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Hi, I Went To Get A Regular Prescription The Other

Posted on Tue, 20 Nov 2018

Question: Hi, I went to get a regular prescription the other day when the nurse checked my heart rate it was 136. i did tell her i was nervous beforehand. the doctor then saw me, and i told him i was having a panic attack. the heart went up to 174. i was taken into emergency, and had an ecg. my heart remained around 175 to 180. The doctor said ecg was clear, and gave me valium and Metoprolol. the heart rate slowly descended, remaining on 150 for a short while. eventually, it dropped to around 93. i explained i take ritalin, and have a fast heartbeat normally due to stress. The doctor discharged me in a few hours and prescribed propanol 10mg; he said to take it when my heart is racing. he said to continue Ritalin, but to follow up with my GP. I'm really worried now, is this normal for anxiety, or could it be something more sinister. i have no family heart history

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that your symptoms could be related to a panic attack or to Ritalin adverse effects.

You should know that this drug can lead to tachycardia as a possible adverse effect.

For this reason, I would recommend you to check regularly (frequently during the day in sitting position after 10minutes of total relax) your heart rate and rhythm (is the heart rate rhythmic or there are skipped heart beats).

If your heart rate remains high, or if skipped heart beats are frequent, I would recommend consulting with your attending physician and performing some tests:

-an ambulatory 24-48 hours ECG monitoring in order to investigate for possible cardiac arrhythmia
- a cardiac ultrasound
- complete blood count for anemia
- thyroid hormone levels for thyroid gland dysfunction
- blood electrolytes for possible imbalance.

If these tests result normal, you should discuss with your doctor on the possibility of reducing Ritalin dose.

Hope to have been helpful!

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr. Ilir sharka, Cardiologist

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

Follow up: Dr. Ilir Sharka (11 minutes later)

will I die from the tachycardia. i am so worried. the pulse doesn't skip and ecg showed normal rhythm; just fast beating. should i continue to take propanalol when my heart races?

Answered by Dr. Ilir Sharka (2 hours later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I understand your concern and would explain that there is no risk of death in this situation.

So, try to relax and don't worry about it!

Propranolol can help against anxiety and panic attacks too.

So, it is OK to take this small dose of propranolol during panic attacks.

Hope you will find this answer helpful!

Wishing good health,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ilir Sharka (24 minutes later)

so you think 180bpm is okay for anxiety? I'll get all the tests done when I return from holiday. thanks so much my friend

Answered by Dr. Ilir Sharka (5 hours later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

You should know that the maximal heart rate based on your age is 190bpm.

This means that it is quite normal for you to reach 180bpm during anxiety or physical stress.

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Ilir Sharka (32 hours later)

Do you think there is a beta blocker with no weight gain effects, and that is less likely to destabilise bipolar disorder.

Answered by Dr. Ilir Sharka (12 hours later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Regarding your concern, I would explain that no one of the betablockers causes weight gain.

This is not a known adverse effect of betablockers.

Regarding bipolar disorder destabilization, all betablockers may rarely cause this adverse effect.

Anyway the recommended dose of Propranolol by your doctor is really low and I don't think that it will cause any effects on bipolar syndrome.

Hope you will find this information helpful!

Wishing all the best,

Dr. Iliri

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

Follow up: Dr. Ilir Sharka (43 hours later)

my heart rate is always tachycardic. Do you think I am going to die soon? It races most of the day, even without ritalin. i know i am anxious, and also have asthma. I'm really worried. I have no family history of heart problems :( can you please reassure me. as i said, my ECG was fine, and heart went down when i took propanalol

Answered by Dr. Ilir Sharka (6 hours later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Regarding your concern, there is no reason to think that you are going to die soon, as your ECG is fine.

I would also recommend performing a cardiac ultrasound in order to examine your heart function and structure.

It is also important performing the above mentioned tests.

Taking regularly a low dose of propranolol can help improve your situation and reduce tachychardia.

You should discuss with your doctor about the above issues.

If you have any other questions in the future, please don't hesitate to ask me directly at any time.

I would be glad to answer to all of your questions.

Regards,

Dr. Ilir Sharka, Cardiologist

Note: For further queries related to coronary artery disease and prevention, click here.

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