RLR
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Okay, I've read your posting and understand your complaint. First off, I'll tell you that your difficulty is extra-cardiac in nature, meaning that the problem lies outside of the heart itself. While the symptoms you are experiencing are affecting the heart's normal sinus rhythm, the heart itself is fine.
Palpitations of the type you are experiencing are caused by inappropriate stimulation of the Vagus nerve. This nerve, also more formally known as the 10th cranial nerve, is the largest nerve in the body and has connections with the heart, lungs, GI tract, the larnyx among other areas and it explains why coughing can interrupt the palpitation sequence. The Vagus nerve innervates the GI tract as the gastric nerve and it's this connection that bears the most common relationship to benign palpitations. If your GI tract becomes irritated for any reason, it is possible for the Vagus nerve to become stimulated and via the parasympathetic nervous system, it can send inappropriate signals to the heart. For an explanation of how this works in more detail, please read my postings in the general forum section entitled HEART PALPITATIONS 101 PARTS 1 throuh 6. This will tell you a little more about how the nervous system is involved here.
Sharp or centralized acute pain that is located just beneath the sternum can arise from several conditions, from pacreatitis to cholecystitis or gall bladder disease(in the case of a "root" stone"), duodenal ulcers, gastritis, even irritable bowel syndrome if other causative exclusions are evident. It's very important that you not be lured into focusing upon your heart simply because that is where you experience the most salient features of your symptoms. Testing can provide peace of mind, but needs to proceed into determining the underlying cause, which in this case is not the heart itself. Thyroid conditions and other disorders like pheochromocytomas can all cause similar symptoms but I just don't believe that's the case where you're concerned.
Since you have blood work, I would suspect that your physicians have already performed a serum amylase to determine if pancreatitis is a consideration. The endoscopy works very well in determining whether GERD and esophogeal errosion is evident. I doubt the biopsy will come back positive, however, for anything of significance. If you're exeriencing a lot of indigestion in the way of eructation, more commonly known as belching and you are having excessive flatulence and changes in bowel habits, then looking at your gall bladder and the possibility of a duodenal ulcer is an option, allbeit luke-warm.
It's also important to realize that none of these consideration have to be present in order for you to experience benign palpitations and acute or chronic anxiety can easily produce conditions necessary for them to occur. Particularly where GI symptoms are experienced, many people unwittingly swallow copious amounts of air, a condition known as aerophagia, and it can produce some pretty far-reaching effects in the way of discomfort. As trapped air is forced through the lumen of the intestines, it can irritate the lining and in turn, irritate the gastric nerve. Changes in eating habits can also exacerbate symptoms in this regard as well.
If you've had any type of serious change to your life in the previous months, be aware that this can establish the premise of anxiety and associated symptoms that are not normally recognized as such. If you've recently lost of loved one, are going through divorce, changed jobs, moved to a new location, etc., then these issues and many like them are all valid precursors for potential anxiety to develop. I'm not stating it to be the case here, but you should carefully examine this area of your life to determine whether a possibility exists.
The fact that you describe your symptoms to fluctuate greatly is a good indicator that the underlying problem is very unlikely to be associated with any serious pathology which more often than not only tends to get worse with time. It is also the case that when people first experience these symptoms, they add to their anxiety a great deal because it is frightening and there is little one can do to alter the symptoms and associated worry it causes, leading to the belief that they are getting much worse in general.
I believe that your tests will likely turn up very little to suggest an underlying physical cause and if so, I urge you to explore whether you may be suffering from anxiety. The holter monitor is widely used, but I doubt if it will reveal anything of significance at all and you also have to realize that as physicians, we don't need to see evidence of benign palpitations to contemplate their presence. They are a diagnosis of exclusion, meaning if all the known pathological causes are ruled out, then the cause is benign in nature and certainly harmless to you in all regards. If you believe there's a chance you could be experiecing anxiety, then there are many ways to effectively deal with the condition and put you back on track, more importantly diminishing your physical symptoms.
Let me know your test results if you care to and I'll be glad to talk to you more about your situation. You're going to be just fine.
Best regards and Good Health
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