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Are Ectopic Heart Beats Caused By Anxiety Inspite Of Having Normal Holter Monitoring Results?

Posted on Sat, 16 May 2015

Question: Hi I suffer from Pacs and rare unifocal Pvcs. On my 48 hour holter I registered 400 PACS and 15 pvcs. I had a stress test done where I reached 90 percent of my XXXXXXX heart rate and doctor said it was normal. My echo showed a structurally normal heart with some trace regurgitation which he also said was normal. My cardiologist says my etopic beats are completely benign and caused by my anxiety. I do suffer from anxiety so I have begun CBT therapy for the past month. I have also had some stress in my life and have 3 small children. I do not use caffeine or alcohol and I do not smoke. I am otherwise healthy. I had blood work done 2 months ago and everything was good. These etopics scare me because sometimes they feel awful. I feel them before bed or in the morning when I wake up. my heart beat will feel like it is all over the place. Fast and slow. I have a resting bpm of 56-60 and during anxiety attack my heart rate has reached 170. Today I was under stress and I checked my pulse and could feel a few etopic beats and even one that felt like a double beat. I know my cardiologist says this is all normal and happens to healthy people but I need some reassurance because its on my mind. My holter showed my slowest heart beat was 42 bpm while sleeping also

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer:
Following answer to your query...

Detailed Answer:
Hi XXXXX!
I read your query very carefully.

Your cardiac examinations and especially your Holter monitoring results are within normal parameters. You have a normal resting heart rate (55-60 bpm) and a minimal heart rat of 42 bpm during sleep (that is normal to).

Moreover your symptoms are typical for anxiety attack because your HR increase to 170 during panic attack. The PACs and PVCs are more frequent at night before sleep (due to quietness) or at early hours of the morning (due to adrenaline peak release).

As you see your symptoms are anxiety related and the treatment of anxiety will relief your symptoms.

Hope this was of help!
Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (18 minutes later)

Hi Doctor Thank you for your input. I'm glad that you have answered my question. I understand what you are saying about the palpitations being benign. My cardiologist says he will not treat me with medication as it is not needed for my situation with the PACS. HE INSISTS they are benign and anxiety related. I just wanted to know is it normal to be able to feel my heart beat or aware if it even if I'm not having palpitations? Sometimes I can feel it when I'm lying down or sitting or even eating? Is that anxiety related and not heart related? Also I have noticed I get palpitations after I eat sometimes is this common as well?

Thank you

Answered by Dr. Benard Shehu (10 minutes later)

Brief Answer:
Your symptoms aren't cardiac related...

Detailed Answer:
Hi back,

The fact that you are able to feel heart beat without having palpitations is related to anxiety disorders. My opinion is that you should treat anxiety this will help to relief your symptoms.

The fact that your symptoms sometimes are caused by eating show that you may have also acid reflux and GERD. My suggestion is that you should treat also GERd with antacids and you should avoid laying down directly (at least 2 hours) after eating.

My opinion is that your symptoms aren't cardiac related but are cause by increased anxiety and acid reflux and treating those two problems will relief your symptoms.

wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (19 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? It feels like any physical activity I do even a small one makes my heart race is this normal? Lastly I wanted to let you know that every time I have to go to the washroom to have a bowel movement my heart starts racing as well.

Answered by Dr. Benard Shehu (7 hours later)

Brief Answer:
Following answe rto your query...

Detailed Answer:
Hi back,

It's normal to experience tachycardia and palpitations if you feel a little anxious. There's nothing to worry about and it's anxiety related.

You should stay calm and relaxed nothing wrong is with you. You should focus on treating your anxiety, nothing wrong is with your heart.

Hope this was of help!
Wish you health!
Dr. Shehu

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

Follow up: Dr. Benard Shehu (18 hours later)

Hi Doctor I just wanted to know if it's normal to get the tachycardia even if I don't feel anxious? Can it be possible due to left over adrenaline in the body? Also I get it after eating sometimes. I noticed if my stomach doesn't feel right my heart races with every movement I make

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer:
Following advice...

Detailed Answer:
Hi back,

Yes it's normal to get tachycardia even if you don't feel anxious. this is due to excessive adrenaline secretion during panic attack and the down regulation of adrenaline elimination.

Another factor that may contribute to PACs without feeling anxious is GERD (acid reflux) because arrhythmia is very common in patient with GERD.

This is why I still insist to deal with your anxiety and GERd problems.

Wish you health!
Dr. Shehu

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