Patient's Query
Hello doctor,
I suffer from health anxiety and have dealt with it for many years, since I was a child. I lost my loved ones. Because of these experiences, I tend to focus heavily on my health. I have been diagnosed with somatization disorder. Since the COVID-19 pandemic, my health worries have mainly focused on heart health. This concern has been fueled by conflicting information online about myocarditis, vaccines, and the virus itself.
In the last five years, I have had five ECGs and regular monthly physicals, during which I ask my doctor to listen to my heart. I also bought a smartwatch, which is FDA-approved for heart monitoring. However, my doctor says I do not need it and that it might actually increase my anxiety, especially if it detects harmless artifacts that could cause me to panic. Still, I have read that some cardiologists believe these watches can be useful if the data is interpreted correctly and in context.
I have shown the results from my watch to my doctor, and she says everything looks normal and healthy. I usually do one ECG (single-lead, of course) per week, and it consistently reports a normal sinus rhythm. The watch also continuously checks for irregular heartbeats, and I have never received any alerts.
My resting heart rate during the day is around 62 bpm, and my average sleeping heart rate is 48 bpm. When I have panic attacks, my heart rate can spike to between 120 and 140 bpm, but it usually drops below 100 soon after the episode passes.
Does this all sound normal to you?
Please advise.
Hello,
Welcome to icliniq.com.
I understand your concern.
Given the losses you have experienced, your focus on your health is entirely understandable and justified. Based on the health history you have shared, your previously normal ECG (electrocardiogram) results, and the normal data from your smartwatch, I am confident that your cardiac health is good.
It is true that there have been reported cases of myocarditis associated with both the coronavirus and the vaccine. However, a patient with myocarditis or heart dysfunction would typically exhibit clear signs and symptoms. These would likely have been ruled out by your treating physician, especially since you have mentioned that physical examinations and chest auscultation were performed.
Typical symptoms of myocarditis include palpitations or episodes of rapid heart rate, shortness of breath (especially during exertion or while lying down), difficulty lying flat, swelling in the feet and hands, and sometimes chest pain. When myocarditis is suspected, cardiologists usually conduct blood tests and a cardiac ultrasound (echocardiogram). In most of these cases, the ECG would also show abnormal patterns.
If your ECG results have been consistently normal and you are not experiencing the above symptoms, it is highly unlikely that you have myocarditis or any significant heart condition. The variations in your heart rate appear to be physiological. An elevated heart rate during a panic attack is a normal response to anxiety. It is good that you have been monitoring your heart rate and rhythm using your smartwatch. However, if this constant monitoring contributes to your anxiety, it might be better to reduce your reliance on it.
If you ever experience any of the concerning symptoms mentioned earlier, it would be reasonable to undergo an echocardiogram or an exercise stress echocardiogram. If those tests are normal, they would provide further reassurance.
In conclusion, if your physician has reviewed all the data and is not concerned about any underlying pathology, that should be very reassuring. Additionally, I would recommend working on your anxiety through cognitive behavioral therapy (CBT) and relaxation techniques. Based on the information you have provided, it seems very unlikely that you have any active cardiac condition at this time. I hope this information is helpful. Please do not hesitate to reach out if you have further questions. I am always here to help with your health concerns.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I really appreciate your advice. If possible, I would like to stay in touch to ask any questions that may come up, particularly those related to my smartwatch data or my anxiety around heart health, as I currently do not have a cardiologist to consult.
At the moment, I am working out at the gym three to four times a week. I understand that I should aim to exercise within 85 percent of my maximum heart rate. During my workouts, my heart rate typically ranges between 76 and 146 bpm, and I do not experience any chest pain during or after exercising. Five months ago, I weighed 299 pounds. I am quite tall at 6 feet 4 inches, and I have since reduced my weight to 273 pounds. My goal is to reach 242 pounds.
My blood pressure is usually around 115/76 when lying down, and 128/82 when sitting. However, it can sometimes rise to 140/90 during periods of work-related stress. My blood sugar levels are usually around 105 (fasting) and 135 after breakfast. I also swim every other day and average about 7,000 steps per day.
My doctor checked my iron, hemoglobin, and hematocrit levels, all of which were within the normal range. My hemoglobin was 15.3, and HCT was 46. I currently take one 100 mg Nattokinase supplement daily. My total cholesterol is 190. I believe I may have mild sleep apnea, which seems to be improving as I lose weight.
