Ectopic beats: anxiety or a medical problem?

March 7, 2018 9:11 AM

I've always had anxiety and I've always had palpitations, but normally it's just an odd beat or 2 and it's back to normal. Lately I've been having runs of skipped beats that are scaring the bejeezus out of me. How should I proceed?

Normally if I have a heart palpitation it's just a hard THUD or it feels like a double beat. Sometimes it's very noticeable, severe feeling. It always startles me and a lot of the time I reflexively grab my chest, but then it stops.

Lately however it's been a milder thud but I'm getting a lot of them. It's like it flares up and I'll get on and off thuds for a few minutes. It scares the shit out of me. Sometimes I'm anxious or thinking about it but sometimes I'm just relaxing and I get one. Then I start to get nervous and then I get more and more. I never know when it's going to happen and it's really affecting my quality of life because it just really freaks me out. The thud manages to startle me almost every time, too, which is leaving me very on edge, which probably isn't helping.

It happens most if I'm either sitting or lying down and relaxing. Being preoccupied with something tends to help, like I don't get them as much if I'm sitting in class, though I did have a LONG run while in class today. If it starts getting up and walking around tends to make it stop. Deep breaths also help. I tend to get thumps when I change position, like if I lean forward. I was having a bunch for a few days, then I got a couple days with NONE, and then suddenly I had another episode in class today.

HOWEVER, I've had my heart checked. I've had two EKGs which were both normal. I also had a stress echo, which was normal. I didn't have any runs like this duirng any of them, though I did get a thump during the stress echo, which the tech did not even acknowledge. Everyone has said that my heart is very healthy. They told me they can't send me to a cardiologist because there's nothing they're finding to send me for.

I also have a lot of anxiety. I have a diagnosed panic disorder. I generally have a lot of free floating anxiety that manifests itself very physically. I always feel like my body is going too fast. I have a lot of stressful things happening in my life right now, too. I'm waiting to see if I got into grad school, I'm not even sure I can afford grad school if I get in, I'm starting a new relationship, and I recently had a pregnancy scare. The pregnancy scare is mostly resolved but not totally.

Rationally I know that the anxiety is causing the heart palpitations, but they scare me a lot regardless, and I just worry that they're missing something. What if I have afib or something and they just haven't caught it? But then again, I don't think afib will go away if I go for a walk or take a deep breath?

I'm in school and my PCP is in another city. Should I treat this psychiatrically and look into starting meds (again) for the anxiety (which I've been considering for a while)? Or should I have a possible cardiac cause looked into even more? I'm having some tiredness and dizziness, but those are likely from my ongoing sinus issues. I don't have any chest pain or shortness of breath.

Thanks.

posted by anonymous to Health & Fitness (15 answers total)

I get heart palpitations when I take hormonal birth control. I wore a Holter monitor and did a ton of tests before I realized that they’d stopped about a month after going off birth control. That was sixteen years ago and more recent forays into hormonal birth control confirmed my theory when the heart palpitations returned.
posted by annathea at 9:13 AM on March 7, 2018

Should I treat this psychiatrically and look into starting meds (again) for the anxiety (which I've been considering for a while)?

This would be my first choice. If you think this would be helpful anyhow I'd look at it this way "It's try this FIRST and then if I still have symptoms..." You can also do a few other anxiety-helping things like watching the caffeine and other heart-healthy things (for me it got worse if I had a lot of potassium, like taking a multivitamin and eating a shitton of carrots, ymmv). So, yeah, I have this same thing, I expressed concern to my doctor who was pretty non-concerned (and who I trust) so I keep an eye on it but mine seems pretty well tied to my anxiety.
posted by jessamyn at 9:19 AM on March 7, 2018 [2 favorites]

1. Would seeing a cardiologist set your mind at ease if no cause was found, or would you just progress to "I bet this particular cardiologist made a mistake"? If you historically feel better after getting medical reassurance and you can afford to see one, why not go?

2. I have heart palpitations that have been better and have been worse. They change over time. I'm not your doctor, but I can definitely tell you that it's possible to have heart palpitations which vary.

3. Is your diet different in any way recently? For some reason, too much salt makes things worse for me and it's sort of cumulative - I don't need to eat a bag of potato chips or something, just a day of slightly-saltier meals can do it, so I don't always notice until they start up.

4. Heart palpitations are common. The types of heart problems that cause palpitations are very rare. There are lots of things that can be wrong with a heart, but most of them don't cause palpitations in particular. I remind myself of this every time I get anxious.

5. When I'm stressed, they feel worse - like, I'll get some and feel fatigued and weird where normally I'd get some and not really feel anything once they stop.

