A 4 week Journey through Anxiety and Insomnia

This is my second post on here, but I do love reading  all your posts, they are so helpful.
My last post was following my first op for a PM on 5th April. I had a very uncomfortable 2 weeks, I was on Propranolol and experienced jumpy heartbeats, which prevented me from sleeping. Unfortunately, insomnia is now a continued problem for me.

I also experienced severe high Blood Pressure,  182 over74 at one point and worse, due I am sure to anxiety and lack of sleep.so bad that I went to my local A&E the day after the doctor's strike, in the UK, luckily as it was empty and I was nearly admitted.
The doctor managed to bring it down with a combination of Ramilpil 10mg and Amlodipine 5mg( ( I was already on 2.5 Ramilpril and had been fine before the op)

I saw my Cardiologist who thankfully fitted me in at 6pm on the following Monday and he was horrified that the young doctor had given me such a huge jump in dosage. I was reduced to 5mg Ramilpril and off the Amlodipine . I am fortunate to have a small private insurance from my working days ( I will be 70 this May) which allowed my op at London Bridge and a Cardiologist who has seen me through more than 20 years of ablations, cardio versions,and countless meds to find the right way to deal with AF, until finally I am left with sick sinus node and Bradycardia/Tachycardia hence the PM  and now Bisoprolol, with the  threat of AV ablation if the meds don't work.
My doctor paced me , ECG, Blood Pressure, the works that night. All perfect, I was so grateful, no arrhythmias to be seen from that pounding heart, But there popping up suddenly were those ectopic beats. 
So he explained everything to myself and my husband, all the pacemaker info and what it means, (helpful to have hubby knowing too ) gave me Bisoprolol 2.5 which I couldn't have before as it brought my HR too low but with a PM it's ok now and sleeping tablets to help me over the insomnia. Wonderful to be able to sleep and I felt like a new woman but if I don't take one I can't sleep and I get all the same problems next day.I just lay awake worrying all night and my mind will not rest even though I do all the right things before bed, no internet, no caffeine, write down things for tomorrow etc.

Yesterday my Blood Pressure was high, my heart was pounding all day my appetite is low and I feel miserable and tired. I took a sleeping tablet last night, had a good sleep and all those problems are gone again. I am eking them out and it's wrong, I need to be able to sleep naturally.
I am checking the internet for self hypnosis and I am about to have counselling for anxiety, I hope it helps otherwise I am beginning to regret having the PM done

I am now on St Thomas' books so will be attending clinic there in future and may see some of these wonderful knowledgable people there.
I just have to hope things improve fingers crossed, I am lucky to have a PM and there are many people in a worse situation than me. But has anyone else had this problem and why is my heart pounding? It was not an abnormally high HR,or I would have gone to A&E. It kept returning to my PM of 50 but was pounding in my head ,chest and stomach, The sleep stopped the pounding strangely and today it is normal again., but of course now I am worrying that it's  going to happen again and I cannot contact anyone.

Sorry for this War and Peace effort, have a good weekend


It will get better

by Gemita - 2023-05-05 14:47:00

Roxy, yes let us hope that we meet one day at St. Thomas’, although I attend Guy’s Hospital now for pacing checks, but we are not so far away.

The pounding heart I know it so well and quite honestly you are only one month on from implant, so healing is still taking place and may continue to do so for up to three months (in my case).  

My blood presssure and heart rate were very volatile for the first few months following implant, but it did settle and I am sure it will for you too.  Fingers crossed, I am almost arrhythmia free on minimum meds and when I do have an arrhythmia, I hardly notice it any more.  I am also on Bisoprolol.  

Yes the combination of Ramipril and Amlodipine at high doses + Bisoprolol, would have been difficult to tolerate long term, so I am glad your Cardiologist caught this early and took you off the Amlodipine and reduced your Ramipril.  Any additional meds need to be introduced slowly and starting at low doses.

Don’t get disheartened, you may be pleasantly surprised that in a few months you will find your arrhythmias might settle without further intervention.  I was due for an AV Node ablation 6 weeks after my implant, but decided to give myself more time before going down that route.

Your heart is pounding now because your heart has been disturbed by your pacemaker/leads, the latter have been attached to your heart.  You are still getting used to being paced as well.  Your volatile blood pressure and heart rate are probably due to your arrhythmias/AF and once these settle, you should feel so much better.

I can see you have had lots of procedures.  I instead have only had three cardioversions and one EP Study.  I also have tachy/brady syndrome like you + AF with a rapid ventricular response rate, but my AF and other arrhythmias have slowly been tamed and continue to be well controlled.   I hope it will be the same for you too, but if not, an AV Node ablation will hopefully be your last AF treatment.  

A 4 week Journey through Anxiety and Insomnia

by Roxy - 2023-05-05 16:34:29

Thank you Gemita,

I was hoping you would answer, I so value your expertise. I did not realise Guys hospital had a pacing centre, much easier to get to for me, so hopefully I will go there eventually.

You have partially put my mind at rest, as, as soon as I ate this evening, my heart started pounding again and I panicked because I keep thinking something has gone badly wrong and needs correcting, so nearly shot off to A&E again. But if these are fairly controlled and expected arrhythmias, perhaps I need to stay calm, so I did some deep breathing and it seems to have helped.

