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Question: Hi Doctor , I'm a 22 year old Male with a history of RVOT PVCs , my arrhythmia started two years ago and the reason behind it was never found ! I was told that I had benign PVCs and PACs . Heart echos , countless ECGs , Holter Monitors , two Cardiac MRIs showed strucually normal heart muscle , MRI showed a bit of enlargment by 9mm above normal size of left Ventricle but the Doctors said it was still normal that my wall thickness was okay . I have no history of drug use ,smoking or drinking , healthy weight and healthy lifestyle has always been part of my life and i really could not understand why was I suffering from theae scary irregular beats ?!
After my heart rhythm problems I started getting panic attacks , I got diagnosed with Anxiety and Panic Disoroder and have ended up in the ER many times because of that .
I had a Cardiac Ablation 6 months ago and so far It has been a succseful one , my PVCs reduced from 15 000 a day to 10 - 15 a day and I am really happy with that !!!
But they still cause me so much anxiety !
I can get a one single PVCs or a PAC i can feel them too and my entire day gets ruined . They feel different now , the sensation is sooooo much stronger when i get an isolated one and i don't know understnd why ?? Can you please tell me how to deal with them ? Is there something i can do to reduce the sensation that comes after a PVC ? Sometimes i feel like they might kill me ? Are they really harmless ? And why do you think young people such as myself gets them for no apearnt reason ? Thanks
After my heart rhythm problems I started getting panic attacks , I got diagnosed with Anxiety and Panic Disoroder and have ended up in the ER many times because of that .
I had a Cardiac Ablation 6 months ago and so far It has been a succseful one , my PVCs reduced from 15 000 a day to 10 - 15 a day and I am really happy with that !!!
But they still cause me so much anxiety !
I can get a one single PVCs or a PAC i can feel them too and my entire day gets ruined . They feel different now , the sensation is sooooo much stronger when i get an isolated one and i don't know understnd why ?? Can you please tell me how to deal with them ? Is there something i can do to reduce the sensation that comes after a PVC ? Sometimes i feel like they might kill me ? Are they really harmless ? And why do you think young people such as myself gets them for no apearnt reason ? Thanks
Brief Answer:
Cardiac treatment yielded excellent results, but need to lower anxiety.
Detailed Answer:
Hello XXXX!
Thank you for asking on HCM!
Regarding your PVCs, seems that the performed cardiac ablation has concluded in quite a success, judging from the amazing results it has provided. Some times there exist a arrhythmogenic focus that generates such a disorder. Though in a structurally normal heart, isolated PVCs do not impose such an important risk, when dealing with RVOT PVCs, especially facing such a quantitative view, there exists a potential in compromising left ventricular performance.
But now, you have to relief your mind, as the appropriate procedure you performed, yielded excellent results.
Seems that the most obvious problem for you is anxiety and panic disorders. They do explain why you are over-sensing such rare and completely unimportant ectopic beats. Anxiety directly affects your common senses, lowering the threshold for sensing even such tiny triggers.
It is a general rule in rhythm disorders, that emphasizes inverse correlation between quantitative importance of extrasystolic arrhythmia and the clinical subjective perception; that is, few ectopic beats are are experienced more explicitly, than a large amount of them.
And anxiety do emphasize more profoundly this discrepancy.
So the main issue to deal with, and the best way to diminish those unpleasant sensations is to treat your anxiety and panic disorders. You need to consult a specialist in the field (a psychiatrist), to define a carefully scheduled work up for the most appropriate management of anxiety.
From the other side, a close discussion should be maintained with your cardiologist, when it comes to decide the most safe profile anxiolytics and antidepressants regarding potential ECG and cardiac rhythm implications.
Hope to have been helpful to you.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Cardiac treatment yielded excellent results, but need to lower anxiety.
Detailed Answer:
Hello XXXX!
Thank you for asking on HCM!
Regarding your PVCs, seems that the performed cardiac ablation has concluded in quite a success, judging from the amazing results it has provided. Some times there exist a arrhythmogenic focus that generates such a disorder. Though in a structurally normal heart, isolated PVCs do not impose such an important risk, when dealing with RVOT PVCs, especially facing such a quantitative view, there exists a potential in compromising left ventricular performance.
But now, you have to relief your mind, as the appropriate procedure you performed, yielded excellent results.
