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Okay, I want to be certain that we understand here that bigeminy and trigeminy are forms of PACs and PVCs, but we're talking about the same thing in general. The pattern of the ectopics as they superimpose upon normal sinus rhythm establish the variants described, but it's all within the same general category. That is why I suggested that you refrain from trying to particularize the events, possibly mistaking them as "something different" based upon the way they feel. If you've read my postings entitled HEART PALPITATIONS 101, there is a section where I discuss the timing of the ectopics and how they can be sensed differently based upon their introduction during normal sinus rhythm. If an ectopic occurs during ventricular depolarization, it can sometimes be rather dramatic depending upon how close or how distant it occurs from ventricular re-polarization. Sometimes, patients describe the events as "small" or "faint" because they actually can occur near-simultaneous to normal ventricular rhythm. In fact, the events themselves are extremely similar, but because of when they occur, they can be felt differently as it often causes the heart to feel as though it stumbles or flutters.
Patients have also described instances where it feels as though the heart has briefly paused altogether, sending them rushing for security and safety. This is simply due to the senses being altered and one's own perspective that may be misguided regarding what is actually occuring by comparison to what the patient "feels" is happening. In my postings, I used the example of two dancers, one with two left feet and the other with smooth, predictable moves. When a bad dancer tries to mix with a good one, the effects will often disturb the natural rhythm of both dancers momentarily. So regardless of the fact that stimulation from the Vagus nerve is more of a constant value, the timing with which it appears can make the experience either mild or dramatic. Does that make sense?
I also want to ask whether you're experiencing any GI symptoms such as acid reflux, indigestion, increased peristalsis, bouts of diarrhea or constipation, or other changes in bowel habits? This is very important with regard to what is taking place, which by the way I'm still convinced is non-pathological. In other words, despite your concerns which are very valid indeed, the pattern here rings very true for an anxiety-related disorder with somatic features.
Changes in exercise and medication will certainly go a long way to making you feel that things are getting worse, but not for the reasons you may think. A reduction in activity that reduces stress, permits it to remain at higher levels and many times causes a reduction in quality sleep. The beta-blockers, whether you may realize it or not, also have a mild anxiolytic effect along with helping to maintain regular sinus rhythm. So I would suggest here that a reduction in exercise and therapeutic agents that were diminishing anxiety symptoms has brought about the notion that something may be getting worse. Well, the symptoms of anxiety may well be increased, but again the symptoms are in no way suggestive of a looming and undetected cardiac pathology.
There are, however, several things to have checked and it's highly likely that your primary care physician or specialist has already done so, but we'll mention it here nonetheless. Although it's more common in women than men, thyroid values are very important to consider when this type of symptom persists to the extent you describe. But in most all cases, changes in thyroid function have a direct relationship upon weight. So if no striking changes have been observed in that regard, then it's unlikely but should be checked nevertheless and a simple blood test for pheochromocytoma will rule out the possible presence of benign tumors on the adrenal glands that can also cause similar symptoms. I will be frank here and tell you that I would be surprised if the tests turned up positive, because in both disorders described, the effects upon the heart are typically far more dramatic.
From another perspective, I suppose I don't have to state here that you need to refrain from any type of stimulants, ie coffee, tea, smoking, energy drinks and so forth. In the presence of a sensitive nervous system, these agents can all have a tremendous effect on the potential for palpitations to occur. In all cases they are considered contributory. I also want to state here that many patients avoid the use of medications because they associate them with the aging process and worries about habituation or withdrawl are most always second on the list. These notions more often than not, represent a challenge for healthcare professionals when trying to distinguish efficacy of prescribed drugs over time. Patients infrequently take them according to direction and often change dosing schedules because they associate symptoms with medications rather than the underlying cause.
I've been at this profession for more than 40 years and certain characteristics remain common for a great number of disorders. My impression is that were dealing with an anxiety disorder. It's also important to consider present life circumstances relative to your symptoms, ie loss of marriage partner or loved one, divorce, failed business enterprise or looming financial problems. All of these examples can have a tremendous impact on chronic anxiety levels.
Best regards and Good Health
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