors think and react the way they do.

The best approach is probably to talk to your primary care doctor about anxiety treatments.

I hope this helps.