[18F] Experiencing heart palpitations and anxiety

Patient Description

An 18-year-old female reports experiencing heart palpitations described as fluttering, pounding, and racing since around age 15. These episodes are sporadic and not clearly triggered by specific activities, although exercise and overheating exacerbate the symptoms, leading to lightheadedness and visual disturbances such as seeing red. The patient experiences constant stress and anxiety, with chest tightness fluctuating in discomfort from 4 to 9, worsening with emotional distress. Relief is found by placing a heavy weight on the chest or holding the breath. There is a family history of long QT syndrome, and the patient experiences regular dizziness and fainting spells. No known swelling in the legs or feet. The patient is prescribed lithium (150 mg), Vyvanse (20 mg), and venlafaxine (75 mg) but has not taken them in a few weeks. Higher doses of lithium cause feelings of being high or delirious. Past side effects include nausea, dizziness, dehydration, mood changes, and behavioral changes. No known allergies to medications.

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Arora's Assessment

What might be happening

Based on your symptoms and history, here are some possibilities:

  • Heart Palpitations: These can feel like fluttering, pounding, or racing. They might be related to anxiety, stress, or an underlying heart condition like long QT syndrome, especially given your family history. It's important to follow up with a cardiologist for further evaluation.

  • Anxiety and Stress: Your symptoms could be exacerbated by anxiety, which can cause or worsen palpitations and chest tightness. Managing stress and anxiety might help alleviate some of these symptoms.

  • Medication Effects: Not taking your prescribed medications could be contributing to your symptoms. It's important to discuss this with your healthcare provider to ensure you're managing your conditions effectively.

What you can do

  1. Consult a Doctor: It's crucial to follow up with a healthcare provider, especially a cardiologist, to evaluate your heart health and consider further testing like an ECG or Holter monitor.

  2. Manage Stress: Practice relaxation techniques such as deep breathing, meditation, or yoga to help manage anxiety and stress.

  3. Medication Review: Discuss your current medications with your doctor, especially since you've stopped taking them. They can help adjust your treatment plan safely.

  4. Symptom Tracking: Use MDandMe to journal your symptoms, track any patterns, and share this information with your healthcare provider.

What you should look out for

  • Seek Immediate Care: If you experience severe chest pain, fainting, or difficulty breathing, seek medical attention right away.

  • Monitor Symptoms: Keep an eye on any new or worsening symptoms, and report them to your doctor.

Remember, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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3 mo ago

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People Also Ask


What are heart palpitations and what might cause them?

Heart palpitations are sensations of a fluttering, pounding, or racing heart. They can be caused by stress, anxiety, caffeine, certain medications, or underlying heart conditions such as long QT syndrome.


How can anxiety and stress affect heart health?

Anxiety and stress can increase heart rate and blood pressure, potentially leading to palpitations and chest tightness. Chronic stress can also contribute to heart disease over time.


What are the potential effects of not taking prescribed medications like lithium, Vyvanse, and venlafaxine?

Not taking prescribed medications can lead to a return or worsening of symptoms they were meant to manage, such as mood instability or anxiety. It is important to consult a healthcare provider before stopping any medication.


What is long QT syndrome and how does it relate to heart palpitations?

Long QT syndrome is a heart rhythm disorder that can cause fast, chaotic heartbeats, leading to fainting, seizures, or even sudden death. It can be inherited and may explain palpitations and fainting spells.


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