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10894761 tn?1413637884

PVCs / PACs / anxiety / panic

Hello everyone,

First of all I'm sorry about my poor English, but it's not my native language and I don't exercise it very much, so I will try my best to explain what I feel.

I'm male, 39 years old, 193cm, about 98Kg, I don't drink, don't smoke, My BP is around 115 / 75, total cholesterol 175, HDL 44. I have a relatively sedentary lifestyle because I work in a sitting position for many hours every day, but I try to walk at least 40 mins every 2-3 days and I try to eat the best I can.  I don't have any serious health issue, the only thing I have is a Hiatus Hernia which makes me take Pantoprazole 20mg once in a while.

Ok, so far you might think I'm a healthy person, which can even be true in general terms, but I started having panic attacks for the first time about 15 years ago, and I've had lots of them for a period of six months maybe. Then I got "cured" of my panic issues and started feeling PVCs. At the time I didn't connect the PVCs to the previous panic episodes, but now I think they were related.

During the past 15 years I didn't have any panic episode, but I've always had PVCs in "cycles". Sometimes I don't feel them for 6 months or so, then I feel again, then they go away again, etc etc.  When I feel them, they're about 10-20 in a hour or something like that.

But since August I've had two STRONG panic attacks, for the first time in my life I was pretty sure I was going to die. My heart rate went to 180 or something like that, and the PVCs during the fast heart rate just made me to worry even more.  I ended up in hospital twice, and after that I had echocardiography, ECG with stress test and they found nothing wrong except only 1 PAC during the stress test (8 minutes test).  I showed the results to my cardiologist and he said I'm perfectly fine and I'm simply too anxious, which is true. He told me to keep taking (I was already doing it) 10mg of Diazepam (5 on breakfast + 5 on lunch) for some time until I feel calm, and told me to walk, even more if possible.

Alright, I was relatively calm for some time and I even managed to control my panic attacks, I've read a lot about them and I found some weird way to stop them: when I start panicking, if I am home I lay on my bed, I take deep breaths, I concentrate my thoughts on my toes, then I put a fan directly to my face, and it works like a charm. If I am driving, I do the same but I turn on the A/C with cold temperature and put it to my face, and my panic goes away! It looks like the cold air works pretty well for me (anyone who's reading this and have panic attacks, just try my "system").

Ok, here is my real problem: since these last strong panic attacks, I started feeling PVCs every single day, some days 10-20 an hour,  some days I feel very few (for example, yesterday I felt 10 all day, max), but today I started feeling like 2 every minute, which I never felt (that's something like  3000 / day, which is far from my "standard" numbers).  I obviously entered panic mode when I felt so many PVCs, my heart rate increased and somehow they went away with the fast heart beat. Then I managed to control the panic and heart rate is now around 80bpm, and I'm feeling those 2-3 every single minute. I'm going crazy with this, even if I'm calm now.

Why did I start feeling so many, after a period when I was a lot more calm than before? This issue is making my life terrible, I avoid going out many times because I feel I will have some kind of attack outside. Sometimes I even avoid exercising because I'm afraid I will have lots of consecutive PVCs during exercise and if it happens, I will have an uncontrollable panic attack! I really don't know what to do. I find myself checking my pulse to see if it's too low / too fast very often. I try not to do it, but I think I'm obsessed with this problem. By the way, I don't need to check my pulse to feel the PVCs, because I feel them very very well (in my throat, usually), even if they have no other effect on me.

Can anyone help me with this?
Thank you very much










7 Responses
1807132 tn?1318743597
Your English is very good so no worries.  I first want to discuss your panic.  You say your heart rate got up to 180.  That is pretty high though I have heard others have gotten that high with panic.  But I want to ask how the rapid beat starts and stops.  Does it feel to you like it starts and stops in one beat?  If it slowly goes up and down it is very likely panic, if it seems to start and stop in one beat, you are fine, then your heart is beating like crazy, then you are all of a sudden fine (no matter if it happened with the cold air in your face)  then if it is a sudden one beat change that could mean you actually have a structural issue that can be fixed.  If not then you may need to learn some coping skills to deal with the fear that rises up in you when you start to notice your heart act up.  I am happy to heart you have found something that helps so that is good.

