You’ve been having these strange sensations in your chest. You’ve taken your pulse and you’ve felt the skips. The jumps.

You’ve called your doctor and he’s run any number of tests, from as little as a stethoscope to your chest to as much as an ECG, Holter monitor, event monitor or echocardiogram.

And then he prescribes an SSRI for you, which sounds fine at the time because what do you know about acronyms and what medications treat which conditions. But you like to know what you’re being told to take and how it might affect you, so you Google SSRI.

Hmm. Serotonin reuptake inhibitor? That’s a drug for the brain, right? And it’s an antidepressant. The doctor thinks I’m depressed and that’s what’s causing my arrhythmia?

Now you feel worse than you did before you saw the doctor. Not only is he not addressing the cardiac issues, he’s trying to pigeon-hole you as a simple worry-wart and mollify you by filling you full of “happy” pills.

Before you go into a tailspin, Googling all the terrible things that might (but in all likelihood will never) happen to you by leaving your primary symptom untreated, please read on.

It’s true that SSRIs like Zoloft and Prozac are antidepressants. They’re also used as anti-anxiety medication, too, and for those of us who suffer from benign heart rhythm abnormalities, they can be a godsend.

What Do SSRIs Do? Do They Work?

Without getting overly technical, an SSRI is designed to help stimulate synaptic cells in the brain by keeping the neurotransmitter serotonin at the surface of a synaptic receiving cell for a longer period of time. The result of this stimulation, as you might expect from a drug called an antidepressant, is to make a person less depressed, or put another way, more happy. Less anxious.

And if stress is a concomitant factor in your arrhythmia, this may be exactly the thing you need to wrangle control of your health and well being back from the brink.

Stress can be a cagey animal. It hits some people long before an upcoming, worrisome event. It hits others during the event. Still others it affects after the event. For some the stress grows little by little, every single day. Just like an animal you feed each day, it grows a bit here and there, but it happens so slowly that you never realize how big it’s become until it’s snarling in your face, demanding all of your attention. And throwing your formerly metronomic heart into fits and quivers.

SSRIs can help you fight this stress animal by keeping your worry and anxiety at manageable levels and maybe even allow your mind to return to a time when your life was simpler. When the weight of the world wasn’t on your shoulders, worrying about your job, mortgage, kids, parents, neighbors, coworkers, spouse and all the rest.

Because SSRIs affect brain chemistry slowly, it takes awhile for them to take full affect. Pharmacists will tell you it’ll take 2-3 weeks and even after that initial “break-in” period you may continue to improve over the following months. And once the stress is wiped away, often times so are the palpitations, skips and spurts.

So don’t dismiss your doctor as an uncaring and self-absorbed just yet. Give your SSRI a few weeks before you decide. It may be just the thing you need to treat your arrhythmia.

I know I’ve said this over and over on this site, but it bears repeating. I’m not a doctor. I’d like to think that if I’d have chosen that path when I was much younger, I’d have had a shot at it. But I didn’t. So I’m not. Bygones.

However, like anyone else who lives with arrhythmia, I have a vested interest in finding ways to reduce or eliminate the heart skips, blips and bursts I deal with on a daily basis. Earlier today I was out on the internet doing research like I do every day, and I ran across a post from someone claiming they’d read somewhere on some arrhythmia site that aloe vera gel was getting a very positive response from PVC/PAC sufferers and wondered if anyone else had tried it.

I drink lemon balm tea every day for the same reason, so when it comes to home remedies or natural “cures”, I’m always going to try to learn more in the hopes that I can rid myself of my palpitations, too.

And Aloe Vera has always been good for the skin, right? It’s good on sunburns and it’s among the ingredients in the finest moisturizers. It’s an extract from a plant, so it’s natural, right?

Unfortunately, trying to pin down hard clinical data has been sketchy at best. Just a cursory Google search for aloe vera gel heart pvc pac nets a site from what appears to be a real doctor. Ray Sahelian, M.D, to be exact. You can find my full opinion of him at the bottom of this article, but suffice it to say the advice he provides is on the sketchy side.*

Next, I found quite a few websites and articles referencing a study done by a Dr. O.P. Agarwal, claiming all sorts of cardiac benefits. ** While the study and the doctor appear to be legitimate, the claims made at the conclusion of the study appeared to be magnified when being reported on other sites that had a vested interest in selling aloe vera. But the claims from the study are interesting, including reduction in total serum cholesterol, serum triglycerides, fasting and postprandial (after eating a meal) blood sugar levels in diabetic patients, total lipids and also increase in HDL (good cholesterol). But nothing about palpitations or arrhythmia.

