Suggest treatment for anxiety disorder and phasic respiratory sinus arrhythmia

Posted on Fri, 12 Jun 2015 in Hypertension and Heart Disease
Question: I have always had a rapid pulse and I do suffer from an anxiety disorder, but for the past few weeks I have noticed a "skipped" beat while breathing in. There is a history of heart disease on both sides of my family. OI am not a smoker, I exercise regularly and I am overweight but not obese. Sometimes it almost seems like a "flip flop" especially after I eat. Why does this happen all of a sudden? What causes this? I am constantly under stress but that is nothing new. I have an echocardiogram scheduled for tomorrow. I did see my MD and have an EKG which was normal along with normal rhythm when he listened to the beats. When I take my pulse it is rapid but when I breath in it skips a beat or two? HELP
Answered by Dr. Ilir Sharka 35 minutes later
Brief Answer:
This seems to be normal due to a phasic respiratory sinus arrhythmia.

Detailed Answer:

Thank you for your question on HCM!

Regarding your concern I think that there is nothing to worry about.

This is a normal phenomenon called "Phasic respiratory sinus arrhythmia", which leads to a different heart rate between inspiration and expiration. It is caused by the different amount of blood flow coming into the heart during these two phases of respiration. It is a normal finding in healthy and sensitive persons.

Your normal ECG is another argument indicating that everything is OK with your heart rate.

To assure that your complaints are totally related to your rhythm findings and to rule out any possible pathological arrhythmia I would recommend you a 24h ECG monitoring, if this keeps disturbing you.

Please upload your cardiac ultrasound results and images, so I can review them for a second opinion.

Feel free to ask any other questions whenever you need.

Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Ilir Sharka 12 minutes later
thank you for your response. I should have mentioned that I had two parts of a root canal done and when part II was done on May 4th my face stayed numb for almost two weeks on the left side. I still have a little tingling in the left lip and this seems to have started this bizarre cycle of irregular beats. Could the dental work have done something to the heart beat? Also I went to a specialist today to get the root canal finished and he would not work on me when I mentioned I had to have an echocardiogram done tomorrow and I believe I will be wearing a halter monitor for 24 hours. My father's father died at the age of 44 of a massive heart attack, my father had two angioplasty which were successful and he has taken very good care of himself and my mother father had a heart attack that he did life through. All the women in the family have had healthy hearts. I should have mentioned the whole dental "botched up root canal" before I wrote to you, but it just came to my mind now. I am a little upset and scared that the root canal specialist will not work on me until I have medical clearance - that kind of tells me he is scared I might die in the chair which is not helping me at all. I am trying to stay calm but it isn't easy. These symptoms are new and coincide with the 2nd part of the root canal, but the fast pulse has been forever. Feedback?
Answered by Dr. Ilir Sharka 12 hours later
Brief Answer:
Nothing dangerous is going to happen.

Detailed Answer:
Hello again!

Seems that your root canal problem creates you really a big stress.

Your increased anxiety and amount of stress imposed by potential unpleasant dental pain, exacerbates such palpitations and respiratory sinus arrhythmia.

You have to wait that cardiac ultrasound and perform ambulatory ECG monitoring (Holter), to assure that, it is just from increased anxiety from the painful procedure.

After that, even your dental specialist is going to feel safer, proceeding to the remained therapy.

I recommend you to relief your anxiety, as nothing dangerous is going to happen.

Wish you a good health. Best regards! Dr. Iliri
Above answer was peer-reviewed by : Dr. Shanthi.E
Follow up: Dr. Ilir Sharka 13 hours later
Hello again I am sorry I somehow managed to put the question in three times. Anyway I went for my echocardiogram and during it the technician was seeing that I was having the PCV's about 6 in a 30 minute period. For the past two weeks they have been very annoying and scary. Right now I have a holter monitor on and I talked to my MD who said these are very common and they should have answers sometime next week around Wed or Thurs. because of the holiday weekend. I need to get away from stressful situations because my whole life has been one big ball of stress and it never stops. I just tried to tell my mother to leave me alone and stop stressing me out and ending up screaming and hanging up in her face. I need to cut people out of my life once and for all and find some sort of meditation. I do exercise Yoga a few times a week and I think I need to walk more. Anyway if you have any other feedback please feel free to let me know and I will get back to you when I get the results. Is my doctor right to say this is very common and not to worry about it?
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
You don't have to worry about that.

Detailed Answer:

I would like to reassure you that your doctor is right a out those unimportant ectopic beats. As you declared, you need a lisitive turn on your life. Just try to live away your accumulated stress and anxiety.
Be patient to complete your cardiac tests and relief your thoughtful mind.
Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by : Dr. Raju A.T
Answered by
Dr. Ilir Sharka


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