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Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem?

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Psychiatrist
Practicing since : 2003
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Dear doctor,

I have a strange sensation in my chest 6 months ago. I had pvcs or pacs . Skipped heartbeat then pause and followed by another harder thump which gives me an urge to cough, no pain , not breatheless and no other symptoms.

It all started when I have gastric issues and digestive problems. And slowly it skipped beat became worse. It is especially when I bend over to pick up something or changed my body posture.. I can't get my mind of this and is in extreme distress. It has taken a toll on my life now. Pls tell me how anxiety caused this. Even when I'm relax the pvcs/pacs can set off.
Posted Sun, 5 May 2013 in Mental Health
 
 
Answered by Dr. Jonas Sundarakumar 4 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I would like to have the following clarifications from you:

1) Have you had an ECG and a cardiac evaluation by a doctor?
2) Have you been diagnosed to have PVCs / PACs or are you just assuming that the skipped heartbeats could be due to this?
3) Do you have any other medical disorders?

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 10 hours later
Dear doctor,

Yes I had 2 ECG done show normal. I jux had a holter monitor done .. And show pvcs or pacs of 491 in 24 hour .. Is it safe ?? I'm very worried and it happened most often when I'm sleeping. However, I never felt it during my sleep.. I felt the least when I'm laying on bed.. But I XXXXXXX knw y it showed up so much while is was asleep.

I never had that before. 6 months ago it was few times a day.. Now I felt it so often.. After meals is even more obvious .. May I know u is this so??
 
 
Answered by Dr. Jonas Sundarakumar 18 hours later
Hello again and thanks for the clarifications.

Firstly, having palpitations or PVCs / PCAs when the ECG is normal is not a cause of worry. If there was any significant arrythmia or any serious cardiac problem, then it would definitely show up in the ECG. Secondly, such isolated or single beat PVCs / PCAs can occur even in healthy individuals. Thirdly, since you don't have any symptoms indicative of a cardiac dysfunction, like chest pain, breathlessness, fainting spells, etc., once again, this means that there is no need to worry. Fourthly, the fact that your symptoms are more prominent after meals and during sleep is another pointer against any serious cardiac problem.

One likely possibility is that this problem could have started off initially as a sensation of chest discomfort due to your gastric problems (gatstritis / acidity problems often present with a discomfort in the chest). This discomfort and strange sensation could have made you become more aware of your heartbeats and maybe, the occasional missed beats. Slowly, the worry and anxiety developing due to this must have ended up worsening the symptoms over the last 6 months. It is important to understand that stress and anxiety can present with not only psychological symptoms but also with physical or somatic symptoms. Irregular or fast heart beats (palpitations) are indeed commonly seen in anxiety disorders.

Now, this does NOT mean that 'everything is in your head' and that you are simply imagining the symptoms. Not at all. It is likely that It has also been found that anxiety is associated with certain neuro-chemical imbalance in the brain and this can cause the person's sensory threshold to get lowered and he / she can become 'hypersensitive' to bodily sensations, and therefore perceive and experience abnormal sensations more. The underlying anxiety also causes a person to become more worried as to why his / her problems are undiagnosed after multiple tests, and then this worry / anxiety itself then starts worsening the symptoms more. Soon this becomes a viscious cycle, leaving the person with more symptoms and suffering.

The basic point is that since your symptoms are not indicative of anything serious, it would be best to try to ignore them and stop worrying about them. You can also try relaxation techniques like deep breathing, progressive muscle relaxation, yoga, etc. Try to keep yourself engaged and occupied always. The more you try to stay relaxed and ignore your symptoms, the quicker will they fade away.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 57 minutes later
Dear doctor,

What u describe is indeed how I'm feeling. Yes I had anxiety disorder for 7 years. The reason I did not mention at first is because I dislike the fact that once doctor knows that the patient had anxiety, he pushes everything g to anxiety and leave the patient alone.

Yes initially was some indigestion , then the chest sensation. Then I can't stop thinking and now doctor, please ... I'm feeling every bit of it right now!! Everyone of them !!! I jux can't ignore.. Even when I'm doing things, back of my head is preparing it to happen !!! It's getting more n more frequent n I'm more and more worried. Yes I got anxiety disorder but y am I feeling these even when I felt relax ?

There will be no anxiety if there are no symptoms... The symtoms are there!!! Is skipping beats now n then ..

Pls tell me what so I do?? I felt like digging my heart out!!!!!
 
 
Answered by Dr. Jonas Sundarakumar 11 hours later
Hello,

I can understand that you have been going through a very tough time with this issue. I do understand that your symptoms are there, but you should also understand that the perception, intensity and impact of the symptoms become multi-fold due to the worry and anxiety about them. Unfortunately, this link between the symptoms and the anxiety is bi-directional, or in other words a vicious cycle - where one fuels the other. Unless this vicious cycle is broken, both the symptoms and the anxiety will keep prolonging.