I also found a guy by the name of George. ^[1] George lives in Ireland and has been a very vocal advocate for aloe vera gel and what it can do to relieve premature ventricular contractions. I get the sense that George is just a regular guy looking for answers, believes he found one and is telling everyone that’ll listen in hopes of helping them. He’s not pushing a product or posting links to other sites. But in the absence of hard medical data and studies, Google can only give me what it can find on aloe vera helping palpitations. And George is what it found.

So what’s the answer? Can aloe vera help stop your PVCs? In a nutshell - I don’t know. Mayo Clinic’s website claims that a part of the aloe plant has been used as an oral laxative, ^[2] but that prolonged use can lead to an increased risk of colorectal cancer, and those with allergies to onions, garlic, chives and tulips should avoid injesting any aloe products (juice, gel, etc). ^[3] Because aloe is a natural laxative, it’s possible that the diarrhea that can result from aloe injestion can lead to an electrolyte imbalace, which defeats the purpose of taking something to stop your palpitations in the first place. ^[3] I found several studies that reported no side effects or adverse reactions of any kind while taking aloe vera, but there even on Mayo Clinic’s own site there is contradictory information. While one page says that even if Aloe Vera doesn’t help, at least it can’t hurt, another page says it can cause all sorts of problems, not the least of which is colon cancer.^[3][4] It seems like the best answer is to just use aloe to moisturize your skin.

* When I first found Dr. Ray Sahelian’s website, ^[5] I was immediately skeptical. Every page on the site is hyper-optimized for search engines, and every page has a product to sell you. I tried to look past the aesthetics of the site because this doctor may be brilliant medically but can’t pick a tie to coordinate with a shirt to save his life. But I wanted to verify that this person was credible. I’ll spare you the blow-by-blow and just provide the highlights. There’s a website called Ripoff Report that included a partial bio of Ray Sahelian and some strong words about his ethics (or lack thereof). ^[6] And on the website Quackwatch, Sahelian is quoted as saying there is potential for harm in using a particular over-the-counter drug, and that it should only be sold in small quantities. And I found this tight rope walking common in Sahelian’s opinions - if a drug is dangerous he’ll say so, but he’ll also provide information about alleged benefits, oh and by the way, here’s a link where you can buy some (from his own company, Physician Formulas, Inc).

I notice he’s produced videos on Youtube. He’s also written quite a few books, some that can be purchased at Amazon.com. He’s got a positive 60,000+ reputation for his identity on eBay. ^[7] Pretty busy for a guy who says he has a busy family practice in Marina Del Ray, California. Since he’s so “well known and respected”, I thought I’d check him out at Healthgrades.com, where patients give reviews on their doctors. He had only 1 review.^[8] Ok, my own doctor didn’t have any reviews, so maybe that’s a bad metric for establishing credibility. But this one isn’t - if you search on the address provided for Dr. Sahelian’s family practice in Google, you find an office complex located right next to a hospital. Except that not one of the offices there has Ray Sahelian listed as being a part of their practice.

Here’s another metric - on his website you can follow a link to send Dr. Sahelian an email, where the site promises he or one of his staff will respond to your query. Odds are the good doctor is the only one reading the email, as the link points you to his personal AOL email account!

One of his other businesses, the creating and selling of herbal nutritional supplements, looks very impressive when you see a picture of the building on his website.

But thanks to Google’s slightly invasive (but useful) drive-by images of most every address on the planet, we see that Suite B of 212 Technology Drive is no more than one office in a business complex. No mirrored glass high-rises or armed security patroling the parking lots. Just a guy that has an office.

So he’s a family practice doctor with a family practice that can’t be found. He’s made tens of thousands of transactions on eBay selling supplements. He has cheesy Youtube videos.^[9] He writes articles about supplements that he has a financial interest in. His reputation has been called into question more than once. Is this who you want to trust your health with?

