Well, I'm an old and tired neurologist from the U.S., although the UK does at times seem very inviting purely from a scenic point of view. As for whining, I never perceive such to be the case with patients regardless of the nature of the complaint. Okay, let's take a look at your concerns:

If you're referring to a transesophageal echogram, then the potential for this procedure to have caused a long-term change in status is quite remote. While the procedure can cause events during the course of diagnostics, it's not been known to have lingering effects in my experience.

It's not uncommon for benign palpitations to change their presentation over time relative to the degree of environmental stress one may be experiencing. I am naturally unable to determine the level of stress you may be experiencing, but I can tell you that the anxiety associated with healthcare concerns is quite remarkable indeed and patients rarely state they "feel" anxious. Nevertheless, its consequences can be very broad and thorough in the ability to influence the nervous system.

In cases where patients experience what appears to be multiple episodes, more common than you may realize, then pharmaceutical intervention for the short term may be wise to help you gain a better emotional foothold on the disorder. Atenolol in the 25 to 50mg range is an excellent choice and at low doses, does a wonderful job in regulating heart rate, but in addition also has a mild anxiolytic effect that helps reduce symptoms relative to labile parasympathetic responses that tend to permit the Vagus nerve to over-respond to the heart. It is not a very invasive drug and unless you're diabetic, then it's a great choice to help relieve symptoms until you've conquered your fears about the presence of the disturbances. Also, depending upon whether you're experiencing GI symptoms, then getting it under control will help reduce the occurences as well.

In any event, it's important for you to understand that regardless of the number of events, they are not doing damage whatsoever, nor will they ever be tantamount to a cardiac event. I've never even heard of such a case in more than 40 years of practice, so that should shed some light on the odds that something bad might happen. It's just not the case. I realize that they frighten you and more lately have come to represent an all out nusiance. Trust me that patients have gone to great lengths to express their particular hatred and frustration with me.

As for feeling "hot" you have to realize that Vagal stimulation is through and through, meaning that it just doesn't affect the heart when it occurs, but rather the signal can transduce to any other area innervated by the Vagus nerve. This is why some patients report coughing sometimes when the events occur, because the Vagus nerve also innervates the larnyx and the sensation can draw forth a cough impulse. Any change is homeostasis, or normal operating procedures by the body, can induce changes in sensory factors. Rapid changes in blood pressure and circulation can make one feel hot and often feel pressure around the ears. The body is merely responding to bring the body back to its normal state.

The entirety of your symptoms appear to rest within the realm of autonomic fluctuations as a consequence of emotional anxiety. You've undergone diagnostic tests with a clean bill of health, so again, while the disturbances are most bothersome, they do not indicate the progression to any serious event at all. I would discuss the use of atenolol with your physician and also make certain that your thyroid values, including an antibody titre, are normal. You're going to be just fine.

Best regards and Good Health

As for being old, I suppose it may indeed all just be a case of relevancy but I'll let you do the math; I joined the navy at 18 years old not long out of high school (only 11 years of education back in those days), attended the naval air academy and served as a combat pilot until age 26. After a couple of years more of college, I was accepted to medical school at 28 and completed my residency by the age of 35. I've since been in practice for nearly 41 years, more recently just part-time. So while I'd like to think of myself as a spring chicken, my crooked bones and aching joints are a constant reminder otherwise.  

Regarding my medical background, while all physicians must undergo training in general medicine for the first four years of medical school and internship, a subsequent elective residency as you know provides specialized training in the area of interest. It's not that I know a tremendous amount of knowledge regarding cardiology necessarily, but the specialization of neurology requires intensive understanding of the body's brain and entire wiring system, so to speak. In order to understand how that wiring system functions, it becomes unavoidably necessary to intimately understand the functions of the various systems controlled and under the influence of the brain and nervous system. And historically, there was a time about a century ago when the specialty of neurology almost absorbed the field of psychiatry, so it gives you an idea of how the two specialties are very closely related in some regards. I have personally found it to be one of the wisest decisions I've ever made regarding my professional career.

Finally, an education and professional career in medicine is, in reality, a commitment to lifelong learning. I still spend a good deal of my time perusing journals and occasionally attending conferences to stay abreast of the latest in treatment options and technology.

I'm glad to hear that you're working hard to put the palpitation events aside. They are indeed harmless and you'll live a full a healthy life. You should be aware that studies have been conducted that indicate persons with actual anxiety disorders tend to actually live long lives by comparison to statistical norms.

how 'bout that?

Best regards and Good Health

Hi RLR,

Thanks for sharing that with us.  You really have had a chequered career!  Wow a combat pilot at 18!  It's interesting that you were in the Naval Air Academy as my profession is in Air Traffic Control!  I've been doing this for nearly 20 years and I work in an Air Traffic Management centre which is based right next to a civil airport.  This is civil air traffic rather than military, but I do come into contact with military pilots and controllers from time to time in the course of my job and have every respect for them.

I can see now from your explanation how you have such knowledge of our complaint on here and that too I find fascinating.  It's also interesting to learn how much psychiatry is involved within the field of neurology.  You've obviously had a very interesting and satisfying career in the medical profession and this shows in your depth of knowledge and interest in all us ‘tickiky tick tockers’ on here!!

Best wishes

Rich

Just to say Angie, that lots of anxiety sufferers seem to list dizziness as a symptom (though I've never had it myself). When I was super anxious about my heart I had a strong feeling of detachment from everything - my surroundings, my family. It was difficult to engage or even speak with people. I couldn't even play with the kids at times. I don't think this sense of unreality is uncommon amongst anxiety sufferers, or those who have suffered a trauma or shock. RLR will have more info though I'm sure.

Reply to Angiebaby:

Please feel free to ask your questions, express your concerns or describe your symptoms.

Best regards and Good Health

You're not "going on" whatsoever and thank you for the post. Remember that this is your forum and as such, you are free to ask questions relative to health concerns in the hopes of a reply. I will always do my best to respond, but also remember that I qualify all of my answers with the caveat that follow-up is always necessary by your primary care physician in all cases where healthcare matters are concerned.

So the fact that you have an upcoming appointment is wise and don't be afraid in the least to undergo testing. It's the absolute best decision you can make when experiencing troublesome symptoms. So now let's get to the business of your symptoms.


Based upon your symptoms described, my first impression without any test results would be something known as Meneire's disease, or more formally called idiopathicendolymphatic hydrops (Whew!! long word). The symptoms of Ménière’s disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear.

Tinnitus and fullness of the ear in Ménière’s disease may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also be an intermittent hearing loss early in the disease, especially in the low pitches. Loud sounds may be uncomfortable and seem distorted in the affected ear. From all the Ménière’s disease’s symptoms, vertigo is usually the most troublesome.

Vertigo may last for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may last for days. Symptoms usually occur without warning as well.

That would be my impression, but testing is always necessary to rule out other causes.  I also don't want you to worry unnecessarily because I have many healthy patients with this disease who live normal, productive lives and the episodes are more of a nusiance than anything else. It won't shorten your life by even a day, so you can relax from that standpoint. More importantly, this is just an impression based upon your description, so don't take what I say too strictly until you've been formally examined and tests have been conducted. Severe anxiety can indeed mimic many of the symptoms, so it's just as likely that it could be the underlying cause as well.

Let us know how the tests turn out and we'll be here to help.

Best regards and Good Health