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Q. I am concerned about my skipped heart beats and palpitations. Please help.

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 17, 2020 and last reviewed on: Sep 12, 2020

Hello doctor,

I am 27 years old. My weight is 225 lbs. My concern is about heart palpitations. I keep experiencing missed beats/heart palpitations. I feel like my heart is going up and down to my belly and losing air for a second or two. I am currently taking Hydroxyzine 50 mg as needed.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine


Welcome to

I have gone through your reports (attachment removed to protect patient identity).

There are extra beats or ectopics in your ECG (electrocardiography). These are usually benign and not serious in most of the individuals. However, we would want to rule out the possibility of any associated structural heart disease by echo and if necessary, then stress test.

There are certain precipitating factors like smoking, alcohol, caffeine, stimulant drugs, sleep disturbances, anxiety/stress, gastric disturbances, etc. Certain medications may precipitate these, if you are on any medications other than Hydroxyzine. So try to identify any triggers. If these are too troublesome, then you may request your treating doctor for beta-blockers to suppress these.

So usually these are benign, but you should also undergo echo along with Holter monitoring. Identify the triggers and have a healthy lifestyle and try to achieve weight loss.

I hope this helps.

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Thank you doctor,

I am wearing the 7 day monitor now since Sunday. I am working about two to three days a week because of bad palpitations when I wake up at night for work, and sleep is hard during that time and do not want to mess up with sleep schedule. Is there a specific way I should sleep and beneficial to reduce the palpitations?

I have had EKGs and told everything was fine on many occasions. I have another question that was not mentioned above, I started using marijuana around the start of symptoms to help reduce anxiety/stress, and it worked in the beginning but has a little to no effect anymore. So is there a possibility for anxiety/stress caused palpitations still a possibility with marijuana and/or Hydroxyzine having reduced effects since the start of symptoms?

What medication would you recommend to help with anxiety and/or stress-related heart palpitations. I have been on many different medications but I am open to try them again if they help with this issue?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine


Welcome back to

12 lead EKG may be normal in ectopics, as these are intermittent and may not be picked up always. But your attached EKGs show the ectopics, which confirms their presence.

Now regarding the possible causes, these can certainly be related to drugs. Drugs itself can precipitate these and even drug withdrawal may precipitate these. Drug withdrawal or tolerance can cause anxiety and anxiety can worsen ectopics. Even ectopics can worsen the anxiety. So everything is interrelated and everything appears to be related to drug-related.

Now this may take a few months before all this subsides. You should focus on gradually withdrawing the drug. During withdrawal, these ectopics may subside in a few months. You should convince yourself that these will be there and go with time, these are unlikely to cause any serious consequences. You may try some meditation and yoga to calm yourself and try to remain as busy as possible.

Regarding medications, the first medication should be tried is Propranolol which can suppress these ectopics and anxiety. If it is not helpful after gradually escalating the dose then you should try to move other antianxiety medicines, as Prozac or other psychological medications may itself cause palpitations. So it should be tried only if Propranolol is not helpful.

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I got my 7 day monitor results back, can you please review and let me know what your thoughts on what should be done from this point forward.

Thank you so much for helping with this. Have a great day,


Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
# So it confirms the presence of atrial and ventricular ectopics, which are responsible for your symptoms. This is not a serious or worrisome issue usually. So, take above mentioned precautions and actions. As I mentioned earlier, echo should be obtained just to rule out possibility of structural heart disease.
All the best.

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So my family doctor has started me on Geodon, possibly help eliminate the noticing of the PVC's however Toprol was offered if Geodon does not work. Your thoughts on the Toprol? Is this a good route for getting rid of these and living normal again?


Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
# Hello,
Is it Ziprasidone? Geodon (ziprasidone) is basically for psychiatric issues like control agitation, bipolar disorder or schizophrenia. It will not be directly helpful to suppress ectopics. It will be helpful only if you have any psychiatric issues. So I wouldn't go for it unless one is having psychiatric issues.
Toprol (Metoprolol), infact a drug of choice for ectopics. You may have it for some time period and gradually taper it once ectopics are suppressed. It's an good option.

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