Managing Anxiety Linked to Premature Heartbeats: Effective Strategies

How to overcome the anxiety associated with premature beats?

Hello, Director.
Thank you for answering so many of my questions recently.
I hope to visit Changhua Hospital in person to express my gratitude.
I would like to ask you how to overcome the anxiety that accompanies premature beats.
Even though it only happens 2-3 times a week, I constantly worry about it escalating to the point where I experience over a thousand beats in a day, along with atrial tachycardia.
At that time, I was only taking Cartil Tablets (Diltiazem) in the morning and evening, but later I gradually switched to Kangken 1.25 and Xinlizheng 150mg, taking one of each twice daily.
My symptoms began to improve, and after about a month, I was experiencing only 3-4 premature beats or 1-2 per week.
I consulted a psychiatrist who prescribed me antidepressants, anti-anxiety medication, and sleep aids.
I was also in counseling, but once I felt better, I stopped the psychological counseling and continued taking my psychiatric medications.
However, I noticed that sometimes when I stopped the antidepressants, I seemed to have fewer premature beats, though I’m not sure if that’s just my perception.
There were a few instances when I felt down and resumed taking the antidepressants, and shortly after, I experienced premature beats again.
So now, I’m not taking the antidepressants, but I still have premature beats.
It seems impossible to avoid them completely; I experience a few each month, and whenever I feel a sudden pause (sometimes it’s slight, other times more pronounced), I pray for stability in my heart rhythm and for relief from discomfort.

Every time I have premature beats, there’s always a noticeable pause, unlike others who seem unaffected even with thousands of beats.
I wish I could be less sensitive, as every time I go to the emergency room, the doctors say I’m too sensitive to my body.
I’ve seen both a psychiatrist and a cardiologist, and I’m taking my medications regularly, yet I still don’t know how to overcome the anxiety that comes with premature beats.
I’m always afraid that one day it will escalate again to over a thousand beats or even worse.
I don’t stay up late, drink coffee, tea, chocolate, smoke, or drink alcohol, yet one day it suddenly escalated to over a thousand beats when I was previously only experiencing five a day.
I can only pray daily and take my medications regularly, but my mood fluctuates.
From your professional perspective, should I continue taking my medications regularly to manage the potential for my heart rhythm to escalate to over a thousand beats, or should I stop? Should I consider undergoing catheter ablation? Or perhaps focus on reducing my weight to a normal standard, as I currently weigh 110 kg? I hope you can help me.
I apologize for writing so much, and thank you, Director.

Mr. Wang, 20~29 year old female. Ask Date: 2022/07/01

Dr. He Dongjin reply Cardiology

Hello, I support regular medication adherence, including for arrhythmias and anti-anxiety medications.
Currently, your dosage is not high, and the side effects are manageable; however, it can control about 90% of your symptoms.
I believe this investment in your health has a good return on investment and is cost-effective.
If you are concerned about the side effects of the medication and take it irregularly, it may lead to unstable drug levels, which could result in rebound effects for both anxiety and arrhythmias.
This would not be beneficial, so it's better to take your medication as prescribed.
I pray for your peace and well-being.
Changhua Hospital cares about you.

Reply Date: 2022/07/01

More Info

Managing anxiety linked to premature heartbeats (often referred to as premature ventricular contractions or PVCs) can be a challenging experience, especially when these sensations trigger feelings of panic or fear. Your situation is not uncommon, as many individuals with anxiety disorders report heightened awareness of their heart rhythms, which can exacerbate feelings of anxiety. Here are some effective strategies to help manage anxiety associated with premature heartbeats:

Understanding the Connection
First, it’s essential to understand that anxiety can manifest physically, and sensations like heart palpitations or premature beats can be a common symptom. The heart and brain are closely linked; when you experience anxiety, your body goes into a fight-or-flight response, which can lead to increased heart rate and awareness of heartbeats. This heightened awareness can create a cycle of anxiety, where the fear of experiencing palpitations leads to more anxiety, which in turn can lead to more palpitations.

Medication Management
You mentioned that you have been prescribed both antidepressants and anxiolytics. It’s crucial to have an open dialogue with your healthcare provider about your medication regimen. Some antidepressants can indeed cause or exacerbate heart palpitations in certain individuals. If you suspect that your medication is contributing to your symptoms, discuss this with your doctor. They may consider adjusting your dosage or switching to a different medication that has a lower risk of causing palpitations.

Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy is an effective treatment for anxiety disorders. It helps you identify and challenge negative thought patterns that contribute to your anxiety. By learning to reframe your thoughts about your heartbeats and anxiety, you can reduce the fear associated with them. Working with a therapist who specializes in CBT can provide you with tools to manage your anxiety more effectively.

Mindfulness and Relaxation Techniques
Incorporating mindfulness practices, such as meditation, deep breathing exercises, or yoga, can help you manage anxiety. These techniques promote relaxation and can help reduce the physiological responses associated with anxiety, such as increased heart rate. Regular practice can also improve your overall emotional resilience.

Lifestyle Modifications
You mentioned that you maintain a healthy lifestyle by avoiding stimulants like caffeine and alcohol, which is excellent. Additionally, consider incorporating regular physical activity into your routine, as exercise can help reduce anxiety and improve cardiovascular health. Aim for at least 150 minutes of moderate aerobic activity each week, along with strength training exercises.

Weight Management
You indicated that you are currently at a weight of 110 kg. Achieving a healthy weight can have a positive impact on your overall health, including your heart health. If you feel comfortable, consider working with a healthcare provider or a nutritionist to develop a weight management plan that is safe and effective for you. Weight loss can help reduce the strain on your heart and may alleviate some of the palpitations.

Monitoring and Follow-Up
Since you have experienced significant fluctuations in your heart rhythm in the past, it’s essential to continue regular follow-ups with your cardiologist. They may recommend further tests, such as an echocardiogram or Holter monitor, to assess your heart's function and rhythm over time. If your symptoms persist or worsen, they may consider more invasive options, such as catheter ablation, if appropriate.

Conclusion
In summary, managing anxiety linked to premature heartbeats involves a multifaceted approach that includes medication management, therapy, lifestyle changes, and regular medical follow-up. It’s essential to work closely with your healthcare providers to find the best strategies for your individual situation. Remember, you are not alone in this journey, and with the right support and strategies, you can effectively manage your anxiety and improve your quality of life.

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