Suggest treatment for heart rhythm changes due to anxiety

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Posted on Mon, 15 Jun 2015 in Mental Health
Question: Hi doctor I have a few questions about my heart. I have had all cardiac tests done a few months ago. This included holter 2 48 hour, 2 stress tests, 2 Echocardiogram and blood work. Everything showed a structurally normal heart and I passed both stress tests achieving 90 percent of my maximum heart rate. The holter showed 400 pacs over 48 hours and 15 pvcs. I had some bradycardia approximately 26 % of the time and 12 % of the time tachycardia. The lowest heart rate was 41 during sleep and 164 while climbing stairs and during anxiety. Average heart rate was 71. Occasionally I get episodes where my heart will start racing approximately 165-170 bpm. It will start off withe climbing the stairs and then I get nervous anticipating a fast heart rate and it happens fpr approximately 3-5 minutes. I do suffer from anxiety and I have some acid reflux and digestion issues. I'm worried because this fast heart rate has happened approximately 3 times over the past 5 days and twice tonight. I do think anxiety has something to do with it. I was just wondering if you believe anxiety is triggering this or if this is triggering anxiety. My Holter both showed sinus rhythm and no significant arythmia. I'm so confused I don't know what's going on I need some help. 

I have been doing cbt and psycho therapy for 2 months now
doctor
Answered by Dr. Chintan Solanki 22 minutes later
Brief Answer:
anxiety can trigger heart rhythm changes

Detailed Answer:
Hello,

Thanks for writing to us.

I read your query and understood your concern. At age of 32 very rare chances are there of any significant cardiac problem.Your complete cardiac check up clearly suggests that you have only anxiety problem and no heart problem.

The way you narrated minute details about your reports indicates that you are too much concerned about your heart functioning.Increase in heart rate on exertion is normal. Episode of tachycardia lasts for 3-5 minutes with sinus rhythm clearly suggests that it is episode of anxiety or physiological tachycardia.
You have anxiety as well as acid reflux can also be related to anxiety.

Anxiety leads to sympathetic hyperactivity.This high sympathetic tone leads to fast beating of heart, rate of which varies according to person's anxiety attack.It may go up to 200 per minute in some cases but for few seconds to minutes only not persistent.This is also responsible for pacs and pvcs.

During anxiety when someone becomes conscious about heart rhythm or checks his own pulse it causes more anxiety and more heart rate.

Cardiac problem can create anxiety but that is not the case in you. Your problem is anxiety is triggering tachycardia.

No need to confuse or worry, you are absolutely fine physically.

It is good that you are doing CBT and psychotherapy.

In my view you should consult psychiatrist also (if not consulted) to get opinion about diagnosis of anxiety disorder and anti anxiety medicines are needed or not. CBT is very effective in anxiety disorders. You should carry on the same.

Hope I have answered your query, I will be happy to help further.

Regards,

Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki 35 minutes later
Hi doctor. Thank you for your reply. When you say the episode can last seconds to minutes, is it common for fast heart rate to last 15-20 minutes? Also can the heart safely handle this? I am too concerned with heart function I don't know why. It is very exhausting thinking about it
doctor
Answered by Dr. Chintan Solanki 15 minutes later
Brief Answer:
yes it can last for 15-20 minutes

Detailed Answer:
Hi,

Thanks for follow up.

Panic episode of anxiety can last up to 20-25 minutes. Heart cab handle the same very safely.
You need detail counselling by a psychiatrist. After 2 months of CBT there is no improvement means either you need medicines or CBT therapist is not able to address your problem well.

Different relaxation techniques help in this type of episode. For example whenever you have such episode take a deep breath(inhale deeply and slowly for 3 seconds, keep breath in lungs for 3 seconds and then exhale slowly in 3 seconds). This will help you to get relief fast from anxiety. Do not think about heart or anxiety during such episode and concentrate on your breathing.

Hope I have answered your concern.

Feel free to discuss further.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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