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Heart & Cardiology/PVCs, concerned about infection


Hi Dr. Richardson. I am a 23 year old female with panic disorder (obviously a complicating factor in the case of PVCs). I have had panic disorder for 3 years, and began experiencing heart palpitations (which I have assumed are PVCs - they feel like skipped beats) fairly frequently for around 9 months now. They began the day after I stopped a low-carb diet, and continued ever since. I am eating normally, with a good amount of fruits and vegetables, carbs, protein, I try to get enough potassium and other electrolytes in the form of natural foods.

I always put the PVCs down to anxiety and stress, as they would occur more frequently when I was highly emotional. They would also occur in the rest period directly after exercise, when my heart was still beating fast. They would occur during panic attacks. All of this seems fairly normal and I am aware that they are usually benign in teh setting of a normal heart. 3 years ago I had an echo and EKG, both normal and nothing to be noted.

The strange part is this - I have had swollen lymph nodes on the right side of my neck (biopsied and came back as reactive) so some sort of infection. I coudl never figure out what the infection was, and put it out of my mind. Recently I developed pain in my right kidney and took Norfloxacin (as prescribed by my doctor). The pain lessened, and even more interestingly, the lymph nodes in my neck reduced completely, and my PVCs went away. I then developed an allergy to Norfloxacin (took it for 3 days) and began taking Trimethoprim instead. I have taken Trimethoprim before and noted a slight reduction in PVCs the last time I took it. I have since not had any PVCs except for about 3 or 4 during an anxiety attack. It has been about 2 weeks and I've gone from having about 50 a day (that I notice) to 0. I am (obviously) concerned that I have (or had) an infection in my heart. This scares me, as I know myocarditis can cause sudden death. I have only just begun to exercise again because my anxiety disorder prevented me from wanting to for about 2 years. I am now scared to exercise again, due to the possibility that I had an infection that has damaged my heart. I know I can go in for many tests, but I thought I'd write to you first to get a bit of insight on what you think the likelihood is that I would have had some kind of chronic infection in my heart for 9 months. It seems unlikely to me but I'm no doctor. Could it also be due to a chemistry shift from the antibiotics? I know that Trimethoprim significantly raises potassium levels.

Please let me know what you think. Thank you so much.

Hello Gen,

Skipped beats are normal heart activity, easy to understand as normal from knowledge of the heart's electrical system and occurring in about half of us.  They don't mean you have heart disease or will in the future develop heart disease or any cardiac catastrophe.

I suspect you had infection in throat (neck lymph nodes) and in kidneys that was increasing the skipped beats.  Damage to heart is quite unlikely.  Ask for an echocardiogram to be sure your heart's structure and function are normal.  Then resume your exercise.

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

David Richardson

Heart & Cardiology

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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