** Doctor Om Prakesh Agarwal and his study on the use of a aloe vera gel and a traditional Indian remedy together was a tougher nut to crack. I found articles citing Dr. Agarwal’s presentation at a college in Texas, but I could find no such college. Further digging found that many of the third-party articles had the name of the school wrong. By quite a bit. “International College of Heart Diseases” should have been “International College of Angiology.” ^[10]

But once I was able to get clarification on the school and doctor, and looked at the abstract from the study itself, I found the results to be a little suspect. The abstract states that 5,000 patients were followed for a period of five years. ^[11] Pretty much every other large scale, long term study loses some of it’s patients just through job changes, loss of contact, the normal things. But this one had exactly 5,000 patients and was able to follow all of them, without fail, for 5 years? Sounds fishy.

As for the study itself - maybe there are some studies published in India on the effects of the husk of Isabgol (a plant native to India and Afghanistan), ^[12] making this study’s results more meaningful, but it appears to me that these two unrelated ingredients, Isabgol husk and Aloe Vera gel, were given to patients over the period of the study. Were there no control groups? Were there no subgroups of patients receiving only Isabgol husk or only Aloe Vera gel? If not, then how can it be stated with any authority that was not one or the other ingredient alone that improved patient’s conditions? The findings of the study were very interesting, but the abstract lacked much of the technical jargon that normally accompanies text, like confidence intervals and hazard ratios. And with such an exact number of subjects in the study and the inability to assign credit to Isabgol or Aloe due to poor study design, I have to say that I’m skeptical of the results.

Jeff

References

So you’re one of the 34 million people in the United States that has been diagnosed with asthma. ^[1] And panic and anxiety, especially during these economic times, have grown to be the most common mental illnesses in America, affecting as many as 40 million Americans. ^[2] That’s more than 10% of the population. Which means that over 3 million Americans out there are suffering from both asthma and panic or anxiety. And one of the troubling issues with anxiety disorders is the problems they can create with your heart. Specifically, palpitations or irregular heart rhythms. ^{[3][4][5][6][7]} For people suffering from anxiety or panic disorders, heart rhythm disturbances are the most common complaint, being reported 80% of the time by patients. ^[3]

You’ve been treating the panic or anxiety with an SSRI (Selective Serotonin Reuptake Inhibitor) like Zoloft and have been able to pretty much smooth over the rough patches most of the time. But you’ve noticed that your heart rhythm has again become unpredictable; you go to your doctor, run some tests and discover that you now have SVT. The go-to class of drugs for most cardiologists in this case is beta blockers, but depending on the severity of your asthma (and your arrhythmia), beta blockers may be dangerous for you, as they can cause asthma attacks. ^[8]

Complicating matters is your SSRI medication for anxiety. SSRI’s can inhibit the metabolism (consumption/elimination) of beta blockers, concentrating them in your body which can lead to complications as severe as requiring the implantation of a permanent pacemaker. ^[9]

So what’s an anxiety-stricken, palpitating, asthma sufferer to do? Here are a few options:

• If your asthma is well controlled, ask your doctor about cardioselective beta blockers such as atenolol or metoprolol. This kind of beta blocker is designed to only impact the heart and not the lungs. However, as the beta blocker dose increases, the selectivity decreases, meaning you would be more likely to suffer asthma attacks even using a cardioselective beta blocker. ^[8]
• Start the beta blocker at a lower initial dose and closely monitor cardiac function, particularly when increasing or decreasing dosage of either beta blocker or antidepressant.
• To avoid the interaction of beta-blockers and SSRIs, use of beta-blockers that are mainly eliminated by the kidneys such as atenolol, acebutolol, betaxolol, carteolol, and nadolol may be considered. ^[9]
• Ask your doctor about calcium channel blockers. Although the mechanism they use to treat tachyarrhythmias is different from beta blockers, if your heart is structurally normal (no tissue damage from myocardial infarction, for example), a calcium channel blocker may work for you.
• If your arrhythmia symptoms are bad enough, you may be a candidate for a catheter ablation, which is often curative and is becoming a first line treatment option for some tachyarrhtyhmias. ^[10][11]
• Try a different class of antidepressant. Tricyclic antidepressant have been used for decades, though they’ve fallen into disfavor due to the success of SSRIs and other classes of antidepressants. Bupropion (Wellbutrin, Zyban), buspirone (BuSpar) are also alternatives your doctor should consider. If the symtpoms of panic are seldom but acute, Xanax or some other benzodiazepine might also be an efficacious treatment option.

References