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Hello I’m A 43 Year Old Male I Have A
Question: Hello I’m a 43 year old male I have a situation when I sometimes bend over my heart begins to beat very fast with a burning type feeling in my chest breathing is fine episodes last 5 to 10 mins sometimes happens about 7-10 time’s a year. Then It stops as fast as it starts Had every cardiac test under the sun all clear endoscopy clear. Colonoscopy clear. Abdominal ultrasound also clear. I’m 5.10 rather slim 190 pounds but have belly fat just in stomach area other than that rather slim these episodes have been going on for 7 plus years with no dr being able to diagnose I’ve been on anxiety meds No help They come on sudden with no strenuous activity simply bending over like something is getting agitated I can go weeks with no symptoms then bam it happens . Drs keep telling me it’s nothing but I’m getting frustrated any help would be great. Mark
Brief Answer:
Need few more details.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query,
Have seen your details and I appreciate your concerns,
Before giving a professional advice I need few more details.
You have mentioned all cardiac tests are done.
Was a electrophysiological study done by doctor. Its called EPS test.
Very likely the problem you are suffering is palpitation.
Palpitations are abnormal heart beats and can be of many types.
EPS is performed by an electrophysiologist and not by every cardiologist.
Secondly what medications had you tried for anxiety please mention the duration and doses also.
Both anxiety and palpitations are linked with each other so details are required.
Waiting.
Thanks!
Need few more details.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query,
Have seen your details and I appreciate your concerns,
Before giving a professional advice I need few more details.
You have mentioned all cardiac tests are done.
Was a electrophysiological study done by doctor. Its called EPS test.
Very likely the problem you are suffering is palpitation.
Palpitations are abnormal heart beats and can be of many types.
EPS is performed by an electrophysiologist and not by every cardiologist.
Secondly what medications had you tried for anxiety please mention the duration and doses also.
Both anxiety and palpitations are linked with each other so details are required.
Waiting.
Thanks!
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi dr XXXXXXX
I have had stress test ekg. Holtr monitor Cardiographs ct scan when they inject XXXXXXX did the scan then. I had some food did another scan all clear nothing to report. For anxiety I was on cipralex for 9 months no change. Any help would be great.
I have had stress test ekg. Holtr monitor Cardiographs ct scan when they inject XXXXXXX did the scan then. I had some food did another scan all clear nothing to report. For anxiety I was on cipralex for 9 months no change. Any help would be great.
Brief Answer:
Gold standard test for your problem has not been done yet.
Detailed Answer:
Hello and thank you for follow up,
Anxiety is dealt in two phases-
Acute relief for which usually benzodiazepene like Clonzepam (0.25 to 2 mg) is used.
Chronic phase for which a long lasting drug belonging to SSRI group is given alone or with a Benzodiazepene.
You were prescribed Escitalopam.
This drug is started at doses of 5 mg per day(It takes 6 to 8 weeks) for this SSRI to build it's plasma levels and hence it's effect starts after 6 to 8 weeks.
Thereafter it is increased to 10 mg per day and after next 4 weeks it's increased to 20 mg per day.
20 mg per day should be taken for minimum of 3 months to see if it's effective or not.
You have just mentioned cipralex 9 months(No doses etc)..So question is was this protocol followed?
Why was Clonazepam or Alprazoram or Lorazepam not given?
So before considering that Cipralex didn't helped you(Which is really effective in most of the patients) I would like you to read the above protocol and revert me if it's followed or not.
If not then drug didn't failed rather the pychiatrist who prescribed you don't followed the protocol.
Now let's move to palpitations.
CT angiogram etc are done to rule out blockage of coronary arteries and in practical have nothing to do with palpitation diagnosis.
Holter is a baseline test but as it records beat for 24 hours there are chances that it turns out to be normal.
Test of choice for you sir is EPS.
In controlled settings your heart would be stimulated to develop palpitations and response would be noted on a sensor.
This test is done by an electrophysiologist ( Only few cardiologists do it).
I would suggest you to go for the test.
You could take a print out of my answer and could discuss with your Psychiatrist and Cardiologist.
Revert me back with what they say.
In short-SSRI would be effective when taken as per protocol and results take time to show.
EPS should be done on you.
Hope I was clear and easy to understand.
Thanks.
Gold standard test for your problem has not been done yet.
Detailed Answer:
Hello and thank you for follow up,
Anxiety is dealt in two phases-
Acute relief for which usually benzodiazepene like Clonzepam (0.25 to 2 mg) is used.
Chronic phase for which a long lasting drug belonging to SSRI group is given alone or with a Benzodiazepene.
You were prescribed Escitalopam.
This drug is started at doses of 5 mg per day(It takes 6 to 8 weeks) for this SSRI to build it's plasma levels and hence it's effect starts after 6 to 8 weeks.
Thereafter it is increased to 10 mg per day and after next 4 weeks it's increased to 20 mg per day.
20 mg per day should be taken for minimum of 3 months to see if it's effective or not.
You have just mentioned cipralex 9 months(No doses etc)..So question is was this protocol followed?
Why was Clonazepam or Alprazoram or Lorazepam not given?
So before considering that Cipralex didn't helped you(Which is really effective in most of the patients) I would like you to read the above protocol and revert me if it's followed or not.
If not then drug didn't failed rather the pychiatrist who prescribed you don't followed the protocol.
Now let's move to palpitations.
CT angiogram etc are done to rule out blockage of coronary arteries and in practical have nothing to do with palpitation diagnosis.
Holter is a baseline test but as it records beat for 24 hours there are chances that it turns out to be normal.
Test of choice for you sir is EPS.
In controlled settings your heart would be stimulated to develop palpitations and response would be noted on a sensor.
This test is done by an electrophysiologist ( Only few cardiologists do it).
I would suggest you to go for the test.
You could take a print out of my answer and could discuss with your Psychiatrist and Cardiologist.
Revert me back with what they say.
In short-SSRI would be effective when taken as per protocol and results take time to show.
EPS should be done on you.
Hope I was clear and easy to understand.
Thanks.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you.
Brief Answer:
Get well soon.
Detailed Answer:
Your welcome,
Do rate the answer sir.
Get well soon.
Detailed Answer:
Your welcome,
Do rate the answer sir.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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