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Overweight, have PVC episodes, anxiety, breathlessness, perimenopausal. Atrial fibrillation, pulmonary embolism. Any suggestions?

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Hi. I'm 46 year old female. I'm a bit overweight but healthy otherwise. I'm losing the weight. I have perfect choelesterol, very low triglycerides, no blood sugar problems, etc. I have had PVC episodes for years. I also had other cardiac stuff that I kept telling doctors about. I do suffer from anxiety and am scheduled to see a psychiatrist next week. I have in the past but quit because the meds they prescribe seem to make me worse. I've had several major panic attacks that sent me to ERs. I frequently feel as though I am short of breath but when I'm checked out, I have no PEs, no low O2 readings, no abnormal ECGs, etc. When I am exercising, although I am constantly worried, I seem to make it through just fine. I am also in perimenopause and have been experiencing hot flashes. I can go for long periods of time in perfect health, I ride horses, exercise, am perfectly normal without fatigue or even slowing down. Then BAM, I get floored with cardiac-like symptoms that kick my but for a week or so. skipped heart beats, fatigue, exercise intolerance, etc. So I complain. Here's the kicker, I finally got my cardiologist to put a monitor on me for a month and I kept track of the funny heart beats and after review, it turns out I had 3 or 4 bouts of A fib (less than 30 seconds). I fealt every one of them. so now I am totally spooked that I'm on a path of decline. Oh, I am on a low dose of metoprolol (2x day) and adult aspirin. I also take thyroid meds for hypothyroidism. The reason I am freaked is that in 2008 I had a pulmonary embolism (airplane, birth control, being 42). So here I am, history of PE, anxiety and paroxymal (?) a fib. I'm scared to exercise, which I like doing and it's slowing me down. My Cardiologist seems to think that this is not a big deal. He said stay on metropolol, aspirin, stop worrying. (Also, I have no genetic factors for blood clotting problems, they ran all the tests when I had the PE). Any comments, suggestions, words of encouragement? thanks.
Posted Wed, 23 May 2012 in Hypertension and Heart Disease
Answered by Dr. Ravindra L Kulkarni 10 hours later

It is good that you have given all your history in detail and treatment details also.
These are good observations and are significant issues.

1 About paroxysmal atrial fibrillation, as these are detected on holter and are significant in frequency, you need Cardiologist clinical examination and review. Consider to add anti arrhythmic medicines for atrial fibrillation so as to prevent further complication.

Also if attacks of atrial fibrillation occur repeatedly or cardiologist feels the need after clinical examination, electrophysiological study - EP studies are performed in these cases of atrial fibrillation. It is day care procedure and it helps us further in medical management. You can discuss this test with your Cardiologist.

2 cardiac evaluations with echo-cardiograph will also be essential to know causes for shortness of breath. Especially if it is due to pulmonary embolism, we observe right heart chamber dilatation and increased pressures of right side of heart that is pulmonary hypertension.

3 As you have past episode of PE, Echo cardiograph will be useful. All other tests for clotting disorders are normal and so no need to worry about this illness as cause of present complaints.

4 Most of complaints also overlap with menopausal symptoms, so also plan to have gynecological check up and consultation.

5 Monitor your thyroid levels and drug doses also. You should avoid excess dose of thyroid supplements, as it is also one of the cause of palpitations.

6 It is good that you are aware of risk factors very well and are taking regular measures like lipid monitoring, exercise etc. Do continue that.

7 as regards to drugs, discuss with cardiologist whether to add anti arrhythmic, and anti coagulant drugs also. He will decide based on your clinical examination in person. Generally these drugs are advised to the cases of paroxysmal atrial fibrillation.

8 lastly, you definitely need to control anxiety levels. Do have our psychiatrist consultation. Be assured that the present heart ailments are treatable and can be controlled with medicines so no need to be worried. Have patience and follow cardiologist instructions and drugs carefully.

Hope this information will help you.

Please feel free to discuss any query if you have.

Wish you a healthy life.
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