Hello everyone, I'm so glad to find this site!  For years I've had VPC's/skipped heartbeats which have really freaked me out.  For months at a time I have runs of skipped beats every day, and then they suddenly fade away for a few months before coming back again.  I actually caught them on a 24 hour monitor, and have had an echogram of my heart, and apparently all is well, no need to worry - yeah, right!  I've been on atenolol, another one I can't remember, and am now on bisoprolol, but none of them stop the beastly things.  I suppose they make them a little less forceful, but that's about it.  Now I've started to get not the usual irregular beat, but very forceful ones which last about 3 or 4 beats and feel like my heart will burst through my chest.  All the skips etc I feel in the middle of my chest, not in the neck like people often say.
I know people say it's often down to anxiety - but it's these things which are causing the anxiety!  :'(  I just want to feel normal - why must I spend my life waiting for the next lot of horrid feelings in my chest??  I really try to be calm, but when the beats are bad, it's very difficult.  And then there are odd things, like when I walk fast sometimes I get a terrific thump in the chest which is almost painful, so I am scared to try to exercise.  I notice that when I realise that 'it' hasn't happened for a while, 'it' usually begins........ am I going mad?  Even in the 'good times' when I don't even think about skipped beats, they can suddenly start, so how can it be down to stress?
Sorry to go on.  I suppose I want to get it off my chest...literally!  Please help!

Well, your rather indifference to the results of the tests is notable but you should realize just what significance the results really depict in your case. You need to realize that although the benign palpitations are very frightening and frustrating, they are not the result of heart disease of any kind and that should come as a great relief. As I've discussed with patients many times, palpitations of this nature arise from mere inappropriate stimulation of the heart by the Vagus nerve as a consequence of stress and/or anxiety. By contrast, dangerous arrhythmias that indicate heart disease actually come about due to failure of the heart's electroconductive circuits and are associated with failure of certain cardiac tissues, extreme hypertension, or other related cause such as thyroid disease.

Here's something else for you to consider; In more than 40 years of practice, I've never even once heard of a single patient experiencing a cardiac event as a consequence of benign palpitations of the type you are experiencing. Not even once. What frightens most patients is that they feel certain it is an indication that something imminently terrible is about to occur, which is entirely inaccurate.

Another common misconception is that patients firmly believe that they must be actively "thinking" about stressful events or situations in order to acknowledge their symptoms as a consequence of stress or anxiety. Here's the facts; chronic anxiety and long-term emotional conflict very often is elevated beyond the extent of mere awareness and begins to exert somatic (physical) symptoms. It is quite common at this stage for patients to be entirely unaware of the level of anxiety or stress being experienced because they have learned or rationalized ways in which to simply "endure" the circumstances but yet not solve the underlying problems. The result is typically benign and vague physical symptoms which cannot be traced to any organic disease. Moreover, the patient's anxiety levels my be increased as a result of constant negative findings on tests as though something terrible is being "overlooked" or missed on diagnostic testing. Patients soon find themselves becoming extremely vigilent to many autonomic functions of the body that they had previously ignored, but now find it necessary to be on the lookout for the slightest abnormality or change, which is more often than not perceived as a symptom of disease.

This pattern can extend over time to the degree that it typically dampens a healthy outlook on life and that no real zest for life is possible any longer due to the imminent nature of their difficulties which they cannot accurately identify, nor can healthcare professionals locate and cure the cause. Activities are diminished because of fears that the heart of body may fail as a consequence of exertion and social activities are reduced as well, to forego any potential embarassment that may arise if an "event" were to occur that incapacitated them to any extent. Repeated trips to the doctor become a regular pattern, often with the need for reassurance that nothing is wrong.

Much of the patient's time becomes transformed into ruminations about health concerns and the reduction in social practices or exercise and activity only provides more time to sit and ruminate to the point of distraction. Apprehension prevails and the resulting dysphoria from all the negative changes only makes matters worse for many patients. They often describe themselves as no longer living the life they once did, or feeling as though their life is no longer recognizable to them as their own. The patterns of apprehension and rumination also lead to expectations that act as a self-fulfilling prophecy of sorts in that if they begin to wonder when the next palpitation will occur, it often does and much to their disappointment. It is a spiralling downward experience for many patients.

First, I recommend that you read my postings on this forum entitled HEART PALPITATIONS 101, PARTS 1 through 6. This will give you a better idea of what is happening when palpitations occur. Secondly, I need for you to realize that your tests are based upon measures which are highly accurate in their ability to detect heart disease. The fact that your tests are clearly negative is the very best evidence that your palpitations are entirely of a benign nature and will never damage your heart or cause you to experience a cardiac event as a consequence.

So in answer to your question, you need not spend your life waiting for anything bad to happen. It's not going to happen. There are many things you can do to reduce the frequency of the palpitations and knowledge is your best course of action. Read the postings and visit with other members to this forum because they are a great group of folks who share many of your concerns.

Lastly, you're going to be fine. Go buy a new outfit and have lunch with the girls. We'll talk more.

Best regards and Good Health

Well, for practical and even legal reasons, this is a question that you must pose to your primary care physician. The reason is that discontinuation from this type of medication must always be under the watchful eye of a healthcare professional to ensure that weaning from the drugs is done in a timely manner. If you do not suffer from hypertension, then cessation from these products is rather safe in the absence of providing alternative antihypertensive therapy.

As for whether the medication is "doing much," I will have to suggest here that any measurement you are using to assess the drug's therapeutic benefit is typically subjective in nature. It is important, however, to determine what course of therapy may best fit your difficulty. In other words, higher resting heart rates strictly as a consequence of anxiety may better be addressed by targeting the underlying condition. Beta blockers in low dose, however, are suitable for addressing this issue if there is a corresponding spike in blood pressure, ie; white-coat hypertension, which indicates a general influence of anxiety upon blood pressure in susceptible individuals. Beta-blockers also have the ability to induce a mild anxiolytic effect, which makes it good for individuals with anxiety disorder.  

Bottom line; discuss discontinuation of the beta-blockers with your primary care doctor in conjunction with how best to deal with your anxiety disorder using short-term medications that are available, together with referral to a professional capable of helping you identify underlying patterns that are causing the anxiety disorder. The combination is extremely effective and provides long-term relief with the least amount of pharmacotherapy necessary, if at all. You're going to be just fine.

Best regards and Good Health