How to manage cardiac arrhythmias?

Question

Hello doctor,

I wanted to know if you could answer a question for me. I experienced an episode that lasted roughly two to three minutes during which I felt as though I could not catch my breath, and it felt as if my heart had stopped beating. I checked my heart rate about three minutes after the incident, and it was at 60 bpm, while my oxygen saturation was at 99 percent. This occurred less than two weeks ago. I had a routine 24-hour tape test, which came back clear (ectopic beats were detected but were benign). I suffer from anxiety and panic attacks, but they generally occur during stressful situations. Could this be a symptom of a panic attack? I should also mention that this happened during intercourse. I am a 35-year-old male, 5'7" tall, and weigh 220 pounds. I look forward to your response and suggestions.

Answer 1

Hello,

Welcome to icliniq.com.

This could be a cardiac arrhythmia, such as PSVT (paroxysmal supraventricular tachycardia) or atrial fibrillation, where the heart rate suddenly increases and then decreases. Symptoms may include shortness of breath, chest pain or heaviness, dizziness, and more. Are you experiencing ventricular or atrial ectopics? Have you undergone an echocardiogram? The presence of ectopics also suggests the possibility of these arrhythmias.

Typically, an ECG (electrocardiogram) is normal (attachment removed to protect patient identity) as it is done between episodes, but it may show ectopics. An ECG conducted during episodes would reveal any abnormalities. You might consider requesting a portable cardiac monitor, either a Holter monitor or another mobile-based rhythm monitor, especially during intercourse, to determine if the rhythm recurs. Alternatively, you could undergo a treadmill test to see if it recurs during exercise. Additionally, a thyroid test should be done if you haven't had one recently.

To help abort such episodes, try coughing hard. Next time you experience this, focus on your heart rate and measure your pulse. These arrhythmias are generally not life-threatening. Overall, that episode may indicate an atrial arrhythmia rather than a panic attack, and our priority is to confirm it through investigations.

I hope this helps, and please reach out if you have any questions.

Answer 2

Hello,

Welcome back to icliniq.com.

No, you do not need another echocardiogram. An ECG taken or a Holter monitor attached during the episode will only show abnormalities if it is a transient event. You should try having intercourse again to see if the symptoms recur. If they do, you should have a Holter monitor attached and engage in intercourse again to provoke the episode, allowing it to be captured on the Holter. If the symptoms do not recur, it would be better to undergo a treadmill test to see if they return while running on a treadmill.

If these methods are not successful, you should consider using an extended ECG monitor which is mobile-based and can be used at home to monitor your heart rhythm.

Yes, quitting smoking significantly reduces risk, and it nearly reaches that of a non-smoker after 10 to 15 years. Heart attacks are not common in this age group, but they can occur. However, your symptoms do not indicate a heart attack, and it is unlikely to be one. Arrhythmias are different from heart attacks, and what we suspect is not life-threatening.

Regards.