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    Suggest treatment for heart palpitations and anxiety

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Posted on Wed, 25 May 2016 in Heart Rate and Rhythm Disorders
Question: Hello

I messaged the other week due to having palpitations. I went to the doctors, had a ECG and a thyroid test and all came back ok. The last couple of days they have come back but really bad this time. I actually have a stethoscope so listened to my heart when it's happening. I can hear an extra beat after my normal heart beat, tiny pause and then a big thud of a heart beat. These are lasting a few hours and the actually extra beats longest period has been about 20 seconds, may stop for a 10 seconds and comes back. Sometimes within the hours it's going on it disappears for 10 mins of so and comes back. I was actually at a and e yesterday as they were really bad but they said they couldn't see anything and said go to my GP. I have a bicuspid aortic valve and had an echo in XXXXXXX They said all came back normals with moderate regurgitation and mild stenosis.
I know palpitations are uncomfortable but I can live with them if I know they are just something that's happening and should clear. I do have a tendency to worry and it makes me worry more when they come so it's a vicious circle. They seem to come about 3/4 pm during the day and may last till I go to sleep. The only thing that had changed is that I'm taking Cefuroxime for a tooth abscess after a root canal. I also take citalopram everyday. Could these play any part ? I've been taking the antibiotics for a weeks already so I thought they would have started when I started taking the tablets.
i have just done my blood pressure aswell and that was 127 / 79 BPM 79
Any thoughts or reassurance would be greatly appreciated.
Thanks
XXXX

doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello XXXXXXX

Welcome back on HCM!

I carefully passed through your recent medical history and would explain that your palpitations seem to be caused by recurrent extra-systolic arrhythmia.

Some isolated and repeated extra-systoles may be very disturbing, giving an unpleasant feeling of premature beats, interrupted heart beating, long pauses, chest discomfort, transient weakness, etc.

Nevertheless, you should know that those premature heart beats are not dangerous on their own. They are just an expression of myocardial stimulation, that may be related to cardiac or extra-cardiac causes.

In your case, there is only mild aortic stenosis and moderate regurgitation. So, not an advanced valvular dysfuncition.

Coming to this point, there is no any severe cardiac disorder behind those isolated extra-systoles.

So, relax!

You just need to avoid excessive physical exertion.

From the other side, that tooth abscess may have played a role on those arrhythmic phenomena, as inflammation/infection coupled with fever are well known as pro-arrhythmic triggering factors.

Meanwhile, cefuroxime is a safe drug in this regard, and has not been accused of triggering arrhythmia.

So don't be afraid of your actual medication.

I would recommend you performing an ambulatory 24 to 48 hours ECG monitoring (Holter) if the above complains persist.

In case you have any available cardiac ultrasound report, please upload them here for a direct review.

Hope to have been helpful!

Feel free to ask me again, if you have further uncertainties!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 27 minutes later
Thats really good to hear, thank you. So you dont think i should be alarmed by these periods that are lasting hours at a time?

Thanks again,
XXXX
doctor
Answered by Dr. Ilir Sharka 11 minutes later
Brief Answer:
Opinion as follows:

Detailed Answer:

Hi XXXXXXX

Considering your actual cardiac status, I don't think you have to be alarmed.

You should know that also anxiety may help in increasing those premature beats.

Nevertheless. if extrasystoles become frequent along the day, Holter monitoring is necessary to better quantify their amount and day-night trend.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 28 minutes later
Thanks. Ill go see thr doctor and request one. Just in regards to you saying earlier about physical exertion, im hoping to be at the gym tomorrow but mainly weights and no cardio. Would uou see that as an issue?
doctor
Answered by Dr. Ilir Sharka 9 hours later
Brief Answer:
You may continue training.

Detailed Answer:

Hi XXXXXXX

I would recommend better cardio and light exertion than weights.

You may continue physical training, but you should not participate in competitive and weights lifting sports.

In case of ambulatory ECG monitoring (Holter) it is recommended during the same daily regimen as usual (including gym training).

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 50 minutes later
Is this in general or during this period where i am getting these palpitations ?
doctor
Answered by Dr. Ilir Sharka 8 minutes later
Brief Answer:
Opinion as follows:

Detailed Answer:

Dear XXXXXXX

Holter monitoring is generally done during a period of 24 to 48 hours uninterruptedly.

We can't predict when those palpitations will occur.

What I was trying to explain is that this ECG monitoring should be able to investigate the quantitative amount and qualitative characteristics of those extrasystoles in a normal daily activity (including all the usual activities: resting, walking, sleeping, gym training, etc.).

In that way, we would be able to properly conclude on the amount, day-night trends of any arrhythmic events spread; also the heart response during physical exertion, etc.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 28 minutes later
Thank you. Ive been to the doctors and they said they will refer it anyway. The thing the doctors have never really explained is why things like weight lifting (as in body building) shouldnt be done. Is it due to progressing things like the aorta dimenions quicker or more due to the something that can happen to the heart whilst doing the exercise?


Ive just uploaded the latest Echo scan results
doctor
Answered by Dr. Ilir Sharka 7 hours later
Brief Answer:
I would explain:

Detailed Answer:

Hi again XXXXXXX      

I carefully reviewed your cardiac ultrasound report and I am glad to confirm you that it reveals a satisfactory overall cardiac function, which permits you to participate in almost every daily physical activity without problem.

Weights lifting and other heavy competitive sports are not recommended, because they impose an excessive afterload on left ventricular outflow tract and also deteriorate aortic regurgitation.

Meanwhile, cardio training doesn’t have these adverse effects.

That’s why the doctors recommend such training profile.

Actually your aortic valve problem just needs to be followed up periodically with cardiac ultrasound test annually.

Hope to have been helpful to you!

Regards,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 15 minutes later
Thanks Dr Iliri, you have been really helpful. On the weight lifting front, are you saying no weight lifiting at all or do you think things like the 10kg bicep curls shouldnt happen either ?
doctor
Answered by Dr. Ilir Sharka 4 minutes later
Brief Answer:
Just light weights lifting is allowed.

Detailed Answer:
Hi,

You can try biceps curls, but not for prolonged periods of time.

Other weights' lifting (heavier weights) is not allowed.

Best wishes,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 18 minutes later
What do you class as light weights? 3 reps of 15 without much strain?
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
Better lower weight and slightly higher reps.

Detailed Answer:


Dear XXXXXXX

If you use that 10 kg weight, 5 reps would be OK. If lower weights (2-5 kg) are utilized, then up to 20 reps would be acceptable.

Nevertheless, I would suggest following a training program under close supervision of a certified expert on physical fitness.

Regards,

Dr. Iliri

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

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