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I am Florin, 25 years old patientold and I suffer from an anxiety disorder.
Since February 2014 I’ve experienced extrasistols. They tend to appear after a short and intense exercise. This month I’ve seen a cardiologist and I performed an EKG, echocardiography and Holter for 24 hours.
The first 2 were OK (no extrasistols and normal structure and function of the heart). I’ve only had a sinus tachycardia due to anxiety (white coat syndrome).
But the problem was with the Holter.
The cardiologist wasn’t concerned of my extrasystols (25 PACs and 1 PVCs) but of 2 pauses (2 seconds each one) that occurred during the night. He told me that I might suffer from AV block Mobitz type 2 and even sick sinus syndrome. He sent me to a cardiac electrophysiologist to read also the Holter result.
Now I am really scared of what he told me

I just can’t see an electrophysiologist because in one week I will be away from my country for 1 year.

I have never had symptoms like light-headedness, dizziness or fainting.

Is that holter result that worse?

Is it possible these pauses appeared because of the high dose of valerian root (400 mg) that I took before I went to sleep?

Thank you,

PS: I have attached the results of the Holter

Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Thank you for your query at DoctorSpring.com
Valerian root can cause conduction abnormalities described by you. It can cause irregular heart beats due to pvcs and pacs and also pauses. Now the question is whether you take them regularly or it was on that particular night? If you have such persistent symptoms and you are consuming regularly then it could be responsible. But if you have symptoms in absence of intake it could be unrelated. If the pauses are related to valerian root intake in a regular basis you could simply stop that and watch out for relief of symptoms. If they get resolved you need not do anything for that.
The holter tracing show atrial premature contractions along with sinus tachycardia a d intermittent bradycardia. There is also a 2:1 heart block. This suggests sinus node dysfunction along with av nodal dysfunction. The picture is similar to sick sinus syndrome. But you could withold the valerian root and see if this all corrects

Dr Vivek Mahajan
DM Cardiology

Patient replied :

Thank you for your reply.
I rarely take valerian root just when my anxiety is high. But it doesn’t seems to help me with the pacs induced by anxiety. (Pacs are the only symptom I have). The only thing that helped me with them was sport. When I practice sport regularly they are reducing significantly.
I took valerian root only that night at 09:00 pm.
I had these pauses while sleeping so I wasn’t aware of them. Could these things happen also to a healthy man during sleep?
Are these findings dangerous? I just cannot repeat soon the Holter because I am going to leave my country for 1 year.
Best regards,
Florin Tomescu

Expert:  Dr. Vivek Mahajan replied 3 Days.

The valerian root doesn't seem to be responsible for your symptoms because the timing doesn't match.
If you do not feel the symptoms you could wait and watch. It usually doesn't happen to a normal healthy man. The sleep time pauses indicates a hugh vagal tone induced heart block. Also the pacs may be related to bradycardia from high vagal tone. Or it could be a part if sick sinua syndrome. Right now you need to avoid valerian root. Watch for symptoms like dizziness and giddiness and they appear you may need a pacemaker in future. A repeat holter is not needed. Some drugs like doxophylline nay reduce the problem if these heart blocks

Dr Vivek Mahajan

Patient replied :

2:1 Heart block as you said means AV block Mobitz type 2?
Could Pacs in recovery period be due to high vagal tone? (I usually get a few Pacs after exercise).On the other hand all these Pacs appeared after a very stressful period but also after becoming sedentary.
Is sport contraindicated in this situation?
I will definitely give up taking valerian root. Hope this was the cause of these findings.
Best regards,

Expert:  Dr. Vivek Mahajan replied 2 Days.

It is difficult to say whether 2:1 block is due to mobitz type 1 or 2. Only an electrophysiological study can tell that. It is possible that during recovery phase of exercise you could have pacs due to interplay of sympathetic and vagal tones. Pacs at night may be due to higg vagal tone. If you don't have symptoms you can continue exercise. And good that you are discontinuing valerian root though it may not have caused all this. It may aggravate it nevertheless
Dr Vivek Mahajan

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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