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What causes palpitation in a patient with anxiety?

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Posted on Tue, 19 May 2015
Question: Hello I had all cardiac testing done with my cardiologist 2 months ago because of palpitations I was having. Mostly PACS and a few PVCS. All my tests came back normal including stress test, echo cardio gram and holter monitor. Only thing that came up was benign etopic beats according to my cardiologist. He has assured me that they are anxiety related since I suffer from anxiety and have been under a lot of stress. I do not smoke, drink alcohol or caffeine. I have begun to do CBT therapy and have seen some improvement. I just wanted to know if palpitations are a common symptom with anxiety? I have had episodes of anxiety where my heart rate has gone up to 165 bpm in the past. My cardiologist assures me I shouldn't worry as I have a very healthy heart. I just need some reassurance please
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Answered by Dr. Chintan Solanki (27 minutes later)
Brief Answer:
Palpitation is the commonest symptom of anxiety

Detailed Answer:
Hi XXXXXXX

Thanks for writing to us. I can understand your concern.

The cardiac investigations you have narrated are sufficient to confirm that there is no serious problem related to heart.

Anxiety due to any factor can cause autonomic nervous system changes. This system controls heart rhythm. These changes lead to change in heart rhythm which is reflected in PACS and PVCS. And there is no also positive history related to cardiac problem in your case.

Factors which are against cardiac problem are
-age of 32
-no smoke, drink alcohol or caffeine
-cardiologist confirmation and negative stress test & holter monitor

Factors which favor anxiety problem
-lot of stress
-improvement with CBT

Palpitation is the commonest presenting symptom of anxiety. So same is happening in your case.
CBT is very good established therapy for anxiety problems.Carry on the same.
Simultaneously take care of timely sleep,meal and exercise. They are helpful to control anxiety.

Just confirm that your thyroid hormones are normal. Hyperthyroid can present like this.

By chance if you find more anxiety while on CBT, anti anxiety drug like propranolol( the best drug to control palpitation) or low dose benzodiaepine can be given.

If at all problem is severe medicine from SSRI group can be added.

In conclusion you do not have cardiac problem that is confirmed. If you have not visited psychiatrist, consultation of the same will be helpful.

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 (13 hours later)
Hi Doctor Thank you for your response. I have one more question. Today I noticed that my heart is racing more than usual. I feel a little anxious. Whenever I get up and do any activity at all such as going to unload the washing machine my heart starts racing. I know the cardiologist says my heart is fine. Can this be anxiety related?
doctor
Answered by Dr. Chintan Solanki (10 hours later)
Brief Answer:
Yes it can be related to anxiety

Detailed Answer:
Hi,

Thanks for follow up.

In any person when physical activity is going on, heart pumps fast to supply blood to muscles. In person with some anxiety problem like you this normal fastening of heart is perceived something abnormal.
But in reality it is just anxiety which makes the person to aware more about heart pumping and feelings of palpitations and racing.
No need to worry.
Try meditation and relaxation techniques like deep breathing(slowly take deep breath ,inhale for 3 seconds, keep breath in lungs for 3 seconds and exhale in 3 seconds). This will make you relax and feel better.

Hope your doubts are cleared. If still any query there, do not hesitate to ask.

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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What causes palpitation in a patient with anxiety?

Brief Answer: Palpitation is the commonest symptom of anxiety Detailed Answer: Hi XXXXXXX Thanks for writing to us. I can understand your concern. The cardiac investigations you have narrated are sufficient to confirm that there is no serious problem related to heart. Anxiety due to any factor can cause autonomic nervous system changes. This system controls heart rhythm. These changes lead to change in heart rhythm which is reflected in PACS and PVCS. And there is no also positive history related to cardiac problem in your case. Factors which are against cardiac problem are -age of 32 -no smoke, drink alcohol or caffeine -cardiologist confirmation and negative stress test & holter monitor Factors which favor anxiety problem -lot of stress -improvement with CBT Palpitation is the commonest presenting symptom of anxiety. So same is happening in your case. CBT is very good established therapy for anxiety problems.Carry on the same. Simultaneously take care of timely sleep,meal and exercise. They are helpful to control anxiety. Just confirm that your thyroid hormones are normal. Hyperthyroid can present like this. By chance if you find more anxiety while on CBT, anti anxiety drug like propranolol( the best drug to control palpitation) or low dose benzodiaepine can be given. If at all problem is severe medicine from SSRI group can be added. In conclusion you do not have cardiac problem that is confirmed. If you have not visited psychiatrist, consultation of the same will be helpful. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.