Heart & Cardiology/Worried


QUESTION: Dear doctor Richardson

I'm a male in my 20's I'm suffer from panic disorder currently controlled with Paxil 12.5 I've come a long way in over coming this. I'm taking a holiday trip soon which requires me to board a flight. I've had a history of ectopic beats usually aggravated by postural change a panic attack sometimes stimulants. My concern is if I get these ectopic beats continuous onboard he flight if I god forbid get a panic attack and they come in runs should I be concerned? I've had my last cardiology check 2 years ago ECG,echo,stress and holster all normal I just wonder even though I get ectopic at rest why do they pop up more during a panic attack will a run of them kill me? Does coughing or changing posture make them go away if they start?

ANSWER: Hello Y,

No, you need not be concerned.  Ectopic beats, even runs, 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. Panic makes them more  frequent.  I'm not sure about coughing or change of posture.  You'll have to find out for yourself.

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

David Richardson

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QUESTION: Thank you so much. I still don't understand why it would be normal activity what exactly causes the heart to act this way? I don't mind the odd pvc its the runs that concern me. I spoke to a GP and he tells me because of my vigourous and intense exercise regiments along with my pvcs I am more prone to a possible cardiac event than a normal individual, I suffer with allergic asthma well controlled so beta blockers are not an option but are their ones for asthmatics? however I must make mention that my asthma inhaler meds called seretide has a beta adrenergic broncodialator in it can this make pvcs. I know I'm boadering on paranoia I just want to live my life, run hard and gym hard be the strongest I just don't understand why these pvcs occur during exercise etc. Could you explain to me just a little why the heart acts this way and why its normal? That GP's comments through me aback I accepted the pvcs and his comments have caused me great anxiety whose opinion do I believe? I'm told if I want to record this pvc I have the option to implant under my skin a event monitor will this help diagnose and treat? Would it make a difference? Look foward to hearing from you

ANSWER: Vigorous exercise is good for the heart and doesn't make you more likely to have a cardiac event.  In my opinion your GP is mistaken.  Asthma inhalers often make PVCs more frequent.  Do the runs occur soon after you've inhaled the seretide?

Any cell in the heart can fire spontaneously.  If a ventricular cell fires, that will make a PVC.  Increase in sympathetic nerve activity will increase PVCs, and exercise normally increases sympathetic nerve activity.

If you are certain that your ectopic beats are PVCs, you need not get an event monitor.  If uncertain, an event monitor might show that you're having PACs, which would be a relief for you, I guess.  I see no reason for alarm or for decreasing exercise.

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QUESTION: Stimulants and exercise and posture changes cause my ectopics also if I have a sudden panic attack they come on during the attack aswell as if I have bloating after a meal or reflux I don't know if their is a correlation. The cardiologist could not pick it up sadly, he assumed it was pvc this was 2 years ago. My question basically is assumed or confirmed would it even make a difference to have it implanted to see where its firing from? And do I actually neeed to go back for a revaluation it is costly? Or should I just ignore these single or runs of pvcs? I am surprised of your relaxed nature about them most doctors don't know or are either dumbfounded when I tell them this. Thank you in advance I look foward to your reply this is my last message to you from Sunny Durban South Africa!

Hello Mr. Durban,

No, neither APCs or VPCs are any threat to a man with no heart disease.  I wouldn't spend money on an event monitor.  Just ignore the premature beats.

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

David Richardson

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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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