Cardiology and Anxiety

I see lots of patients who deal with anxiety because of their medical conditions. Last night, I had a woman who gets palpitations frequently. She calls 911 and comes to the ER. She has been seen by Cardiology and does not have any underlying cardiac rhythms that would be considered concerning. She has PVCs and PACs, which can be distressing but are not typically thought to be dangerous. They don’t require interventions or medications, but she has also at times had atrial fibrillation, which is a more concerning cardiac rhythm. She has been evaluated by Cardiology, has worn extended cardiac monitors to try to capture the rhythm, which has been unsuccessful. She is clearly distressed when these palpitations happen because she thinks it’s something dangerous. I can’t fault her for that; it actually could be something dangerous, but most of the time it is not.

I also had a 49-year-old gentleman with severe coronary artery disease last night who had just had an angiogram a few days ago. He again came in with chest pain. He got the usual chest pain workup for a 49-year-old with coronary artery disease, and without finding anything acute that needed intervention, he was discharged. He was very anxious at discharge, feeling like we didn’t do anything for him. But I’ve done this long enough to know that when I call Cardiology and tell them about the patient and the diagnostic tests that I’ve done, they don’t have any further intervention to offer. And yes, it’s true, he might die of a cardiac event at any time, but that horse is out of the barn. I can’t undo the condition that he’s in, but he also can’t live his life in the ER or the hospital just waiting for a terrible event to happen. I don’t have an exact explanation for his chest pain. Maybe it’s something related to his heart, but again, the diagnostic tests did not require any further intervention.

And I understand that for both of these patients, the palpitations and the coronary artery disease, makes life kind of suck. And at any given time, you could have some life-threatening disaster happen. You have underlying conditions that could get worse, and I don’t have a good explanation for your symptoms. I don’t have an intervention, I don’t have a specialist that needs to see you in the middle of the night, I don’t have a surgery or procedure to offer you, and I acknowledge that it feels really terrible.