One possible approach would be to try a low dose of a 'beta blocker' medication (like propranolol). Beta blockers are commonly used in the treatment of palpitations / heart rythm problems as well as in the treatment of anxiety disorders. This is likely to help reduce your symptoms as well as the exaggerated perception of your symptoms due to your anxiety. So, can discuss this option with your doctor and try a low dose of Propranolol. Since the worry and distress due to this issue seems to be putting you through a lot of suffering, it would also be a good idea to take anti-anxiety medication for a short period till this problem settles down.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 10 hours later
And also I heard that beta blocker can cause more side side effect and not encouraged. Is it true. I can't distract myself alway. I appreciate your understanding. Could u tell me how to alter my thoughts when I can't take that early skipped beats of my head??? I'm trying my best.
 
 
Answered by Dr. Jonas Sundarakumar 13 hours later
Beta blockers in low doses (for example, 10 mg twice a day) should be quite safe and in fact, are very commonly used in the management of such kind of problems.

I understand that it is not easy to not think about your symptoms or distract yourself. But with practice it is definitely possible. There are two areas which you have to try and work on - one is your thoughts and the other is your behaviours. You can deal with your thoughts by challenging and reasoning out your exaggerated fears and doubts. You should reason out calmly and be able to gradually convince yourself that even if you experience skipped beats or palpitations, you need not worry about them because they are not potentially XXXXXXX That is, you should be able to realize that these are merely bodily sensations and that the less you give importance to them, the less prominent they will be. The second part is to adress your behaviours. When you feel these skipped beats, you automatically seem to go into a response mode of anxious behaviours. These consequential anxious behaviours need to be prevented, so as to prevent the "viscious cycle" (that is symptoms leading on to anxiety, and then anxiety worsening and leading on to more symptoms). So, as whenever you experience a symptom, have a standby (practiced) response - for example implementing a relaxation technique or a distraction technique, so that you prevent the triggerring a maladaptive, anxious response.

Don't get frustrated because learning to control your thoughts and behaviours will take tme and a lot of practice. Be persistent in your efforts and you will be able to see positive results. You can also consider the opton of seeking professional help as there are effective therapies available, such as CBT.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 20 hours later
Dear doctor,

Thank you so much for your advice . I am working extremely hard to distract myself. I do get frustrated and becoming impatient .. I'm so afraid it wil come again. I find it so hard to control my emotions. I was easily agitated. In trying my best. The beats does come, I try n distract myself by eating or playing hand held games.

I had read in forums that some people had this premature beats for more than 10years. I'm so afraid that I will end up like them. Why aren't the cured then?? Is it that some nerves around the heart is damage or injured? If yes than there must be some help that can be done?? Sorry I'm jux preparing for the worse. Those in forums are so discouraging . I'm so afraid I will end up like that for years n not recovering ...,
 
 
Answered by Dr. Jonas Sundarakumar 14 hours later
Hello again,

You should not think of the worst scenario or compare yourself with others who report the worst situations. This is because, in your situation, you don't have anything serious or potentially XXXXXXX and your anxiety seems to be a major role in perpetuating your symptoms.

Much of the information posted in public forums can be misleading and you should remember that they are posted by different people with widely different problems, which need not and rather should not be applicable to you.

Like I had mentioned before, when you keep repeatedly analyzing, dissecting and pondering over these things, your anxiety levels will only increase and so will your symptoms. I understand that it is difficult not to think about this or distract yourself, but when you set certain ground rules for yourself and keep practicing the relaxation techniques, you will gradually be able to get rid of these worrying thoughts. It is practically impossible to expect all these thoughts to go away in a few days itself, but if you are patient and persistent in your efforts, they will initially decrease and gradually fade away (...and so will your symptoms).

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 32 hours later
Dear doctor,

Firstly I would like to thank u for your professional advice , as well as your patience .im really working very hard to listen to each n every of your advice. Trust me. I can only say that I can totally understand your point but yet I can't do it.

I'm currently running a business with a partner. He is so incompetent that escalate my anger n agony everyday. This actually had been going on for the past 1 year . I can't control n suppress my anger . And I had thought of thousands of ways to "let go" each time he made unnecessary mistakes. However because it is business matters, I cannot choose to "let go" simply I can't let those mistakes affect the day to day running of the business. And the fact is that my biz partner is also my close childhood friend.. Contradicting situation between friendship n biz matters. As a anxiety disorder sufferer, this issue had bothered n escalated my symptoms. But is something I can solve. So everyday or alternate days , I would have to scream my head off!! FYI, my partner is a slow brainer, he can only follow instructions wrongly. He admitted his mistakes n he don't know y he behave like this .. So I'm suffering a lot of "shit" from him. Then my body starts to give way.. N I guess my skipped heart issue had more or less to do with it.

Sorry for my sharing on personal issues, I jux hoped to tell u more so u can direct me.