Seems that the most obvious problem for you is anxiety and panic disorders. They do explain why you are over-sensing such rare and completely unimportant ectopic beats. Anxiety directly affects your common senses, lowering the threshold for sensing even such tiny triggers.
It is a general rule in rhythm disorders, that emphasizes inverse correlation between quantitative importance of extrasystolic arrhythmia and the clinical subjective perception; that is, few ectopic beats are are experienced more explicitly, than a large amount of them.
And anxiety do emphasize more profoundly this discrepancy.
So the main issue to deal with, and the best way to diminish those unpleasant sensations is to treat your anxiety and panic disorders. You need to consult a specialist in the field (a psychiatrist), to define a carefully scheduled work up for the most appropriate management of anxiety.
From the other side, a close discussion should be maintained with your cardiologist, when it comes to decide the most safe profile anxiolytics and antidepressants regarding potential ECG and cardiac rhythm implications.
Hope to have been helpful to you.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks so much for the respond !
Yes ablation seems to have a very good results but the Doctor has said that arrythmias can still return.. thinking about this happening again worsens my anxiety !:( but I just want to ask you Doctor and I know it is impossible to say it 100 % but still how big is the risk for me ? Since every test i have had on my heart has showed normal execpt rhythm probelms ( PVCs ) can i stay PVCs free from ablation rest of my life ? Was that focus taken out of my heart or just burned during ablation ? Can it reactivate again or get a new one ? If yes ? How big is the risk ? Thanks
Yes ablation seems to have a very good results but the Doctor has said that arrythmias can still return.. thinking about this happening again worsens my anxiety !:( but I just want to ask you Doctor and I know it is impossible to say it 100 % but still how big is the risk for me ? Since every test i have had on my heart has showed normal execpt rhythm probelms ( PVCs ) can i stay PVCs free from ablation rest of my life ? Was that focus taken out of my heart or just burned during ablation ? Can it reactivate again or get a new one ? If yes ? How big is the risk ? Thanks
Brief Answer:
No any obvious risks for you in the near future, but follow up is mandatory
Detailed Answer:
Hello again XXXX! I passed carefully though your concern, I would like to explain you as follow:
(1) Cardiac ablation, when performed by experienced hands (and minds), respecting strict protocols yields a very high rate of success, and, as it seems, that's your case. If provocative tests done during EPS (electro-physiological study), has not concluded in any triggered arrhythmia, then this confirms with a high certainty (over 95%) that arrhythmogenic focus is successfully treated, and the risk of returning even when triggered by anxiety is almost insignificant.
(2) The chances of maintaining these steady successful results of cardiac ablation (that is free of PVCs) are very high (facing the actual cardiac tests conclusions). So, relax! There doesn't exist any indicators to show that a relapse could be possible in the near future. You need carefully scheduled cardiology follow ups to confirm repeatedly your normal clinical status, and prevent any appearing anomalies.
(3) If the primary EPS study has been a comprehensive one, cardiac ablation has managed to burn arrhythmogenic focus as well, and subsequent provocative tests has not yielded any triggered arrhythmia, then the risk of a reactivation is very very low and other potential focuses excluded as well (in-existent).
(4) So at the end, I would like to reassure you, that those very rare remaining PVCs (10-15) are totally insignificant. You don't have to consider them. Do not panic about them! Their meaning is nothing. No obvious risk could be found by your resultant clinical scenario and performed tests.
Hope to have been helpful to you.
My Best Wishes! Dr. Iliri
No any obvious risks for you in the near future, but follow up is mandatory
Detailed Answer:
Hello again XXXX! I passed carefully though your concern, I would like to explain you as follow:
(1) Cardiac ablation, when performed by experienced hands (and minds), respecting strict protocols yields a very high rate of success, and, as it seems, that's your case. If provocative tests done during EPS (electro-physiological study), has not concluded in any triggered arrhythmia, then this confirms with a high certainty (over 95%) that arrhythmogenic focus is successfully treated, and the risk of returning even when triggered by anxiety is almost insignificant.
(2) The chances of maintaining these steady successful results of cardiac ablation (that is free of PVCs) are very high (facing the actual cardiac tests conclusions). So, relax! There doesn't exist any indicators to show that a relapse could be possible in the near future. You need carefully scheduled cardiology follow ups to confirm repeatedly your normal clinical status, and prevent any appearing anomalies.
