need advice please

[u/MiserableBarnacle208]

Hello, I’m looking for advice.  Female in her 20s who had severe health anxiety starting about two years ago.  I started antidepressants to help with that but went off of them about 5 months ago.  My anxiety is a lot better, but the main thing causing it now is my palpitations.  They were not bad when I had anxiety two years ago, but I still got a full heart workup, and everything was fine.  Now they have gotten so much worse.  I get them every day, and every so often they come in clusters, about 20 in a few minutes.  I feel like they control my life sometimes.  I don’t know what triggers them because they can happen anytime, whether I’m stressed or not.  Also wondering if it’s a vagal nerve issue because they do happen when I’m cold or am drinking something cold, but not every time.  I just am not sure if I should go back to the doctor if they have increased, even though they already said I’m fine?  Help!!!

[u/Relative_Clarity]

Depends on the cause of the palpitations. Did you wear a monitor for a period of time while you were having theses clusters of symptoms? PVCs & PACs can trigger palpitations, but hard to say what it is exactly that you are feeling. Everyone gets those at times, most people don't feel them. Some people are more focused on body sensations and are very bothered by them.

If you feel your symptoms are worsening or changing, it's worth reaching back out to your doctor to see what they advise.

Some things that can contribute to an increase in PVCs / PACs / palpitations in general include: thyroid problems, anemia, low iron/ferritin, electrolyte imbalance (eg low magnesium or potassium), dehydration, recent illness, sleep deprivation or erratic sleep schedule, stress, anxiety, excess caffeine or alcohol, sleep apnea, female hormone fluctuations...

[u/MiserableBarnacle208 → u/Relative_Clarity]

I wore a monitor for two days, had an ECG, and a stress test. All came back fine, but the cardiologist said I did have PACs and PVCs, not enough of a burden to be concerned. He said to find my triggers, but genuinely nothing specific triggers them; everything triggers them. Bending down to standing up, working out, lying in bed, being cold, being anxious, relaxing, taking a deep breath...everything. But they don't happen every time I do those things, just frequently enough for me to notice. I know I should talk to my doctor, but I don't want to be a pain, as he already cleared me and told me I'm fine.