Overall, I feel like I am doing everything I can to look after my heart health.
Would you agree?
Hello,
Welcome back to icliniq.com.
It is important to stay physically active and exercise regularly; however, it is not necessary to reach 85 percent of your age-predicted maximum heart rate for cardiovascular benefits. Consistent physical activity at a moderate intensity is sufficient to support a healthy heart.
Your current body mass index (BMI) falls within the obesity category. The closer your weight is to the ideal range, the more likely you are to enjoy better overall health. Continued weight loss will help you stay active, reduce anxiety, maintain optimal blood pressure, and support heart health.
I am glad to hear that you have adopted a very healthy lifestyle. With this commitment, you should continue to lose weight gradually and sustainably. The health parameters you have shared are all within ideal ranges, which is very encouraging. Maintaining a heart-healthy diet is also essential as part of your wellness plan.
I encourage you to continue this healthy lifestyle to gain the maximum benefits, especially in terms of weight loss. As you mentioned, sleep apnea is likely to improve as you lose more weight.
Please remember that I am always here if you have any health concerns.
Take good care of yourself.
Best regards.
Patient's Query
Hello doctor,
Thank you for the reply.
As discussed previously, I will be using your advice alongside my primary care physician. I have health anxiety and am constantly monitoring my heart rate. My resting heart rate when calm and relaxed is normally in the 50s, and my average sleeping heart rate is 48 bpm when I am good. What I have noticed is that when I eat late at night, I get quite bloated, and something seems to trigger a thing inside me where my heart rate can sometimes get to 120 bpm. Because I am monitoring my heart rate, it panics me and sometimes increases. What I have noticed is that once I burp and release gas, my system calms down, and my heart rate returns below 100 bpm.
My doctor says I have aerophagia, and the bloating activates my nervous system, which sends my heart rate up. Does this make sense? My doctor says it is a vagus nerve reaction, and I am hypersensitive. It only happens when I am bloated, mainly on weekends when I go out and have a few glasses of wine and eat some food later at night. The rest of the week, I do not drink alcohol, and I eat clean. My second question is whether that is fine. I have noticed that some days, I feel more tired if I wake up and then go back to sleep for an extra hour. On those days, I notice I feel more tired and my heart rate is about 10 bpm faster. My doctor says that it is normal on days when you are tired and your heart sometimes works a bit harder, but it is still within the normal range.
Please suggest.
Thank you.
Hello,
Welcome back to icliniq.com.
I have read your query and can understand your concern.
Your proactive approach to your health is truly impressive. Please feel welcome to discuss any health concerns you have. We can address them together. The relationship between gastric and gastrointestinal issues is well-established. As you rightly noted, gastric bloating and distension can trigger the vagal nerve, thereby generating a response that alters heart rate.
Remember, it is best to avoid any foods that causes stomach discomfort. Also eating large meals or having small meals both promote gastric distension and having 3 to 4 balanced meals a day is the way to avoid gastric distension. Furthermore, excessive alcohol and junk food are detrimental to heart health in general. The feeling of being tired on some days is also understandable.
Human energy levels naturally fluctuate. We do not maintain the same vigor all the time or on all days. Sometimes we feel low due to a variety of external and internal stimuli. In such instances, we can prioritize good rest, stay well-hydrated, and engage in activities that boost energy, stamina, and confidence. Daily walks and exercise are excellent ways to maintain good health.
Additionally, healthy eating, especially consuming meals at regular times, enhances overall fitness in every aspect. The good news is that all your heart rate variations are within the normal range, and there is nothing concerning at present. I would encourage you to maintain healthy lifestyle and specially stay focused on weight loss.
I hope this answers your query.
Let me know if I need to assist you further.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
As you know, I suffer from health anxiety. Every day, I do an ECG (with the help of a watch). Today, I got an inconclusive result, which made me stressed, but shortly after, I got a normal sinus rhythm. I am wondering if the stress and anxiety while taking the ECG caused the inconclusive result.
I have attached both the inconclusive reading and the normal one, taken within a minute of each other. Recently, during a general check-up, my doctor listened to my heart and said everything was normal.
Hello,
Welcome back to icliniq.com.
