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Forum Name: Arrhythmias

Question: Palpitations and pregnancy


 smc246 - Thu May 10, 2007 6:37 am

I am a 34 y.o female pregnant with my first baby. I have suffered with palpitations for several years. I have worn a holter on 3 occasions most recently in 2/07 which showed 118 venticular events, 1 run of nsvt lasting 9 beats. My cardio then sent me for a cardiolite stress test 3/23/07 which was normal. I have also suffered from anxiety in the past and the flare up of palpitations is making it worse. I have had 3 normal echo's only showing mild mvp, and normal ekg's. If it comes to a point where I can no longer stand the palpitations would it be safe to take a beta blocker during pregnancy?? All I can focus on are the palpitations. Could the increase be related to the change in hormones?? Thanks so much for your input.
 John Kenyon, CNA - Thu May 10, 2007 3:40 pm

User avatar Hello smc246 - You appear to be one of those people who has premature heartbeats routinely, with rare runs (which constitute, according to the book, non-sustained ventricular tachycardia or NSVT, if there are 3 or more in a row). Your doctor did the prudent thing in performing a Cardiolite stress test to rule out evidence of cardiovascular disease and structural heart disease. Premature beats (most commonly PVCs, as in your case) in themselves are not diagnostic of anything and are generally completely benign. When there is a run of V-tach detected (which is the result of sheer chance) it is appropriate to investigate further. Finding nothing, it then becomes something of a non-issue. V-tach is generally only of concern when the left ventricle is diseased and not functioning properly. That has been ruled out.

Anxiety can produce more PVCs and even runs of V-tach in some people, and young, healthy people can generally tolerate the V-tach and may not even be aware of it. Both PVCs and related arrhythmias are more likely to occur during pregnancy due to the hormonal changes and the slow, progressive crowding of the heart's space. (The heart doesn't like to be crowded and will often "kick back" by discharging some early beats).

It would probably be wise to be followed for this during your pregnancy, but it seems unliikely a doctor would prescribe a beta blocker for you unless the benefits outweigh the risk to the fetus. These decisions are made on a case-by-case basis, and if your doctor should decide this to be an appropriate therapy for the irregular heartbeats, he or she would certainly counsel you extensively on the pros and cons. Beta blockers are not known for any remarkable teratogenic problems, but anything taken during pregnancy must be weighed for its potential risk.

Unfortunately the same thing holds true for anti-anxiety medications, which would probably benefit you as well. Again, your doctor is in the best position to make this call.

It sounds as though your are in pretty good shape overall, but if the anxiety can be managed the PVCs and associated arrhythmias would probably be reduced, which would be all to the good.

Best of luck to you and please do stay in touch.
 smc246 - Fri May 11, 2007 6:34 am

Thak you so much for your insight. For the past four years I have been hearing that they are benign but I just kind of freak out when they happen!!!! I need to get a handel on my anxiety or this is going to be a very long 9 months!!!!
 John Kenyon, CNA - Fri May 11, 2007 11:57 am

User avatar You're very welcome. It is one of the more difficult things in life, I think, for people who are aware of these irregularities (and some actually can't feel them!) to accept that they are benign when they feel so bizarre and scary. Even when we have accepted that odd fact they still catch us off-guard and sometimes set off that internal alarm, which is really the most unpleasant part of the experience.

Management of anxiety is more difficult during pregnancy for the simple reason that doctors are, very reasonably, reluctant to prescribe many drugs that would otherwise be a first-line approach to many problems.

Pregnancy is something of a challenge without the added aggravation of something like this. One thing to bear in mind is that you're in good company. This is an extremely common problem in the general population to varying degrees.

All the best to you in the coming months. I feel certain that once the newcomer has arrived all this will seem like it just flashed by.

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