Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 35 year old male • Known case of anxiety disorder • Complaints of: multiple anxiety symptoms and skipped heart beat. Anxiety manifest its symptoms by increasing adrenalin level in blood. Adrenalin can be reduced in body by washout (difficult to do) or by reducing release. Basic defect in excessive anxiety is lack of serotonin in brain, so medicines, which increase serotonin level in brain control anxiety and reduce adrenalin level in blood and its manifestation. Unusual sensations and trembling are also symptoms of excessive anxiety. Skipped heart beat or premature ventricular contractions (PVCs) are among the most common arrhythmia and occur in people with and without heart disease. In some people, it can be related to stress/anxiety, too much caffeine or nicotine, or too much exercise. But sometimes, skipped heart beat or premature ventricular contractions (PVCs) can be caused by heart disease or electrolyte imbalance, it better to get them investigated by cardiologist. There is need for treatment, if symptoms cause significant personal distress or affect personal/professional life. Both drug and non drug treatment like cognitive behaviour therapy (form of psychotherapy) are used for treatment. Choice of treatment depends on severity of symptoms, personal preference and availability of treatment. If anxiety is severe and chronic then it is better to go for combined treatment with medical management and cognitive behaviour therapy. We have seen significant changes in patients with such treatment. In drug treatment two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect. Apart from above advice following natural measures will help you: -Decrease worrying by keeping yourself busy and distracted from worrisome thoughts by talking to family members or watching T.V. or counting back (100 to 0). -Healthy diet: Milk and fruits in diet. -Daily morning walk -Do not use excessive caffeine (tea, coffee and cold drink) -Stop substance use like alcohol (If present in your case) -Meditation (which you can learn from some nearby expert) I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

---