Okay, take a deep breath and relax. I see nothing in your test results as described that should cause you to be alarmed in any manner. Your ejection fraction is fine and the reason that the mitral regurgitation was tossed aside was that it is a very common presentation in many people. Mild regurgitation is something we see frequently and care should be taken when reviewing online literature concerning this issue. Your situation is not the degree or characterization of mitral valve degredation that causes the type of problems you refer to in your posting. Your heart will be fine.

Many persons can feel their heartbeat when lying down. When blood pressure first drops as a consequence of lying down for sleep, the body's sensors initially react to try and compensate and the result is increased cardiac force to raise blood pressure. This can be felt as momentary pounding heart and does not represent an increased demand on the heart, nor does it indicate insufficiency of any type. Sedentary lifestyles can increase the time necessary for the body to adjust to workload circumstances and many persons feel "winded" under circumstances that they feel should not warrant the case. Improving conditioning and stamina through regular exercise will diminish the winded sensation.

Changes in pulse vary with circumstances and if you are experiencing stress or anxiety, increases in adrenaline can produce rapid changes in pulse. The type of variation you speak of does not suggest it to be the consequence of cardiopathology of any type and your stress test and other diagnostic criteria as described certainly support the case.

You're going to be just fine. Eat healthy and exercise regularly. Your heart will do its job for many, many years to come and the mild regurgitation is of no consequence in your instance.

Best regards and Good Health

The sensation of skipped beats or fluttery sensations has to do with stimulation of the heart by the Vagus nerve. The Vagus nerve is activated by the parasympathetic nervous system and in this instance, responsible for slowing the heart rate subsequent to increased activity by the sympathetic nervous system in response to a fearful or stressful event. The Vagus nerve also innervates the GI tract as the gastric nerve and in cases where anxiety or tension is present that disturbs the GI tract, sensory impulses can be sent inappropriately along the Vagus nerve tract. When this signal reaches the heart it is superimposed upon the normal heart beat. You sense this as a flutter or thump, depending upon precisely when the signal is imposed during the cardiac cycle. The signals are typically erractic in nature as well and persons can experience a range of sensations. So while simply lying down can cause changes in physiology necessary to produce palpitations, disturbances to the Vagus nerve can also bring about similar consequences. The reason that the GI tract can cause palpitations is primarily due to the fact that if air is trapped in the upper GI tract, it is influenced by a change in body position and begins pressing against the diaphragm and can cause stimulation of the Vagus nerve. A change in body position will usually interrupt the sequence.

The main point to remember is that these disturbances are entirely harmless. They will never damage your heart or cause you to suffer any type of cardiac event. As I've told other visitors to the site, in over 40 years of practice, I've never once even heard of a person suffering any type of cardiovascular event as a consequence of benign palpitations.

Depending upon how long you've been taking the Metoprolol, you have to realize that this medication is a beta blocker that, among other therapeutic effects, reduces cardiac force. In periods of exertion, the body will reach the threshold of exhaustion quicker because the medication is restricting the heart from reaching maximum potential. As a result, patients under such therapy can feel winded. The body also begins to produce perspiration earlier. You can certainly discuss any unwanted or undesirable effects with your primary care physican to determine if dose adjustment will reduce the effects. You should also be aware that GI upset is a common side-effect of beta blocker medications. Sometimes taking the medication with food reduces the effect and in some cases tolerability is increased with continued treatment. In some cases, however, intolerability in this regard necessitates changing medications to another class in order to avoid the undesired side effects.  

Finally, the sort of damge to cardiac valves we typically see are the consequence of certain infections and diseases which cause calcification of the valves, typically the tricuspid, which results in decreased viability that ranges from regurgitation to total valve insufficiency which requires surgical intervention to replace the valve entirely.

I have to tell you here that despite having no familiarty with your medical history, I seriously doubt that you fall into this category because there are a number of symptoms that must accompany this condition for it to represent the kind of pathology we're speaking of here and since you make no mention of any of these symptoms, which all such patients do in one form or another, then there's no reason to consider it. Additionally, the condition would have readily made itself prominent on the treadmill stress test and the echocardiogram would have shown signs of calcified valves. Nothing to worry about in your case.