It is good to hear from you. I hope you are feeling well and in good health.
I have reviewed both ECG recordings. The first is normal, and the second also shows a normal sinus rhythm with a few premature ventricular contractions. These are expected in healthy individuals unless they are very frequent.
Anxiety can also trigger these, but they are generally harmless. The watch is unable to differentiate and pick these changes and hence shows inconclusive results. I would suggest recording a few more times and sending them to me so I can review an extended ECG monitoring.
Have a good day.
Please let me know if you need anything else; I would be happy to answer.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
It seems to happen consistently when I am stressed or hold my breath. Here is a normal reading, and I have had two more normal sinus rhythms after that.
Hello,
Welcome back to icliniq.com.
That is very reassuring. As we have previously discussed, please stay focused on your heart health and let me know if you have any concerns. I’m always here to help you.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Here is one reading. I was still a bit stressed while doing it, almost like I was trying to “beat the machine,” and I do not think I was breathing correctly.
Hello,
Welcome back to icliniq.com.
Thank you for sharing your ECG with us.
This ECG again shows some premature ventricular contractions or beats. I suggest you stay relaxed, as there is nothing to worry about. If you have any current laboratory tests, please share. Also, please let me know your current medication regimen.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Here is the most recent.
Hello,
Welcome back to icliniq.com.
Again, it is a normal sinus rhythm with a single premature ventricular contraction at the end of the strip. There is nothing to worry about. All the segments and intervals are normal.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
So, it is probably just an anxiety-related issue. I am very stressed this morning, so I guess that makes sense.
Hello,
Welcome back to icliniq.com.
Yes, most likely. Please try not to be stressed and find ways to stay relaxed. A healthy walk, a good hobby, reading an interesting book, watching a movie, and spending quality time with friends and family are always relaxing and helpful.
If you can, please share any recent laboratory tests and tell me about any current medications you are on.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I went to my doctor today, and she did a physical examination, including listening to my heart. She gave me the all-clear and advised me to take the watch off, explaining that it is not helpful to do ECGs when I am stressed or anxious, especially while watching the screen.
Hello,
Welcome back to icliniq.com.
That's really good to know, and your doctor said the right thing.
I wish you a very happy and healthy life.
Always here to help you with your health concerns.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I did this one on my watch with her after the reassurance, and she said it is anxiety.
Hello,
Welcome back to icliniq.com.
I hope you are feeling much better and relaxed now.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, I am. It was this one, much more in pattern. It is amazing how anxiety and stress can affect your heart rhythm.
Hello,
Welcome back to icliniq.com.
I am happy to see an ECG in a completely normal sinus rhythm without any premature ventricular contractions.
Patient's Query
Hello doctor,
Thank you for the reply.
I did two more readings this afternoon while I was relaxed, and they both look normal.
Hello,
Welcome back to icliniq.com.
Thank you for sharing your ECGs.
Both show a normal sinus rhythm without any premature contraction. All the segments and intervals are within normal range.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I have done 15 ECGs over the past two hours, and they all show the same results, so I think we are fine.
Hello,
Welcome back to icliniq.com.
Yes, absolutely. All the findings are very reassuring. There is no need for further ECG monitoring at the moment.
I wish you very good health.
Take very good care of yourself.
Patient's Query
Hello doctor,
Thank you for the reply.
I hope you are doing well. I am feeling quite confident now that the few premature beats I noticed the other morning were likely due to stress, anxiety, and sweating. Since we last spoke, even though you reassured me that my recent watch ECGs were fine, I admit I went a bit overboard.
Anxiety and smartwatches really do not go well together. I have done 98 ECGs over the last three to four days, and all of them have come back clean, without any premature beats. I think I can relax now. I have attached two examples, but they all show a good, consistent pattern.
I have also noticed that even slight movement can affect the baseline quite a bit.
Thanks again for your support.
Hello,
Welcome back to icliniq.com.
Hope you are doing well. It is good to see your reply.
I am happy that all your ECGs are within the normal range and that there are no premature ventricular contractions. There is no need for continued monitoring, as it would not benefit you and would cause anxiety. Minor variations in heart rate are physiological and appropriate.
I wish you very good health.
Kind regards.
Was this conversation helpful?
Answered byDr. Wajahat
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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