Expert: David Richardson - 7/1/2009

Question
Last year in June I had an abnormal EKG. ST depression. I was having a full blown panic attack when this happened. I was followed the next week by a cardio and had a normal cardiolite stress, normal holter monitor with a few PVCs and slightly high pulmonary hypertension on an echo. I was in full panic mode from June of 08 till March of 09 until they finally did a right and left heart cath on me. My heart cath was totally normal. Normal pulmonary pressures, no blockages and everything was structurally normal. I got a sinus infection right after that and it took two rounds of antibiotic to clear it up. Since March I have had a soreness behind my nose. When an ENT runs scope up my nose they find inflammation and that is it. They biopsied it and it came back as benign inflamed respiratory mucosa. I was tested for allergies as well and am allergic to many things. This pain feels like sore throat pain but it's behind my nose. They think it's either allergies or LPR reflux. My question is I have anxiety still quite often although no full blown panic attacks. I get PVCS when my anxiety acts up. I am on 5 mg of Bystolic, about up to 2 mg of Klonopin sometimes less. I have tried PPIs for the possible reflux and it made me very sick to my stomach and gave me constipation and bad pains in my stomach so I had to stop the PPIs. I tried three different ones. I am now taking 150 of zantac. I am scared of medication effects on my heart combining all three of these meds along with a monthly vitamin D supplement. I get anxious and then my anxiety cardiac symptoms return such as the flip flopping sensations in my heart, racing, etc... I get stuck in a catch 22 worried if it's all the meds damaging my heart or hypersensitivity to the meds or just anxiety about my hellish year and the fact that I have this inflammation up my nose that no one can diagnose. Is it safe for me to combine a beta blocker, benzo, vit D and a an H2 blocker? Do you think the PVCs are anxiety with the clear heart cath? He said my heart cath was perfect. I read it too and there was nothing abnormal about my heart at all. With all this talk about Michael Jackson and meds and me already having major anxiety and hypersensitivity to meds I feel like I am chasing my tail. I have had increased PVCs since I started the zantac but I also became very anxious about starting it and not even really knowing if I need it or something for allergies. Sorry this is so long! I don't want to drop dead from some sort of medication interaction or am I still not clear with the normal heart cath since I still have PVCs? I admit I have bad bad anxiety problems but I did have the abnormal EKG although I was hyperventilating and my BP was very high due to the panic attack. I cannot have an EKG w/o a major panic attack. I cannot take SSRIs for my anxiety either. I am 41 am, 5'3 about 130 pounds, never have smoke a day in my life and never drink. I am female. Oh I had an MRI on my head which included soft tissues of my neck orbits of the head, brain and clavicle area ordered by the ENT and he called it "boringly normal" nothing was found on the MRI to cause this nasal inflammation. Thanks so much for you time!

Answer
Dear Karen,

Premature beats are normal heart activity, no threat to life or health in someone with normal cath and echo.  About half of us have them, they are easy to understand as normal from knowledge of the heart's electrical system, and they don't mean you will ever get heart disease or any catastrophe.  They are truly harmless.  You will not drop dead from PVCs. Anxiety and panic make them more frequent.  PVCs occur in perfectly normal hearts.

Hyperventilation and high BP can make the EKG temporarily have ST depression.  You can safely ignore the ST depression.

If benzo is Klonopin, that combination will not harm your heart.

I can't help with the nose pain, sorry.

Please write back if this note doesn't answer all your questions.

David Richardson