My heart skipped/pacs/pvcs whatever is not improving . I always felt recharge when I wake up in the morning but once I wash up n ready to "go" after a warm glass of water , the twitches wil come. N after meals it's even more obvious. My point is , i accepted the fact that could be due to anxiety . However, I belive surely the body must had some wear n tear, or some "unbalanced " in which ever organs or nerves that had caused this to happen . I really XXXXXXX think ignoring it will totally work because "something " in there is not normal?? This "thing" is tiring out , damaged , burn out , drained or whatever . There must be something I need to do with this "thing"!

So not only I hoped to ignore the symptoms, I wanna know what is in "it" that I need to take care off or eat?? I XXXXXXX know. I know about the vicious cycle thing , if I can't break the part on ignoring it, then I must break the part of stopping the sypmtom. Pls teach me how?? Or if I'm not right to think this way, pls correct me n tell me how should I think .

When the beats are there , I'm joyful n happy . But halfway when I'm feeling relax n joyful, the beats come n will totally destroy my mood as the twitches come attacking non stop for hours only to stop or get lesser after several hours. So tell me is symptoms causing my anxiety or anxiety causing them ?

I'm not afraid to die,as this is all predestined n decided . All I wan is to stop this symptoms n not let bother my life everyday on n off. It's agonizing!! I felt like digging my heart out!!!

Sorry for this long email .. I jux need a clear,detailed and logical explanation. And u belive u are one of those profession who can help me with that.. The heart jux skipped a few times as I'm engrossing in typing these words. Something in there is not right. Pls help me, I jux wan them to stop asap!!!!!
 
 
Answered by Dr. Jonas Sundarakumar 19 hours later
I can see that you are already in the midst of a lot of stress from your work sphere, due to your partner. The stress and anxiety due to your symptoms seems to be adding even more pressure.

If you are finding it impossible to ignore your symptoms, then I suggest that you take some symptomatic treatment like a beta blocker. You should however understand that merely having a bodily symptom does not indicate an underlying major medical disease or disorder. What would have been a benign, mild and transient symptom can get exaggerated and become extremely distressing, if the person becomes more and more anxious regarding the symptom.

It is a very well known and scientifically proven fact that anxiety and stress can even manifest itself with purely physical symptoms. I had already explained to you in my previous answer how anxiety can result in the production or worsening of physical symptoms. And like I mentioned earlier, the anxiety triggers symptoms and the symptoms then trigger more anxiety and this is how a vicious cycle sets in.

That is why I have suggested that you can try a dual approach, where you can target the symptoms as well as tackle your anxiety. You seem to be wishing to find or detect one ultimate, sinister cause for your symptoms which, if treated, will make your symptoms disappear instantaneously. Unfortunately, there doesn't seem to be such a cause or one-off remedy, and analyzing your symptoms more and more, thinking of sinister causes or considering the worst possibilities is only going to be counter-productive to your improvement.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Strange sensation in chest, skipped heartbeat, no pain , not breatheless. Due to gastric problem? 3 days later
Dear doctor,

Firstly I would like to thank you for all the advices u gave. I'm trying my best to follow your advice.

Recently I read about Passion flower tea n decided to try it. Amazingly, the twitches I felt in my heart was reduced. Or rather it does not pound as hard as before. It became slower ,weaker n less noticeable . I do get panicky as I sometimes tried very hard to feel my heartbeat as after drinking passion flower tea i hardly felt them.. is it normal? So which is better which is not?

Could u give me your opinions of this treatment?

I had been on lexapro, zactin and seroxat years back. Seroxat was the longest n I put on 12kg when I was on it for 2 years. I XXXXXXX think I improved during these 2 years , seroxat only gives me good appetite and when i eat it distract my bodily symptoms. I finally discussed with my psychiatrist n we agree to stop medication. I understand GAD is something that can only be controlled n not cured.

Thks again n I appreciate every of your advices
 
 
Answered by Dr. Jonas Sundarakumar 12 hours later
Hello again,

Passion flower extracts have been known to be useful in treating anxiety and sleep disorders. It is also claimed to be beneficial in controlling symptoms of a variety of medical conditions like menopause, high blood pressure, palpitations, fibromyalgia, narcotic drug withdrawal, etc. There is scientific evidence that it can indeed be effective in the treatment of anxiety disorders. Evidence for the other medicinal claims is not robust.

In your case, you have mentioned that your symptoms of twitches / pounding of the heart had reduced after trying passion flower tea. Your heartbeats becoming less noticeable is actually a good thing (because normally, heartbeats should not be noticeable). So, if this seems to be helping your symptoms, you can continue to take it. Since it is a herbal preparation, the possibility of side effects is very less and so, if taken in moderate quantities, it should be quite safe. You don't have to get worried about not being able to feel your hearbeats, as this is normal.

Lexapro (Escitalopram), Zactin (Fluoxetine) and Seroxat (Fluoxetine) all belong to the same class of medication - SSRI anti-depressants / anti-anxiety agents. But like you had decided, medication are not a compulsory option for treatment of anxiety disorders. And like you have rightly mentioned, anxiety disorders can only be controlled; but when you learn to accept and take control of your symptoms, you will be able to be well functional and lead a normal life.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
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