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.

[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.

[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.

[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]

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]

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.

[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.