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Panic disorder. Rapid heart beat. Heart arrhythmias. Is stress and anxiety the reason? - Online Doctor Chats

Date : 14-Mar-2013
User rating for this question
Very Good Posted in: Anxiety and Stress
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1722 Questions
User:Thank you
Doctor:how can i help u today ?
User:I had a few question about heart arrhythmias
Doctor:sure, please proceed
User:ok i'll give u a little history first
User:5 years ago i was diagnosed with panic disorder so I know a lot of my "symptoms" are related to that
User:in FEB of 2010 I was given a stress test and it came back normal
User:but before then I was constantly having palpitations and rapid heart rates, pounding heart beats and so on
User:so I kept telling my doctor about it for the next year or so and they order another stress test and a 24 hour holter
User:the stress test came back fine and the holter said I was having sinus tach
Doctor:may i know your age ?
User:ill be 25 next month
Doctor:sinus tachycardia, is not abnormal , hence is not a arrhythmia
Doctor:it is a higher rate of heart beat, which is common when a person is anxious, stress, working out, etc
User:but mines up high ALL the time
Doctor:may i know what is the heart rate ?
User:i know anxiety happens to people but how can someone be anxious for 5 years everyday
User:it goes from 55s to 160s
User:if im standing up it is constantly in the 130s and higher for most of the day
User:and it is hard to deal with because I constantly am aware of it i can feel it all over
User:when I eat it shoots up in the 150s or higher
Doctor:have u been tested for thyroid conditions ?
User:yes all came back fine
Doctor:how often do u check ur heart rate ?
User:pretty often because it is constantly pounding
User:i feel it every where in my head my chest my stomach my teeth its unbelievable
Doctor:are u on any medications for anxiety or panic attacks ?
User:i take klonopin as needed
User:i have been on anti depressants but they make my blood pressure high so the doctor has taken me off all the ones we have tried
Doctor:if your heart rate is so, high, has your doctor advised any pills to reduce the heart rate with medications called beta blockers
User:i was on propranolol for about 4 years but the cardiologist told me that it's not really going to benefit me because it was only sinus tach
Doctor:in addition, to the klonopin, you should try to reduce your anxiety, with counseling , and measures like meditation, and breating exercises
User:i am in therapy and trying to find the right therpist for me
Doctor:such exercises, when done during the episodes will help to control your symptoms
User:i do have some other things though
Doctor:may i know your occupation ?
User:i am a student right now
User:when they did the holter test yes i did have the higher heart rate but i didnt experience the skipped beats that day
User:without them seeing the skipped beats how can they determine what they are?
Doctor:skipped beats , occur, when the atrial firing rate is very high
User:what does that mean
Doctor:in such cases, the ventricles are already in contraction , and hence some stimulations from the Sino atrial node, (the pacemaker of the heart), do not get processed by the ventricle
Doctor:and hence there are no ventricular contractions ( seen as missed beats)
User:and thats normal?
Doctor:but essentially, they are normal, and do not count , especially, when the atrial stimulations from the SAN, are present
User:so basically like PACs
Doctor:occasional missed beat, specifically when HR is around 150, is not that significant
User:ok now i have another thing i have to get off my mind
User:one morning i woke up and my heart rate was rather normal in the mid 50s and i was curious so i listened to my heart with a stethoscope
User:and it wasn't beating normal and it wasn't skipping beats it was like a fluttering sound
User:it didnt have the la dub normal sound
Doctor:during sleep, the heart is beating at the resting rate (around 60 or less)
User:it was like all over the place
User:i was lying down when it was making all these weird noises but when i sat up it was normal
Doctor:and at such a slow rate, since the cardiac muscles are contracting in a reduced intensity, you may not hear it too loudly
User:i laid back down and it was all over the place again
Doctor:and when u are in the lying down, the load of blood on the right side of the heart increases
Doctor:hence, you may have such changes, in the heart beat audibility
Doctor:you need not worry about them
User:i just get nervous when i exercise and its skipping beats whether i should stop or just keep going
User:the feeling of it is just so intense it hard to ignore
Doctor:I understand
User:i just recently started working out again and its been hard i always have anxiety after i work out because im worried about my heart
Doctor:but, when you do understand that it is just a normal response of the body, and there is nothing to worry about, your anxiety should be reduced
User:i wish it was that easy haha
Doctor:since , all the tests, have not detected any thing abnormal, it is clear that you will be normal
User:the last 5 years of my life have been completely shattered because of this stuff i used to love running and playing basketball now im just scared
Doctor:in case, you had any episodes like fainting, syncopes, arrhythmias can be
User:nope no fainting i do get extremely dizzy after working out tho
Doctor:but , in your case, i am of the opinion, that your heart rates are very benign
Doctor:for now, you can get back on cardioselective beta blockers
Doctor:after due consultation by your doctors
User:ive checked my blood pressure after work outs and seems pretty normal so i have no idea why i get so dizzy
User:ok i will talk to them
Doctor:this will help to reduce the heart beat, to some extent
Doctor:and also reduce your symptoms
Doctor:in addition, try meditation, like Yoga, or breathing exercises regularly
User:ok dr i will try my best thank you, you have been very helpful
Doctor:they are really effective to reduce the heart beat , to normal levels
Doctor:You are very welcome
User:be well doc thanks again bye bye
Doctor:take care and have a good evening
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