(3) If the primary EPS study has been a comprehensive one, cardiac ablation has managed to burn arrhythmogenic focus as well, and subsequent provocative tests has not yielded any triggered arrhythmia, then the risk of a reactivation is very very low and other potential focuses excluded as well (in-existent).
(4) So at the end, I would like to reassure you, that those very rare remaining PVCs (10-15) are totally insignificant. You don't have to consider them. Do not panic about them! Their meaning is nothing. No obvious risk could be found by your resultant clinical scenario and performed tests.
Hope to have been helpful to you.
My Best Wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thank you so much Doctor ! You have made me feel so much better .
Unfortunately I ended up in The ER last night after a chest pain and of course was dischared with no diagnosis , bloods , X ray and ECG was normal and the doctor said it was probably anxiety related but this time the type of pain I had was something I have not experienced before .. Numb , burning sensation on my left side radiating down to my elbow ... I really though i was having a heart attack and I called the ambulance , they had to use a GNT spray which caused me a terrible headache and for some reason my hearr rate was going up and down after they used that spray , it was a sinus rhythm but it would go over 100 and down again .
The ER doctor said it most likely was pectoral trigger points ? Pressing on my skin was painfully .
Now I realise that i can not go on without anxiety meds and therapy is not helping much . Most of them have cardiac side effects and wanted to ask you if you can suggest something for me ? An anxiety med with less cardiac side effects ? Thank you !
Unfortunately I ended up in The ER last night after a chest pain and of course was dischared with no diagnosis , bloods , X ray and ECG was normal and the doctor said it was probably anxiety related but this time the type of pain I had was something I have not experienced before .. Numb , burning sensation on my left side radiating down to my elbow ... I really though i was having a heart attack and I called the ambulance , they had to use a GNT spray which caused me a terrible headache and for some reason my hearr rate was going up and down after they used that spray , it was a sinus rhythm but it would go over 100 and down again .
The ER doctor said it most likely was pectoral trigger points ? Pressing on my skin was painfully .
Now I realise that i can not go on without anxiety meds and therapy is not helping much . Most of them have cardiac side effects and wanted to ask you if you can suggest something for me ? An anxiety med with less cardiac side effects ? Thank you !
Brief Answer:
I would recommend you alternative non-pharmacological options.
Detailed Answer:
Hi XXXX!
I am glad to hear that you keep going without any obvious cardiac problems.
I have no doubts about that. Regarding your anxiety and panic attacts, first I would suggest not to come under the influence of those anxiety meds.
You are a young man with lots of creative energy. You can find the power to overcome every possible obstacles in your mind. I would recommend you to consult an expert in the field (psychiatrist), to investigate if any anxiety problems really exists, and to buid a comprehensive work up, on how to deal with this issue, if it is necessary. At the beginning you have to try with exploring your insight (supported by the mental therapist), and see the results. Only if expected progression isn't enough you may think of meds. You can discuss with your therapist about any, such as alprazolam, sertraline, etc. All of them have side effects, some have fewer, but the most important is to be cautious, and follow advices step by step, and eventual drug treatment under medical supervision.
So, you should discuss with a psychiatrist on how to resolve these issues.
Wish you good health! Dr. Iliri
I would recommend you alternative non-pharmacological options.
Detailed Answer:
Hi XXXX!
I am glad to hear that you keep going without any obvious cardiac problems.
I have no doubts about that. Regarding your anxiety and panic attacts, first I would suggest not to come under the influence of those anxiety meds.
You are a young man with lots of creative energy. You can find the power to overcome every possible obstacles in your mind. I would recommend you to consult an expert in the field (psychiatrist), to investigate if any anxiety problems really exists, and to buid a comprehensive work up, on how to deal with this issue, if it is necessary. At the beginning you have to try with exploring your insight (supported by the mental therapist), and see the results. Only if expected progression isn't enough you may think of meds. You can discuss with your therapist about any, such as alprazolam, sertraline, etc. All of them have side effects, some have fewer, but the most important is to be cautious, and follow advices step by step, and eventual drug treatment under medical supervision.
So, you should discuss with a psychiatrist on how to resolve these issues.
Wish you good health! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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