Exercise and strenuous activity does not increase the chances of cardiac events in the presence of benign palpitations.

To sum things up, the ectopic presentation is harmless. It may vary from time to time, even dissipate altogether. It will not cause you any physical harm.

Best regards and Good Health

Well, your candid thoughts are appreciated and it would be wise for you to read your posting from the standpoint of the anxiety that it represents and how it has historically affected your lifestyle. Many persons with intense anxiety in reality have constant sensations that they have no control over much of their life, as if many situations are out of their reach of influence. Self-confidence and self-image are usually affected greatly and lifestyle in general is grossly restricted in ways such as decreasing the circle within which travel and adventure is gambled. There is oftentimes a lot of rumination or repetitive thoughts about what lies just ahead with regard to social and occupational undertakings. This anxiety is typically discharged by conducting life in a very ritualistic pattern, no matter how slight, to also include avoidance of situations which are perceived to increase anxiety.

An important characteristic of anxiety disorder is relegation to the moving target syndrome. In other words, if a point of authority confirms your worries to be irrational by demonstrating undeniable facts to the contrary, the anxious person is compelled to think "yes, but what if that's not the exact case for me? What if I'm somehow different? What if something has been overlooked and will be discovered only when it's too late?" And if all facts become overwhelmingly contrary to what the anxious person believes, then they settle upon a new target altogether; "I don't think it's my heart any longer . . . .I've noticed headaches and trembling in my arms and my vision is blurred . . . I've read where those are signs of a brain tumor . . "

Anxiety disorder is a puzzle whose individual pieces have been forged by life experiences over time that have produced erroneous beliefs or perceptions, which the person affected has come to rely upon over and above all evidence to the contrary. Humans are naturally and sometimes overwhelmingly influenced by cause & effect thinking. While the most evident and irrational examples of this phenomenon would be raindances or something similar, many people conjure far more subtle relationships between events and circumstances that they don't realize are faulty. The mind will tend to accept these subtle premises and before long, begin changing the way they interact with the environment and people around them. So let's use a subtle premise by example to demonstrate how this phenomenon exerts its influence on almost everyone:

If a person eats a meal and becomes extremely sick to their stomach, suffering a rather traumatic experience, they might associate the effect with the food and make a vow never to eat it again. The effect might have been the food, but might also have been salmonella poisoning, the person might have contract an intestinal virus at roughly the same time, or the problem might have been with the beverage they were drinking with the meal, etc. and there might have been absolutely no problem with the suspected meal at all. Does that make sense? People only have their immediate experience with with to develop perspectives and sometimes these perspectives can be entirely false in nature, but yet cause tremendous influence over future similar circumstances. So we can take this small, quaint example and extrapolate it to other countless events in one's life over time to see the dramatic potential for misperceptions to form that can avidly affect the way a person thinks and acts. In other words, aside from the meal example, if a person had been exposed to an environment of great unpredictability, say within a home where rules changed constantly and where dependability was erractic, where blame was imposed for errors that were actually part of the natural learning curve for all persons, then the affected person might begin to try and anticipate their environment far ahead of actual occurance because the consequences represented emotional discomfort and inability to exert influence before it was too late.

Not that this example is intended to suggest it is representative of your difficulty at all, but merely to demonstrate how persons with anxiety suddenly find themselves very deep into life patterns that have changed the way in which they live, without the ability to pinpoint the cause which may have occurred many years ago with far more subtlety and insiginficance. Anxiety is largely a disorder that grows slowly over time, whose origins may consist of many small and insigificant trials that have grown over time in the way of avoidances and anticipations to preempt their reoccurance. Make sense?

We'll talk more. Your heart valves are fine. The diagnostic tests do not miss anything like that, nor do they overlook an early process that may grow sinister.

Best regards and Good Health