Frequent PVCs / bigeminy / fast heart rate with anxiety

[trus75]

Hello everyone,
This is not the first time that I post about this theme, it's a kind of update.

Since a few months ago I am having episodes of anxiety / panic attacks with fast heart rates and frequent PVCs/PACs, sometimes in bigeminy. The panic attacks are not a new thing for me, I'm kind of "used" to them, but now they're getting a little more frequent. All of these episodes of bigeminy occurred after some panic, except one that came just after swimming. But even that one could have been caused by panic, I probably felt the first PVC and then booom.. they came in a row.

I've had a few EKGs and a Holter this year, echo and stress test last year, blood tests, they were all fine. (but none of these episodes were caught on Holter). I went to a cardiologist and explained exactly what I felt, I told her it only happens with fast HR, but she told me that it's ALL caused by my anxiety and that I'm perfectly fine, but to be honest that's hard to accept.

My big question is: Is it possible that you have PVCs and Bigeminy with panic but not with exercise when your heart is beating fast? Are the mechanisms different? What's the difference between a fast rhythm caused by anxiety and a fast rhythm caused by exercise? Is it the amount of adrenaline? This is the one question which intrigues me.

Thanks

[trus75]

Hello and thanks
That's one of my theories too..

I think it's proved that anxious people have bigger levels of adrenaline in their blood, even when relaxed (I saw a study somewhere about that). And the exercise probably "burns" adrenaline in a much different way than a panic attack. A panic attack with a fast heart race looks like a very inadequate response from the body to a situation which is not risky at all (I mean the heart rate is incompatible with the situation itself) and that can be the cause for this issue.

Thanks once again for your opinion.  

[itdood]

I think this isn't well known.  Your heart rate from the SA node by default is about 100bpm.  The parasympathetic nerve branch coming from the autonomic nervous system will regulate that down.  When your heart rate is 100 bpm that's because of sympathetic tone and/or adrenaline, norepinephrine.  

As an example, when my father had a heart transplant, all the nerves were cut going into the heart.  His resting rate was 100bpm, at first.  Over time, the nerves grew back into the heart and his resting rate came down into the 60s and 70s.  When he exercised, all the rate increases were from endocrine, at first.  

What percentage of rate increase comes from nerves, and what percent comes from endocrine is probably impossible to know.

A complete guess, I would say the rate increases from anxiety are more endocrine (adrenaline).  pure guess.