I am just cross that this has happened only recently and I have felt reasonably ok since going on the Bisop except for the insomnia which I hear is a side effect anyway. So I cannot understand why this has just started playing up.

Like you, I am on the list for an AV node ablation but asked if we can cope with meds first as I am worried about relying completely on a PM.

I wonder how many other people have had the full ablation and are happy with the outcome??? Does it make life a lot easier not worrying all the time about your heartbeat and where it's at???? Or am I just being naive?


Atrial Fibrillation

by Gemita - 2023-05-05 18:20:46

Roxy, yes Guy’s Hospital has a pacing clinic and the doctors from St. Thomas’ hospital attend the Guy’s clinic also.  I got transferred over to Guy’s during the Covid period and I much prefer it.  It is more relaxed and less busy than St. Thomas' and an added bonus, London Bridge Station is on the doorstep!  

Take one step at a time.  Get used to your pacemaker first before thinking ahead to any AV Node ablation.  You have plenty of time and like me, you might improve so much when things settle down, that you won’t need any further treatment and your rhythm disturbances can be controlled on meds alone.   I have held it off for several years now and I don’t regret it.  

You need to give yourself a few months at least. You are safe now with your pacemaker and your doctors can give you rate control meds without fear of reducing your heart rate too much.

You will continue to be safe providing your heart rate can be controlled and are on anticoagulation if you need it.  I never go to A&E for my AF anymore.  It would stop by the time I got there in any event.  I rest if I need to, keep well hydrated and relaxed knowing that the episode will soon pass.  I am now in control of my AF.  

There are members here who have had an AV Node ablation and to my knowledge they have been happy with the outcome.  Of course AF would still continue in the atria but the fast signals would not get through the AV Node to push the ventricles too fast.  Also the fibrillating sensations in the atria and the irregularity of rhythm would stay in the atria and my EP told me that I would certainly not be so symptomatic anymore, since it is the “irregularity of rhythm” that troubles me as much as the speed of any intermittent AF episodes. 

Yes if we cannot control AF, an AV Node ablation is the last resort but effective and certainly patients are able to stop many of their meds afterwards which would be an added bonus.  Also, after an AV Node ablation, we would start pacing in the ventricles at a steady rate, ignoring all the chaos happening in the top chambers of our heart but this all comes at the cost of becoming pacemaker dependent.  However pacemaker dependency is usually well tolerated whereas uncontrolled AF is certainly not

Heart Pounding

by Rch - 2023-05-05 21:18:30


You went into the Urgent Care clinic with symptomatic hypertension, and they tried to put out the fire with administration of 10 mg Ramipril and 5 mg Amlodioine, neither of which is a mega dose in an urgent situation. They probably should have discharged you home on a lower dose once the BP was normalized with a f/u with your PCP the next day or at least a phone call. Now you are on 5 mg Ramipril, 2.5 mg of Bisoprolol and a sleeping pill!! IMHO your pounding heart and associated high BP might all be anxiety related or due to sleep deprivation! I strongly urge you to try any non-pharmacological approaches to control your anxiety and insomnia. I know it's easier said than done but longer you stay on the tranquilizers it's harder to get off! I wish you well (PS: Any up-titration of Ace inhibitor should be followed up with a lab test within 1-2 weeks. I take Lisinopril and my PCP routinely checks my labs with any changes in dosage). Please follow up with your PCP


by piglet22 - 2023-05-06 06:45:11

All I can add is that stress is responsible for all sorts of ailments including high blood pressure.

Some people can stroll through life without a worry, others worry about everything.

As I get older, I get bolder. I used to worry about work and there were people who used their little bit of power to intimidate and for some colleagues, bullied them.

Now, no-one is better than me. They can be rich, influential, Royal, world leader. They've been lucky, but they aren't better. Be positive and exclude these people.

A good stress buster is having something to look forward to. Meeting old friends, a good meal.

Don't take problems to bed. I find listening to the radio is a good way to drift off.

Hobbies and interests like walking can take your mind off stuff. I like planning projects, a good tax spreadsheet that works, taking up interests I liked as a kid, model railways, boats, planes. Airfix plastic kits should be available on prescription.

And, share your problems. More often than not, you will find you aren't alone, and this club is a good start.

Anxiety Treatments

by Penguin - 2023-05-07 07:39:33

My only additional comment is one you appear to already know about - the sleeping pill! I'd take that one out of the equation as soon as you can. 

Re: self hypnosis and counselling - not sure how easy you will find self hypnosis? The conventional hynosis techniques (performed by a hypnotherapist) and achieving a hypnotised state isn't as easy as Paul McKenna makes it look!  

Anxiety is normal. Unless it's out of control and there's no good reason for it (and you have good reason) practical help / support / reassurance may work better than analysis or CBT.  

Not sleeping and feeling your heart pounding is the pits and it will keep you awake and you will feel anxious until it (hopefully) begins to improve! I hope you can ride it out.  You've had some great advice in this thread from people who have been in your position.  It's really difficult to do nothing apart from try to go with it and let it take it's course, but accepting that this is a normal course of events might be decent advice.  Deep breaths and patience! 



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