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Does anxiety cause palpitations and skipped heart beats?

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Dr. Ivan R. Rommstein

General Surgeon

Practicing since :2008

Answered : 9755 Questions

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Posted on Wed, 20 Aug 2014 in Mental Health
Question: Hello Doctor,
I was in the ER today with a panic attack. I'm having such a time since my husband died 3 years ago. I'm not used to living alone yet. I have heart palpitations a lot ---- skipped heart beats --- TONS of them. I've had heart work-ups in the past, and all have come back just fine. But I still have spells of these --- lately really miserable. The doctor insists its anxiety. Do you agree that anxiety can cause these? And are they dangerous? I'm afraid to do much of anything. Also, this morning my TSH was 3.758. In March of this year it was 1.911. The doctor mentioned that my thyroid function is low. My anxieties have take over and I'm worried about that, too. Isn't that a huge fluctuation in TSH over just a few months time? Thank you for helping me!
doctor
Answered by Dr. Ivan R. Rommstein 4 hours later
Brief Answer:
Hi and welcome

Detailed Answer:
Dear XXXXXXX I understand your difficulties and I can agree with your doctors that anxiety is main cause of all your symptoms. of course, any somatic underlying pathology should be ruled out, but I am sure that doctors checked all possible emergent conditions. Any serious heart arrithmia would be seen on ECG or ergometry so palpitations are probably just your own sensation which is common and normal in people who are emotionally stressed and you have reason to be anxious considering your husbands death and fact that you live alone. beside heart palpitations, anxiety can cause variety of symptoms such as fatigue, headache, chest pressure, breathing difficulties and many other. Fortunately, all this is not serious if anxiety is the only cause and you have to learn how to deal with these symptoms. First of all, you should understand that nothing bad will happen,try to rest, take deep breaths and think of something nice. Certain medicines may help too. FInd some activities which could occupy your minds. Finds someone who will be with you during panic attacks. Anxiety can also cause hormonal imbalance but your TSH levels arent worrying at this point. Hormonal levels vary from day to day and it isnt strange to have such fluctuations. Check T3 and T4 levels, it will tell us more about thyroid condition. It is good that you care for your health,but I am sure that you are very healthy woman ,you just shouldnt think about diseases so much. Trust me,if there is some problem with your body, you would have symptoms and signs which are detectable and doctors would finds cause of it. So,try to relax a bit, your heart works fine if you dont have chest pain that radiates into left arm. I hope you ll feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ivan R. Rommstein 1 hour later
Thank you for your reassurance. In the past year I've worn a 24-hour monitor, had several EKGs, an echo stress test, and heart enzymes checked. All were normal --- but I didn't experience any skipped beats during those testing times. So the doctors say that all those tests were fine and no need to repeat, but this is anxiety related. It's so miserable. I had them about a year ago and one day they just disappeared and never came back ---- until a week ago. There they were again!!! And I'm still having them. I have no other symptoms except a little nausea now and then, but I suppose that can be anxiety related, too. The doctors tell me I'm healthy. But then when I get some little pain or something, I think they must be missing something. I keep thinking I should be having an easier time with living alone after 3 years, but that's still not the case.
I really DO need to find some activities to occupy my mind, but it's hard to find an interest with my husband not here anymore. I have a sewing machine and a weaving loom and haven't used either one in a long long time. Maybe it's time to push myself a little bit!
My Free T4 level was 0.97 this morning. I don't know if that's normal or not. I was most concerned about my TSH. It's never been even close to that number in the past. Can anxiety cause TSH levels to change?
I see a psychologist about once a month. She has me working on some meditation and mindfulness exercises. And I do take valium as needed. I"ve been on that for 20+ years and recently weaned off it. I went a month without any, but now the doctor said to use is just as needed.
Thank you so much for your help. I need reassurance more than anything, I think. I've been anxious all my life and grew up in an anxious household.And one more question along with what I just wrote above: Can doctors determine a heart problem in tests if the heart is beating regularly during the tests? Nothing was ever picked up on my stress echo done last September. I was told it was perfectly normal. And I had just a few skipped beats while I wore the halter monitor --- not a lot of them like I often have for hours on end!! So I wonder if heart problems can be diagnosed if the symptoms aren't there at the time of the testing. That's a question I have along with the one regarding my Free T4 result. I wonder if that is normal Of if I have reason to be concerned about my thyroid. Thank you very much, Doctor. Also, does it hurt anything to take walks or do things like that if I'm having skipped beats. I often can't seem to do anything when they get bad because they kind of take over my entire life!
doctor
Answered by Dr. Ivan R. Rommstein 22 hours later
Brief Answer:
hi

