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I have a lot of skipped heart beats. I've had them off and on for years old patientand years. I'm now 68 years old patientold, and they seem to be bothering me more than ever. In the past year, I've had several EKGs, wore a holter monitor, and had a stress/echo test. All came back normal, although I didn't have any skipped beats during those times -- except a couple of minor ones on the holter monitor that were nothing significant. They seem to be worse in the mornings, but my anxiety level is highest in the mornings. My husband died 3 years old patientago, and I'm still not used to being alone. But I seem to get along fairly well, but these skipped heart beats are just miserable. My doctor says it's anxiety because all my tests were fine. But when my heart isn't skipping during test time, how does he know it's OK?
In the past, I've also had numerous EKGs, wore holter monitors and had echograms done --- they were always fine and after a while, the skipped beats would disappear again. But now I've had these for about 2 months this time, and my doctor says I need to tell myself it's anxiety and they will go away sooner. Please tell your thoughts. I'm really tired of these things!!

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

Your doctor may most likely be correct about your symptoms being due to anxiety given that you had a previous normal workup. However it is worth getting a repeat holter and ecg because you are having a recent increase in symptoms and the current status needs to be evaluated. You are correct in saying that the holter examination would be more likely to pick up abnormalities when you have symptoms. A normal holter in face of symptoms is a reasonable assurance of you being normal. However the sane cannot be said if you dint have symptoms and your holter comes out to be normal. So I would advise you to get a repeat 2d echo and holter done.

Dr Vivek Mahajan
DM Cardiology

Patient replied :

This morning I visited my GP. I was put on a low-dose beta blocker. He said this is worth a try. It was just 2 months ago when I had an EKG, thyroid check, and heart enzyme check when these skipped beats began bothering so much. All were normal. And it was just one year since I last wore a holter monitor and had an echo/stress test done. I told him that the holter monitor didn''t pick up anything, and he said that often happens. All other tests were normal. He feels that this is still anxiety related. He also said that PVCs are very common and aren't dangerous at all ---- just annoying. He said to come back in a month, and if the beta blocker hasn't worked that he mght then send me to a cardiologist for more in-depth testing. But he's so certain that these are benign PVCs. So anothre question to you ---- are there such things a benign PVCs, and can they be so persistent that they stay for a couple of months, like they are this time? They seem to be worse in the mornings, and pretty much disappear as the day goes on.

Expert:  Dr. Vivek Mahajan replied 3 Days.

There are benign vpcs. If the echo is suggestive of structurally normal heart then the ventricular premature beats are most likely benign and need not be taken seriously. Ventricular premeture beats men last for 2 to 3 months in the face of ongoing anxiety and stressful situations like you are going through. I agree with the line of treatment prescribed by your doctor and i think that it is worthwhile to try beta blockers for 2 or 3 months and if the symptoms persist then repeat evaluation can be advised. If you had undergone cardiac evaluation in the last few months then it definitely does not need repetition. However if it was way back in the past then it warrants a re investigation.

Dr Vivek mahajan

Patient replied :

Thank you so much, Doctor. You have provided the reassurance and answers that I was looking for. I honestly believe they are related to anxiety. A year ago when I had my stress/echo workuip, I was told that I had a happy, healthy heart and all the heart structures were very much normal. The holter monitor didn't pick up anything of significance, but again, my heart wasn't skipping while I wore it. But since the echo was very much normal, that should suggest that these skips are benign. Is that correct? Please answer that one more question for me, and then I will give you a wonerful rating. I've had heart skips ever since I was 20 years old patientold!! I"ve had the cardic work ups several times, and they always came back normal. The long-lasting skips this time have happened just since my husband died. This has happened to me a lot since he died 3 years old patientago, which makes me think it's related to anxiety. Thank you so much for your opinion. I appreciate your time and your thoughts.

Expert:  Dr. Vivek Mahajan replied 2 Days.

Sorry for the extreme delay in my reply and thank you for the kind words of appreciation.
Since you have a long history of this issue and ECHO has been normal, it indicates that the VPCs are benign.

Anxiety due to loss of a dear one can not only increase the VPCs but also you tend to be more aware and scared. Your reactions change. So you can relax as there is not much of a problem. You should ignore the VPCs and try to think positively.

Regards, Dr Vivek Mahajan.

Patient replied :

I have one last question. I"m sorry to keep bothering you. Many times the heart skips happen when I'm active ----- if I am gardening or cleaning my house. And then when I sit down for awhile, they stop ---- only to start again when I'm active. So the doctor ordered the stress/ECHO. And, of course, I didni't have a single skipped beat while I was on the treadmill. Everything always returns to normal while I'm testing!!! Do you think the skipped beats with exercise could still be anxiety related? Thank you again --- and I promise this will be my last question. I thank you for your patience and your professional advice. You have been wonderful.

Expert:  Dr. Vivek Mahajan replied 1 Day.


The vpcs may still be anxiety related or it could be exertion related. The reason behind both is probably same. The excessive sympathetic hormonal activity associated with these conditions can cause vpcs.
The important thing is that the echo and stress test are normal rendering these vpcs as benign. So don't worry.

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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