### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I take 400mg wellbutrin and 60 mg prozac daily. I also take yaz. Today I had a large coffee and took A vivarin tablet that was 200mg. I felt okay most of the day but now I am lying in bed and I feel my heart rhythm is abnormal. Whats going on? How bad is this and should I do anything about it?

### output:

Hello and thank you for using Chat Doctor. I carefully read your question and I totally understand your concern. But you should not worry. I will try to explain you something. This abnormal heart rhythm has to do with some electrical issues in the heart. Some electrical impulses that generate in a part of the heart different from normal sinus rhythm cause premature heart contraction that you feel like skipped beats, abnormal rhythm. This might be just ekstra-sistolic beats or other different arrhythmia. The extra-sistolik beats generally are followed by a pause till the next normal heart contraction. If these are not frequent, in Young and normal heart, it is nothing to worry about. There are different factors that might cause this skipped beats or arrhythmias like emotional stress, excessive coffee consumption, coca-cola or energy Chat Doctor. As you explain, you are under Prozac, an antidepressant medication. It is quite known in medicine that stress disorders might cause high frequencies, exra-sistolic beats. All sow pathology like anemia or hyperthyroidism might be other causes of this rhythm issues. So, if I was your treating doctor I would say that you have nothing to worry if this happens once a wile, its normal because of stress or coffee usage. But if they begin to bother you and interfere in your live we can decide to do some examinations like a blood analyze, your thyroid hormones, an electrocardiogram, echocardiography and of course a holder rhythm monitoring to have a full view of your rhythm. Only than we can decide what we should do. Hope I was helpful. Best regards.