Now onto the pvcs, they can occur more frequently from an irritated heart.  Being in tachycardia at 180 can irritate the heart so the 2 conditions kind of feed off each other.  As well any stress and anxiety that you are producing in your body will actually cause the pvcs to be worse.  So it is in your best interests to learn coping skills at dealing with stress and anxiety.  Beyond your tricks to get it to stop maybe try and see if you can head the panic off at the pass by doing deep breathing and relaxation techniques once you notice the fear coming up in you.  

Beyond the fear and panic other things that can lead to an increase in pvcs are diets high in caffeine, carbohydrates and sugar.  As well any stomach issues like acid reflux and gerd will aggravate the vagus nerve which will send signals to the heart causing it to act up.  A hernia may do the same.  Are you going to get it fixed?  But regardless try and work on your stress and anxiety and any stomach issues you may have an you may find your pvcs decrease and possibly even disappear all together.  Take care and keep us posted on how you are doing.
10894761 tn?1413637884
Hi Michelle, thanks a lot for your reply.

I'm pretty sure the tachycardia is caused by panic. The first of those "strong" panic attacks happened like this: I was feeling a little dizzy, nothing serious, so I decided to check my blood pressure and it was 150/90, that's not normal for me, my normal BP is around 115/75 when I'm relaxed, as I said before. But it was just after the lunch and I was already a little anxious about it, so I think the high BP was related to my emotional state. At the time, my heart rate was just a little high, something like 95 or so. Then I started to think about BP and got even more anxious, felt my heart beating faster, and it triggered the attack. I felt like I couldn't control the heart rate, so I got more and more worried and felt the heart going faster every second, and it was uncontrollable. I told myself to calm down, but then I thought if my BP was 150/90 before, it must be 200/100 now. And then I got even worse, I tried to measure heart rate (manually) and I'm pretty sure it was around 180, maybe a little more. Then I felt a kind of strong tingling in my head (I think it's the adrenaline) and I REALLY thought I was going to die.

I was very lucky that I wasn't alone at home, and other people told me to lay down, talked to me and called the emergency service, and somehow it made me a little better, but I was still terrible. Then I was lucky once again: the ambulance arrived in less than 3 minutes and it helped a little more. But at the time I arrived in the hospital, I was feeling like drunk and very tired, and even if they done ECG right away and told me to not worry, and even if they gave me 10mg sublingual diazepam immediately, my heart rate was 115bpm, and 6 hours later it was still 100bpm! That was some strong panic attack, even comparing with everything that I've read about it.

On the other hand, I really feel that my heart is pretty normal, I don't get tired very easily, I don't have any pain, I can walk long distances for long time, climb some difficult places, my resting HR is around 65 and I don't feel nothing else, except those (censured) PVCs.

But the PVCs or PACs (i'm not sure which ones I have) make me mad! Today I'm specially concerned because they are very frequent, like never before, and I can't understand the reason, because I was really calm all day (before they started). During the time I'm writing this, I felt 30 or more, and it's awful. I was going out today to buy some stuff and I gave up, just stayed home. At this time I don't live alone, but I feel I'm not even able to do it, If I need to. I feel like I will have to move to some relative's home because I can't handle this anxiety thing.

Thanks again for your help, Michelle.  



