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Fibromyalgia and panic disorder

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About 2 year ago I ended up in the ER for chest pain and shortness of breath. After some testing, the ER physician said my heart was fine and he diagnosed me with costochondritis. Since that time, I've had a myriad of symptoms, ranging from dizziness, overall body myalgia, palpitations, chest and arm tenderness/pain, trouble sleeping, etc. I've been diagnosed with fibromyalgia and panic disorder, which I don't like since it is a diagnoses of exclusion and leaves several possibilities of more serious illness open. My main symptoms are cardiac and I've seen two different cardiologist concerning them. I've undergone numerous EKGs, two stress tests, an echocardiagram, numerous holter monitors, and an event monitor for 14 days. All of these tests revealed either ectopic PVC/PAC or came back normal. I've tried beta blockers, calcium channel blockers, SSRIs, Buspar, etc and nothing seems to help or I can't stand the side effects. I currently remain sane by using lorenzepam as needed. My main concern is an undetected arrhythmia that has missed my monitors, specifically v tach or something serious. I've recently been experiencing bigeminy PVCs with dizziness and more frequent dizziness spells. Nothing seems to be helping and although many physicians have assured me all of my symptoms are benign, I still have the thought in the back of my head that something was missed (perhaps the anxiety). I don't feel anxious before my symptoms occur, but feel that I am anxious because of my symptoms. I just wanted to know if all of the above sounds right and if the standard of care has been followed. I run and cycle at least 5 times per week and eat a healthy diet free of caffeine and do not smoke.

Category: Cardiologist

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Category: Cardiologist
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Hello
Thank you for your query at doctorspring.com.
I have gone through your case and I understand your concern.

Did you have any family history of a sudden cardiac death or arrythmia syndromes like QT or Arrythmogenic Right Ventricular Cardiomyopathy (ARVC)?
During the 14 days that the event recorder was in place, did you have any symptoms?
If you had symptoms in that period and the event recorder did not show any arrythmia, then it is non-cardiac.

In the absence of any structural heart diseases, which is indicated by your normal 2D ECHO, the likelihood of life threatening arrythmia like Ventricular Tachycardia (VT) is rare.
Also in view of a normal EKG and ECHO the likelihood of long QT syndrome or ARVC and any other congenital or genetic arrythmia syndrome is rare, specially if your family history is not significant.
What you are experiencing looks to be related to anxiety and does not seem to be a cardiac cause.

I hope this has helped, feel free to follow up with any query.

Regards.



Patient replied :

Thank you for the reply. I have no family history of sudden cardiac death or other arrhythmia with the exception of an 89 year old maternal grandmother who was dx less than a year ago. I did have symptoms on the 14 day monitor such as palpitations and dizziness, but sometimes they don't always feel the same so my worry is the monitor isn't here for this feeling or that feeling instead of the one the monitor picked up. The only thing the monitor picked up were ectopic beats (mostly PACs with a few PVCs). Thank you for the reassurance. With all of that in mind, what would you recommend for treatment? I've tried beta blockers (propranolol) but felt weak and tired on the lowest dose. My normal blood pressure is 110/70. I've also tried SSRIs and buspar, but actually had an increase in palpitations on prozac. Also not sure if this is relevant, but my cholesterol is pretty low - <130 total, 50 HDL and 55 LDL with <100 triglycerides. I've read that low cholesterol can cause anxiety and since my anxiety appears to be completely health related (I'm not stressed at my job or home life) that is also a concern.
Thanks!


Hello

If you had symptoms like palpitations and dizziness during the loop recorder and the recording was normal then you shouldn't probably be worried. Because you dont have family history no risk factors no structural abnormality so it is almost unlikely that you have any serious arrhythmia.

Possibly it is all related to some anxiety that you are not aware of.
Beta blockers are the best drugs from our side. Unfortunately you can't tolerate it. You could possibly try a lower dose of beta blockers. Better than propranolol you could try carvedilol or metoprolol in low dose. You could see a good psychiatrist for anti anxiety medications.

It is good to have low cholesterol levels. It will protect you in the long run.

Hope this answers your questions, feel free to discuss further.

Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Last question - should I be concerned about palpitations occurring during my running and biking? I've gotten them after exercise before, but never during.


Hello

Since you have already had 2 stress tests and during exercise you didn't have any documented arrhythmia, I don't think you are suffering from any exercise related arrhythmia. Also your echo is normal. It rules out structural heart disease.
If those tests were long back say 2 years or so you may repeat a stress test and if normal it rules out any significant arrhythmia.

Regards
Dr Vivek Mahajan
DM Cardiology


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
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
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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