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Getting heart palpitations and suffering from panic disorder. What to do?

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Practicing since : 1998
Answered : 1306 Questions
Dear Doctor,
I had a full physical 5 months ago. When I say full I mean mri of heart, echocardiograph and bicycle stress test (where i reached 289watts and 156%, if that means anything to you) and all blood test work up and even an 3d imaging of my heart.
I was declared very healthy.
Then 2 weeks I started getting some heart palpitations and I called my doctor up and he took me in for another bike test. The results were even better than the last but he said at the end as I was cooling down there was what he called a benign systolic something something?? He showed me on the graph and assured me they are common and nothing to worry about.
Still every other day they come back and they feel like an extra beat or fluttering, I can even feel them in my neck.
I train on a cross country machine every morning and I never feel them while exercising but right after i cool down they are back for at least a half hour. I also get them after a meal.
I usually feel them in the morning and while lying in bed.
I don't know if I always had them and now I notice them or they are new.
I guess my question is, Is this common and do I have anything to worry about.
I search the net but I can't process the info..all I see is "sudden death".
I do have genaral panic disorder but I don't feel that I have had this Before.
Its is very debilitating and I feel stupid if I call him back and he has to reassure me that they are normal.
Thank You
Posted Mon, 10 Jun 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 20 minutes later

Thanks for your query.

1. Palpitations are increased by tea/coffee/anti-asthma drugs/ anti-cold drugs/ stress/ anxiety/ fever/recent common cold/asthma/ Thyroid disorder. Please look for these factors.

2. We need to know the rhythm at time of your palpitation, for which we need to get an ECG at time of your palpitation or a 24 hour Holter monitor (provided you have these palpitations daily).

3. If these two modalities catch the rhythm and the rhythm is not XXXXXXX only a single drug (like beta-blockers or calcium channel blocker would suffice). Commonly, they are premature contractions which in the absence of structural heart disease are not XXXXXXX

4. I presume that you never had a blackout/ loss of consciousness/ giddiness/ chest pain associated with these episodes. If you ever had you must tell this to your doctor and see him on priority.

5. Since you do not have any alarming symptom as narrated above and your heart is structurally normal on MRI (Magnetic resonance imaging) and ECHO (Echocardiogram) and your stress test is also normal, likelihood of a serious rhythm disorder is very low.

Feel free to discuss further.

Above answer was peer-reviewed by
Follow-up: Getting heart palpitations and suffering from panic disorder. What to do? 15 hours later
My cardiologist tells me that pvcs are very common and many people have hundreds a day with out knowing it.
He told me they are very common after exercise.
I guess I am just looking for a second opinion and confirmation from another doctor.

Answered by Dr. Sukhvinder Singh 22 minutes later
Dear Sir

Yes, your cardiologist is correct. (If he identified that, your rhythm at the time of palpitation is PVCs only). They are very common in normal population. You may have thousands in a day without appreciating them. They may appear during or immediately after exercise (especially after exercise).
Only condition is that we must be able to pin point / decipher that at time of palpitation the ECG has PVCs only.

I hope it helps. Feel free to discuss, if there is anything else.

Above answer was peer-reviewed by
Follow-up: Getting heart palpitations and suffering from panic disorder. What to do? 59 minutes later
what other things would he be looking for on the ecg?
understand I am walking around like a zombie because all I see is sudden death when I look at the internet pages on palpitations. I feel every pvc will be my last beat.
Answered by Dr. Sukhvinder Singh 1 hour later

If a patient has PVCs and no structural heart disease, (which is not there in your case) there is nothing to worry. They are not known to be associated with sudden cardiac death. Be assured.

Do not worry; a number of drugs can control these PVCs which do not have much side effects. Have faith in your doctor and discuss out everything. A solid support comes from normal MRI, normal ECHO and normal Stress test in your case.

Palpitation can be associated with a number of abnormal rhythms like PVC, PAC, AF, SVT, AFl, short runs of VT etc. (I am not writing the details because it is not would be extremely hard for you to make out the difference; your doctor can exclude these). Out of these first two are more common possibilities.

I hope its clearer to you. Let me know if you need clarifications.


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