10894761 tn?1413637884
Michelle,

I forgot to answer about the stomach: my doctor said the only "fix" to the hiatus hernia is surgery, but she didn't recommend it, because my symptoms are not very bad and it will probably cause no symptoms at all if I lose 6 Kg or so (about 13 lbs). Once or twice I managed to reach my ideal weight and in fact I got much better from the acid reflux, but I'm lazy, so I'm always in the limit between the ideal weight and excessive weight (at least I'm lucky to lose and gain weight very easily).    
1807132 tn?1318743597
I would not assume your bp is super elevated.  A high heart rate actually lowers the bp.  But it sounds like focusing on the symptoms is part of the problem.  So work on the anxiety and acid reflux and see if it helps lessen the amount of pvcs you are having. The fact of the matter is if the top end of your high is 180 it isn't anything the heart can't handle.  You will not drop dead from that rate.  It is maybe slightly above exercise rate so just try to focus on that.  That your heart is a very very strong muscle and it can handle all sorts of odd things and still keep going strong.  Your heart has been evaluated to be strong.  Focus on that.  Keep doing what you are doing to stop an attack if one gets away from you but also work on the breathing I talked about to try and head it off before it gets too a panic state.  As well work on the acid reflux.  Try antacids after meals and try to eat smaller meals avoiding overfilling your stomach and see if that helps.  You can't control your future but you can take charge of your anxiety.  If you need help there is nothing wrong with seeing a therapist to help you to do that.  Take care and remember calm your breathing and your thoughts when you feel yourself starting to stress out.  With time it will become habit and hopefully turn your panic response around.  
10894761 tn?1413637884
Hi again Michelle,

Can you give me any advice on the relaxation techniques? Should I do it every day or only if I feel anxious? Do you have any good link to an article explaining how exactly should I do it? Or if you have some time and patience, you can write here, if possible.

I will try to control my anxiety and my stomach problems, will drink less coffee and cut on the sugar, and hopefully the PVCs will go away.

By the way, I'm slightly better now, I only few one every 2-3 minutes maybe, so I think I will be fine tomorrow (at least I will have the "normal" number of them).

Once again, thank you very much for your time.
1807132 tn?1318743597
I don't have any specific exercises but just try to pay attention to when I start to feel stressed. When I do I try to sit and relax and part of my body that is feeling tense and I focus on deep breathing.  Just telling myself to calm down it's going to be OK.  Deep slow breaths until I am able to let go of the tension.  This is especially important when you start to notice yourself getting anxious.  I think in this instance breathing is the best exercise. You can also try yoga and meditation and see if regular practice of those helps center your nerves in general.  One exercise I did read about was called the 5 finger memory exercise or something like that.  When you notice yourself getting upset or obsessing about something stop and use one hand to recall 5 memories of times when you were happy and carefree.  Obviously have these memories picked out ahead of time but the point is to use memories that conjure up good feelings.  Ones that can switch your focus to happier times and stabilize your mood.  But mostly just do a lot of deep breathing. Slow deep breaths as many times a day as necessary.  Deep breath in, hold it for a moment then slow breath out.  And just focus on calm safe thoughts to help you relax the worry.  It won't necessarily stop the pvcs but may help you not stress as much reducing the amount of them that you have.  And one last thing that sometimes helped me for some odd reason, when I was having loads of pvcs sometimes if I coughed it would help get them to stop a pattern.  Well hope it helps and I do hope you have a much better day tomorrow.  
10894761 tn?1413637884
Hi Michelle,

I will try the deep breathing exercise on a regular basis, maybe it will make my anxiety go away.

By the way, I woke up at 7:30 today, now it's 10:10 here and so far I haven't had any single PVC / PAC, or at least I didn't feel them. I measured my resting heart rate this morning and it was 61, which is great for me, and usually it's a good indicator of how anxious I am (the bigger the resting HR, the more anxious I am). But I simply can't find a reason to explain why I am very anxious sometimes, because there's no REAL reason.

That's what makes me crazy about all this thing. My theory is: in my case, it's a mix between anxiety / caffeine / stomach stuff which triggers the PVC, or make them worse. For a long time I've been drinking lots of coffee everyday and haven't had PVC problems, but I think it makes effect on long term. And apart from that, the coffee makes my stomach problems a lot worse, for sure.

Once again, thank you very much for your support, it made me feel much better!  
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