Concerns About Long-Term Medication for Arrhythmia Management

Concerns about long-term medication for arrhythmia?

Hello Doctor: Recently, I experienced a twitching sensation in my chest that startled me, almost like my heart was suddenly being "tweaked." During these episodes, I checked my wrist pulse, and I noticed that my pulse would momentarily stop when the twitching occurred.
I have been seeing a psychiatrist for a while due to anxiety and chest tightness, and my doctor prescribed "Xanax" for me to take.
Additionally, I was given "Coralan" to take if I felt uncomfortable with a rapid heartbeat (the dosage is 0.5 tablets three times a day).
However, since I never felt that my heart was racing, I never took "Coralan" until the day I experienced paroxysmal arrhythmia (which happened approximately every ten minutes).
I remembered that I had "Coralan" to take, and to my surprise, it alleviated the twitching sensation in my chest.

In the days following, besides using "Xanax" and "Coralan" for control, I quickly went to the cardiology department at the hospital and underwent a 24-hour Holter monitor test.
On the morning of the test, I had already stopped taking medication for 6 to 8 hours when the symptoms began to appear.
By around midnight that night, I thought the machine must have recorded unstable ECG data, so I resumed taking my medication and went to sleep (I consulted with the nurse about whether I could take medication to relieve discomfort after the monitoring, and she confirmed that I could).

On the day I received my report, my blood tests (thyroid) and echocardiogram showed only mild mitral valve regurgitation.
The 24-hour Holter monitor recorded over 70 instances of arrhythmia, and the doctor said it was so mild that I could almost ignore it.
I didn't realize it was counted; had I known, I wouldn't have taken the medication...
Moreover, the doctor I saw that day did not prescribe any medication for me.
Currently, I am just continuing to get "Coralan" and "Xanax" from the psychiatrist (which generally helps control my symptoms effectively, but I still experience arrhythmia during certain physical activities or when lifting heavy objects).

I mainly want to ask if taking these two medications regularly and consistently over the long term could lead to tolerance, requiring me to take higher doses.
Additionally, can I take these two medications for life if the arrhythmia issue remains unresolved? I tend to be a sensitive person, and this greatly disrupts my life; even a couple of sudden irregular beats fill my mind with pessimistic thoughts, causing me to lose interest in things I once enjoyed.
I really want to return to my normal life.
I apologize for taking up your time, and I am very grateful for your help!

A-Hong, 40~49 year old female. Ask Date: 2017/06/11

Dr. He Dongjin reply Cardiology

Hello, you have mild mitral regurgitation and a 24-hour ECG shows over 70 instances of arrhythmia, which is very mild.
This is considered benign arrhythmia and poses no life-threatening risk.
Continuing to take Heart Care and Zanon can effectively manage your condition, so keep taking them without worry.
Changhua Hospital cares about you.

Reply Date: 2017/06/11

More Info

When it comes to managing arrhythmias, particularly with the use of medications like "心康樂" (which is likely a beta-blocker or similar medication) and "讚安諾" (which is likely an anxiolytic), there are several important considerations regarding long-term use, potential side effects, and the development of tolerance.

Long-Term Use of Medications
1. Medication Tolerance: One of the concerns with long-term use of certain medications, particularly anxiolytics like "讚安諾," is the potential for developing tolerance. This means that over time, the same dose may become less effective, leading to the need for higher doses to achieve the same therapeutic effect. This is particularly relevant for benzodiazepines, which are commonly prescribed for anxiety. However, beta-blockers, like "心康樂," generally do not lead to tolerance in the same way. They can be used long-term for arrhythmias and hypertension without the same risk of needing increasing doses.

2. Chronic Use Considerations: While both medications can be effective in managing symptoms, long-term use should always be monitored by a healthcare professional. Regular follow-ups are essential to evaluate the effectiveness of the treatment and to make any necessary adjustments. If your arrhythmia symptoms persist, it may be beneficial to explore additional treatment options or lifestyle changes that could help manage your condition more effectively.

Side Effects and Risks
1. Potential Side Effects: Both medications can have side effects. For beta-blockers, common side effects include fatigue, dizziness, and in some cases, depression or sleep disturbances. Anxiolytics can lead to sedation, cognitive impairment, and dependence if used long-term. It's crucial to discuss any side effects you experience with your healthcare provider, as they can help you weigh the benefits against the risks.

2. Impact on Quality of Life: The anxiety and fear associated with arrhythmias can significantly impact your quality of life. It's important to address not just the physical symptoms but also the psychological aspects. Cognitive-behavioral therapy (CBT) or other forms of therapy may be beneficial in managing anxiety and improving your overall well-being.

Lifestyle Modifications
In addition to medication, lifestyle changes can play a significant role in managing arrhythmias and anxiety. Consider the following:
- Stress Management: Techniques such as mindfulness, meditation, and yoga can help reduce anxiety and improve heart health.

- Diet and Exercise: A heart-healthy diet and regular physical activity can improve cardiovascular health and reduce the frequency of arrhythmias.

- Avoiding Triggers: Identifying and avoiding triggers that exacerbate your symptoms, such as caffeine or high-stress situations, can be beneficial.

Conclusion
In summary, while long-term use of "心康樂" and "讚安諾" can be effective for managing your symptoms, it is essential to have regular consultations with your healthcare provider to monitor for tolerance, side effects, and overall effectiveness. If your arrhythmia symptoms persist or worsen, further evaluation and possibly additional treatment options may be necessary. Remember, managing both the physical and psychological aspects of your condition is crucial for improving your quality of life. Don't hesitate to reach out for support, whether through healthcare professionals or support groups, as you navigate this journey.

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