Something hilarious I noticed as a fellow somatizer-of-anxiety: I was getting breathless climbing stairs and having sorta-chest-pains (my doctor was not concerned and didn't feel they rose to the level of chest pain). I was very freaked out and made all kinds of medical plans, worried about my cholesterol, visualized my arteries getting clogged, etc. I started eating ancient grains for their fiber content and heart benefits...and the symptoms disappeared. Now, this obviously isn't because the ancient grains did anything immediate - it's because my unconscious mind was like "you're addressing your heart issues! Good job!" and stopped giving me all this grief.
posted by Frowner at 9:23 AM on March 7, 2018

I had this happening to me for a while, and I am not sure what exactly made it stop, but it did turn out that I was also deficient in iron and low in potassium, and when those things were resolved, the palpitations seemed to stop. I still get them every once in a while, but not like I was. Just a thought to check out maybe. I also do take anti-anxiety meds and those have really helped. My prescriber recommended a dose of an alpha blocker which she explained as sort of quelling the physical symptoms of anxiety, and that has been a life-saver for me.

(She first recommended a beta blocker but I was allergic to that one.)
posted by fairlynearlyready at 9:24 AM on March 7, 2018

I get heart palpitations when I have acid reflux or stomach distress -- which are often caused by anxiety. It's a fun cycle! Tums often help, as does water, and making sure I don't eat anything that causes acid reflux. You might try that too.

It may cause you more anxiety to look up heart attack symptoms, but they are more than just heart palpitations, to be sure. My parents both have afib, and the doctors found them using the same methods that cleared you, to my understanding.

My anxiety channels into health anxiety, too. It is truly suffering! The anxiety often causes me intermittent chest pain and palpitations and I was super freaked out. I got an EKG (normal), and my doctor told me it was probably stomach acid and/or anxiety. He prescribed me some Ativan and some Omeprazole. At the first sign of my chest pain/palpitations, I took the Ativan. They went away immediately. SCIENCE!!!!!! I finally felt like I could really believe and trust what was going on.

So, your question "should I treat this psychiatrically?" -- I would start there. It seems the most likely culprit. You already did your due diligence to make sure there wasn't something VERY IMMEDIATELY serious going on (the doctors would have found it with their tests). If the anxiety meds don't work, well, you've knocked that one off the list too, so you can keep looking ahead to the next possible root cause and solution.

Good luck. I'm sorry you're going through this. It's really no fun.
posted by pazazygeek at 9:27 AM on March 7, 2018 [1 favorite]

An easy thing to do would be to have a blood test for electrolytes. jessamyn mentions above that a diet high in potassium might be tied to her having palpitations. People need their electrolytes to be within normal range for the heart's electrical system to function properly, so if your diet is not great, this might theoretically impact heart functioning. Potassium and calcium spring to mind as two electrolytes that need to be near-normal for good heart rhythm.

This is entirely separate from your anxiety issue, but if you are anxious and don't have normal electrolytes it could be synergistic.
posted by citygirl at 9:28 AM on March 7, 2018

It is super common for anxiety and especially panic attacks to be experienced as some form of heart or breathing "symptoms." I would try to get treatment for that first (also for general improvement of quality of life!). The doctor will probably prescribe a small dosage of a "rescue" benzodiazepine. If that helps with the symptoms, it'll be pretty obvious.
posted by praemunire at 9:37 AM on March 7, 2018

I have this too, and freaked out and went to the doctor. She said it's called cardiac awareness (or something similar). It's something that happens to a lot of women starting in their late 30s--feeling palpitations or thumps when lying down or resting. Doc says it's nothing to worry about unless accompanied by pain or nausea or fainting.

Interestingly, I found this article that might help.

Definitely work on your anxiety--you'll feel much better!
posted by orrnyereg at 10:02 AM on March 7, 2018

I had a panic attack that sent me to the ER (because of course, I thought I was dying). I had extra beats - PVCs - pretty consistently for a few hours. It was uncomfortable because I was scared, but tests were fine. Doc said just about everyone gets extra beats, but not everyone feels them (and panics about them). That was years ago and I feel them sporadically. Realizing I’m not dying helps, as do breathing, water, and standard approaches to calming down.
posted by OrangeVelour at 10:20 AM on March 7, 2018 [1 favorite]

Oh man, I read the above the fold and was going to tell you to go get an EKG etc and then I come in and see you already did! I had bad heart palpitations AND chest pain several years ago, finally my PCP sent me to a cardiologist for a full workup, wore a halter monitor for 24 hours...and it was "just" anxiety and musculoskeletal issue with my rib cage. Ha, "just", right? But I did find having that authority say it was anxiety was really helpful, so it might be something to consider whether you can do, maybe go back to a new PCP if you can't get to yours. (Mine were always worst at night while lying in bed....and distraction helped.)