Detailed Answer:
First,this is normal T4 levels so this shouldnt concern you. TSH may fluctuate and TSH is hormone that controls T4 secretion and tsh has no other function in our body so it shouldnt be related to any of your symptoms. 24 -hour monitor is sensitive test which would detect any heart arrithmias. Ocassionaly palpitations are normal and most of people feel it,even those who are not anxious. It is always aggravated by some physical or emotional stress but if tests were fine then it wont have any effect on heart function. When heart become weak,then it is constantly weak and when some arrithmia such as fibrilation or nerve bloc occur, then this is always present and it can be detectable by simple ecg or echocardiography. So normal tests are indicating that palpitations are caused by anxiety. I understand that it bothers you and can effect quality of life but heart medicines shouldnt be prescribed if there isnt proved heart disease. it would be smart to take some weak low dosage anxiloytic medicine. this will slow done pulse and relax heart muscle. But more important that you convince yourself that you are healthy. just have regular follow ups at doctor. there is no purpose of focusing on thyroid levels and other findings, it will just make you nervous and stressed. When real disease occur.your doctors will tell you this,now you just have to enjoy in your life no matter how hard it seems to be for you. Try to have on mind that many people of your age arent healthy as you are and have much more serious diseases.and your heart seems to last at least 100 years:)
You need to surround yourself with friends and hobbies, think positive and I am sure you ll feel better.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ivan R. Rommstein 20 minutes later
Thank you so much Doctor. You have been very helpful. I WILL focus on counting my blessings!!! I want to feel happy and content.
doctor
Answered by Dr. Ivan R. Rommstein 4 minutes later
Brief Answer:
hi

Detailed Answer:
yes, this is good attitude. You can leave this query opened and ask me in future anything. I d be glad if I could help. Also, i suggest to check thyroid levels in 2-3 months and measure BP daily.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ivan R. Rommstein 2 hours later
If I'm having a thyroid problem, would be BP be high or low? I check it about once a week. It's usually in the 110 to 130 range on top and in the 60s on the bottom. Occasionally I'll catch it at 150 or 160, but it comes right back down in a short time. I just checked it now and it's 135/69. The top is just a tad higher than it usually is.
But at this time, you don't think there's a thyroid problem. Is that right?
I guess I have just one more question for you. Today I received a copy of my lab results from the day I was in ER with my anxiety attack. The doctor mentioned to me that my TSH was slightly elevated and gave me a number. So I was concerned and wrote to you about it. He didn't mention these other numbers that are marked abnormal by the lab. I'll give you those. I don't know what's normal, so I don't know how far out of normal these are. Please tell me if these are concerning. My WBC was marked low and the number is 4.54. Something called ALT was marked low and the number is 10. And something called Eosinophils% is marked high and the number is 3.7. Will you please tell me if these are a concern --- I know you said the TSH wasn't worrisome, but now I have these other numbers. Please tell me what they mean. Thank you so much ---- and then maybe I can actually stop worrying!!! Thank you.

I would like to leave a wonderful rating, but I can't do that until I hear from you again. Thank you.
doctor
Answered by Dr. Ivan R. Rommstein 7 days later
Brief Answer:
hi

Detailed Answer:
If there is hypothyreosis than bp will be lower, if there is hyperthyreosis then it will be higher. these BP values that you mention are completely fine.So you would have some other symptoms and other tsh,t4 levels if there is thyroid disorder.

Well,wbc 4.54 can be highlighted as low in some laboratories, actually,normal range of wbc is 4.5-10.8 but each hospital may have some varieties in these normal value range. in every case, this is not abnormal wbc and it isnt indciating anything. if you repeat it today it may be 5,or 6 or higher so it also fluctuates rapidly.
The same goes with ALT which is one of the liver enymes, and when it is elevated it can indicate liver damage. it is much better that it is low than high.
This is normal eosinophyles count. if these are only abnoirmal blood tests then you are really healthy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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