Palpitations scare me to death

[sean1975]

I was trying to post something in the Heart Rhythm 'Ask a doctor" section, but couldn't figure out how to do it.  In 2005, I was under a great deal of stress.  At that time, I began having heart palpitations.  There was no pain, however, it felt as if my heart was beating oddly and it kind of knocked the wind out of me.  I would get two good beats and then a pause.  It felt like my heart was shifting to the right and pressing a lung.  I would even grunt out loud as if something had hit me from inside, but with no pain.  After each weird beat, I would break into a quick sweat, but not a profuse sweat.  I experienced no tingling, or pain, but I did feel a little light-headed.  At the time, it terrified me because I lived alone.  I drove myself to the ER and was on an EKG monitor for 3-4 hours.  The doctor released me and the diagnosis was Arythmia - Benign.  At the time I was taking .5 MG of Xanax for panic attacks and had taken on just before arriving at the ER.  
Tonight, the same thing happened again.  Once again, I am under an extreme amount of stress-both good and bad kinds.  I was about to go to the ER again, when all at once it stopped.  I stayed still, took my .5 Xanax and nodded quietly for an hour or so.  I had a friend come over to sit with me when I woke.  It seemed over.  However, when I got up and walked around, it began again, but only for a minute.  Now, it hasn't happened for 2 hours and I seem fine, but still frightened.  I suffer from Panic Attacks, am overweight, and do smoke about a pack a day.  All of these are contributors to this.  I know I'm not going to die, but the thought is still there.  Can anyone set my mind at ease.  I really don't need to worry about this now.

Thank you so much.

[sean1975]

It's good to hear this.  Everything I've read has been along these lines.  Today I spent part of the day not thinking of them at all, the other part I've been paranoid.  I haven't had a palpitation since 8pm CST last night, but I have been self-monitoring to an extreme.  I'm not going to give in to my paranoia by running to the ER this time.  I did take my blood pressure at the local Wal-Mart today.  Though, the store-based machines aren't super accurate, I could tell my blood pressure was a little high today, and it was.  So, I'm just going to stop panicking, make a doctor's appointment for a regular checkup, and just stop freaking out.  I don't know who you are, but thank you for your kind words.  They really cheered me up.

[ptadvoc8]

I've had arrhythmia episodes for over 40 years so I understand how you feel. Despite worrying that I was going to die each time I had them, I'm still around -- and still having them -- if that is any reassurance to you.

Panic attacks and arrhythmia are often seen together in patients. Certainly panic attacks and stress (with the release of adrenalin and catecholamines) can precipitate arrhythmias, but there are also many instances where arrhythmia has been misdiagnosed as purely a "panic attack" because symptoms can be similar. Some researchers are even beginning to question whether panic and arrhythmia might have some common physiological basis so that one may cause the other and visa versa -- sort of like the old "which came first, the chicken or the egg" conundrum.

Xanax, and, many other anti-anxiety meds (like benzodiazapines), can affect heart rate and rhythm in a couple of ways. First, by "relaxing" you they can cut down on the stress induced catecholamines that seem to make hearts "nervous" and jumpy. Secondly, they may affect vagal nerve tone, which then can affect heart rate. Thirdly, they may affect neurotransmitters which can indirectly affect the heart. Because of these actions, many patients find these meds will make their episodes better, but there are also many patients who find these meds actually may make their symptoms worse -- and there was some interesting research that suggested the benzodiazapines can make an acute episode of arrhythmia better, but that there might be a "rebound" effect as the drug is wearing off...

The vast majority of these episodes are more frightening than serious, which is why likely why the ER pronounced your condition as "benign". Still, if these continue and you are feeling fearful, it is often worth the time and money to be reassured, so if you have any lingering concerns, symptoms or questions, you might want to consider a complete exam with a good cardiologist who specializes in rhythm disorders. And it is definitely proven that all the unhealthy things you do to your body (like smoking) can certainly exacerbate the problem, so if you don't like what is happening, try changing your lifestyle and see if the episodes improve. Hope that helps reassure you a bit and that you feel better soon!