Anxiety sucks really bad and health anxiety is truly terrifying. I didn't want to go on long-term meds (I did take ativan for bad panic attacks) at the time because I was planning on getting pregnant relatively soon, so on the advice of my therapist I did neurofeedback treatments. It wasn't covered by my insurance but it was truly life-altering. It teaches your brain calmer patterns, there are no side effects, and it works. It's amazing. I'm back on it again and this time it is covered so YMMV. But maybe consider that if you can't or don't want to do antianxiety meds.
posted by john_snow at 10:32 AM on March 7, 2018

IANAHealth Care Professionnal I have experienced both panic attacks & palpitations. My Mom had SVTs (SupraVentricular described the heart chamber, Tachycardia is abnormal/ rapid heart rate) and she was quite dramatic about episodes. Went to my doc, EKG unremarkable, and my doc said SVTs were not a big deal. I ignored palpitations for years, drove while having them, learned that Xanax would help, learned that a very cold wet washcloth on the face would help reset my heart rate. Eventually, I had palpitations one day and they would not stop. Called my doctor's office and they said Emergency Room, Now. Friend drove me, I was all chill, ER people were all chill until they put the clip on my finger and my heart rate was @ 190. The had me on gurney with an IV, heart leads, and an excited doctor by my side in short order. My heart rate converted to normal rhythm on its own, but I got a trip to a cardiologist and an echocardiogram (sonogram of my heart), which is super cool to watch, and a prescription for a beta-blocker, which I can't take daily, but use as needed.

I still get SVTs. Sometimes it feels like getting kicked in the chest, sometimes, it's subtle. In my case, definitely stress related. I have an app for my android phone, Instant Heart Rate Monitor, there are others.

There are a lot of types of palpitations, some are more dangerous than others. If you can get to an ER while you have them, they can be diagnosed. Meanwhile, there are ways to manage them.
- Stay hydrated. The heart has its own electrical system and being dehydrated causes trouble.
- Meditate and learn relaxation techniques. When I have an episode of tachycardia, I do calming breathing and it helps. Lowering stress is good for you, in general.
- a very cold wet washcloth on the face stimulates the Mammalian Dive Reflex which slows the heart rate. This also works quite well for panic attacks.
- the Valsalva Maneuver is a vagal maneuver where you bear down on your diaphragm. This works quite well to reset heart rate. You can become lightheaded, so use caution. Vagal maneuvers affect the vagus nerve and some people use them to control stress.

I use the heart rate monitor app to confirm my heart rate, then use conscious relaxation and the valsalva maneuver to manage SVTs. At one point, life was so stressful that I was having them pretty much every day. There is a procedure to correct the electrical system in the heart, but I took sick time from my toxic job, instead. Anxiety/stress is really bad for you, so prioritize managing it. Good luck.
posted by theora55 at 10:34 AM on March 7, 2018 [2 favorites]

Eh, if this is bothering you as much as it seems like it's bothering you, go to a cardiologist and get them to set you up with a Holter monitor to record your cardiac activity at home. That's the typical next step in assessing for arrythmias that aren't obvious by EKG or by an hour or two on a telemetry monitor in the clinic or the ED. Get your PCP to refer you. If they won't or can't, self-refer. I'd refer you if you were my patient.

Having a structurally normal heart which is non-ischemic with activity, by the way, as would be demonstrated by a normal stress echocardiogram, in no way rules out cardiac electrical wackiness. It is not unreasonable to get this issue further looked into.

NB: I am not your doctor.
posted by killdevil at 11:02 AM on March 7, 2018 [1 favorite]

I had SVT and for what it's worth, they were never able to capture the arrhythmia as it was happening. I had so many echocardiograms, EKGs, etc.

However, there is more than can be done than in-office EKGs or a holter monitor for a few days. There are longer-term methods to catch the off rhythm, such as wearing electrodes with a small monitor for a month, or an implantable device that can be used to monitor your heart rhythm over a longer term.

In my case, I actually did have a heart arrhythmia. It was treated via catheter ablation and I haven't had an episode since. There's no way to know if my condition was dangerous, but as you noted, it was scary and made my life worse, so I'm glad it's in my past.

This is not to say that your symptoms are definitely physical rather than psychological. Just that it doesn't seem that unusual to me that you wouldn't be able to capture the rhythm during the course of an in-office exam or test.
posted by ZeroDivides at 11:50 AM on March 7, 2018 [1 favorite]

I have both PVC and the vagus nerve thing. Do you cough when using a q tip? I wonder if they're related.

Theora has it. Vagus nerve. I also notice palpitations if I eat a lot after a long time (8h) of not eating. The sudden food / blood sugar triggers it. Are you on a diet? Finally, cruciferous veggies eg broccoli can impact the thyroid and in my case I noticed a direct correlation btwn broccoli/kale over consumption and skipped beats.

Since they found "nothing" not even pvc I would ask to wear a holter monitor just to be sure. As zero divides says you just want to be sure. I say this bc I know a holter monitor case that missed something serious. So they are not infallible.
posted by St. Peepsburg at 1:30 PM on March 7, 2018 [1 favorite]

What if I have afib or something and they just haven't caught it? But then again, I don't think afib will go away if I go for a walk or take a deep breath?

No, A-fib doesn't go away with vagal maneuvers like SVT and even SVT can be difficult to get rid of with vagal maneuvers.

If you're concerned, the best thing to do is go straight to the ER when it's happening so they can hook you up and tell you what's happening.

It doesn't sound like you have SVT.

If you have anxiety and panic attacks having a meditation practice, practicing more self care (enough sleep, relaxation, activities your enjoy (reading a novel, taking a walk) and get some cardio exercise (gets endorphins going, good for mental health, body, and soul).
posted by loveandhappiness at 1:40 PM on March 7, 2018