Heart & Cardiology/Strange rythm

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Hello Dr. Pearl,

I am a 58 year old female who has been plagued with PVCs and PACs practically my whole life. Over the course of years I have had 3 echoes, the last being done 3 years ago, have worn 2 Holter monitors and 3 event monitors, the last one being worn for 30 days and ended Sept. 30th of this year. I have been diagnosed with afib and have had maybe 10 events over the last 25 years. They have always reverted back on their own within a couple hours with a dose of supplemental mag glycinate. I have learned to live with the PVCs but lately I have been having a change of symptoms that are not the typical ones from all my previous times of having them.

In the mornings when I sit quietly to work on the computer, I begin to get a strange sensation in my chest, a thumping and somewhat of a flip-flop feeling. When I feel my pulse, my heart seems to be slowing down and then going completely out of rhythm. There are pauses, then a few beats, some fast, some not so fast. It is certainly not a steady pulse. If I get up and walk around, or hop on my bike, my pulse becomes steady, but once I settle in to work, it happens again. When I am totally distracted I don't notice them, and if I take my pulse it seems steady. But then it happens all over again. Of course, now I am thinking every morning when I sit down to work that this will happen and of course it does. It also happens now throughout the day, more and more. And interestingly, when I am going through this I notice that I am not breathing normally but holding my breath somewhat. When I settle and breath normally with even deep breaths the rate becomes normal.

Since this was something new, I went to my PCP, who is an excellent doctor, and he put me on a Holter/Event monitor to be worn for 30 days. During those 30 days I did feel this particular symptom a couple times. The results were PVCs, PACs, with an average pulse of 80. The slowest was 53 while sleeping. He put me on a 25mg dose of Metropolol to hopefully steady some of the symptoms. By the way the echoes I have had showed a +1 mitral regurg but otherwise normal heart. I have had the regurg since my early 20s. A nuclear stress test showed no abnormality. My cholesterol is 170 with an HDL of 63 without medication.

I must interject that my father, who is since deceased, had a slow heart rate but never experienced symptoms. By the way, his heart didn't kill him. Unfortunately he had cancer.

One more thing, I do have anxiety issues and when under stress it tends to come out with preoccupation over my health. Then I become focused on that particular issue. Lately I have been under a lot of anxiety and stress and have been obsessive with these symptoms. But I guess there is always the chance that something could be wrong. And since I have just enough of a medical background to make me miserable I tend to diagnose myself. I have wondered about sick sinus syndrome and if I could have developed that. So even though I sound like a complete basket case, I humbly ask you these questions and would so appreciate your expertise in answering.

1. Can anxiety really cause this to happen?
2. Should I be concerned about these symptoms and ask for additional tests?
3. What about sick sinus syndrome?

Answer
1 - It could be a factor

2 - Ask your doctor about a 64 slice CT to look for calcium indoor coronary arteries. If your score is above zero then your cholesterol is not good enough.

3 - With PAC, and A Fib you have a form of sick sinus syndrome.

Good luck!!!

Dr. P

Heart & Cardiology

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Frank J. Pearl, M.D.

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Voluntary Professor of Medicine, University of Miami Miller School of Medicine, Miami, FL. Board certified in cardiovascular disease

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