Hi RLR, everyone,

I'm back!  It's been a long time since I last posted, probably a year now I guess!  I don't know if anyone will remember (me)  :'( but I have been suffering from ectopics for about 25 years now and multiple runs for over 4 years.  

Since my last ramblings and lots of reassurance from RLR and you lot on here I have ignored my heart to a certain extent and just got on with life.  I have felt numerous flutters, runs, bigeminy, trigeminy, PACs, PVCs and sometimes just a fast heartbeat.  

I haven't had a lot of stress and have not focused or got anxious about my heart.  I've even been in meetings and presentations and while my heart has been popping and bumping away I have just carried on calmly without missing a beat!!!

The odd ectopic here and there during the day does not bother me in the slightest anymore but it's the runs of ectopics which seem like a different heart rythmn altogether from the PVCs that still don't make sense.  

These runs of ectopics consisting of what I can only describe as very light almost half beats without a compensatory thud.  sometimes they are back to back and other times there is a normal beat or two in between.  These runs normally consist of about 8 or 10 abnormal beats then my heart starts back to normal again.

The thing that bothers me is that I first started noticing this new type of rythmn a few days after having a TEE procedure (camera down my throat to veiw the back of my heart).  Ever since then I started experiencing this every few weeks.  Gradually this got more frequent and now I experience it about 10 times every single day without fail.

It does not seem to correlate to anxiety because I have been anxious in many situations and this does not happen.  I do seem to get it after meals which ties in with RLRs Vagus nerve explanation.  But I also get it happen at any time of the day and the more worrying part is that if I exert myself in anyway at all even just running up the stairs then it triggers it.  

I cannot even do the garden or clear out the garage or anything remotely physical without this happening.  If I carry on with exercise through this then it just carries on it does not subside but instead it is doing it with a much faster heartrate.

So obviously my question to RLR and everyone is how can this be normal?  If my heart goes into this rythmn just at the slightest bit of exercise then surely my heart cannot cope with exertion.  Also I often wonder why my symptoms have changed over the years and now these runs are what dominate the irregularity.  Surely if it is all normal why don't other people I know get anything like this at all!  Let alone every time they exercise or just anytime during the day when it feels like it!

The other thing is if it is the vagus nerve that is causing the problem then is there a problem with my vagus nerve that I can a cure for by some form of medication or operation?

Thanks for reading my new ramblings

Hope you are all well and hanging in there with these most irregular things!

Best wishes

Rich

Richard,

There are some reports by patients and diagnostic evidence of bradycardia that has occurred during the TEE and although we are uncertain of the precise cause, we do believe it is the consequence of a parasympathetic nervous response subsequent to mechanical stimulation within the esophageal corridor. There are extremely rare occasions wherein a small perforation has resulted from TEE, but unless you are running a fever and experiencing difficulty such as esophageal discomfort or pain, then it's highly unlikely. It would not be the sort of thing to result in intermittent palpitations of the variety described anyway, but rather an increasingly difficulty of the symptoms I've already mentioned.

Based upon your description of the events, together with the fact that your diagnostic tests reveal no pathology, I'm going to suggest here that the palpitations are a variant of the original circumstances which led you to originally obtain the TEE.

It's important to realize that the palpitations can never place your heart under any type of exertion and although the sensation makes them feel quite overt, they are in actuality quite subtle by comparison to the normal sinus rhythm of the heart and it's steady performance.

These events are inacapable of causing a cardiac event because they are extracardial in nature and merely represent a superimposed electrical signal that is sort of added to the normal pacer emissions from the heart. Palpitations occurring under exertion do not place the heart or its function in any type of jeopardy as well. You are thinking of the palpitation events as supplanting or dominating the heart's own pacer and this is not the case at all. Only because of the overt sensations do you feel this must logically be the case. From a physiological standpoint, however, they are sublime in nature.

They are due to a parasympathetic response by the vagus nerve, which has some, but not overt or predominant control over the rate of the heart. Again, the events feel dramatic, but in fact are quite insignificant from a physiological standpoint.

There is presently no medication capable of reducing this type of benign palpitation and although some drugs have been known to demonstrate a reduction of parasympathetic activity, the side-effects are less tolerable than the palpitation events themselves and constitute a risk in some cases.

Also, I want to mention here that situational anxiety and its familiar sensations are far and away different from the somatic of physical features of an anxiety disorder. They are two different circumstances entirely and the basis for physiological response is occurring in two different arenas. So when patients state that it's not anxiety because they don't "feel" anxious, then they are referring to an entirely different set of circumstances than ones which produce physical symptoms such as palpitations, etc.

I think it might be of some benefit to speak with KCHendrix who is also a member on the forum and just recently overcame circumstances quite similar to your own in some regards, particularly the change in the patterns of his palpitations. His outcome might help to provide some contrast to your present concerns.

Otherwise, I see nothing in your description that would make me concerned or give consideration to another cause, particularly one associated with any type of cardiopathology.

You'll be just fine Richard and again, it's good to see you here.

Best regards and Good Health

Hi Richard,

I understand how you feelregarding these pvc's.  They are annoying as ever.  I get pvc's all day, everyday.  For the past 6 weeks I have been getting a pvc every 3 to 4 to 5 beats all day long and they are with me until I fall asleep.   I am guessing I am getting well into the 30,000 a day at least!  Plus I get runs of 8-12 beats in a row.  

I had the usual tests and my Cardio said my heart is normal and strong and I know sometimes I let this get the best of me and think "how on earth can this be NORMAL?"  Especially since I get them all the time!

But I CAN say that RLR is sooo right when he says worrying or even thinking about them will produce more and more and willkeep the cycle going.  Even though we may not "feel" anxious we obviously are, or we would not be on this board posting our concerns/worries.  The more we check our pulse, the more we are telling our brains something is wrong here (which nothing is as hard as it may seem) and the more our brains signal our fight or flight response for possible "imagined" danger.

Like RLR says, the characteristics of palpitations can vary quite a bit. The "new" symptoms we feel constitute the SAME symptoms we had before, the frequency just changes.  So we are not experiencing a new symptoms but rather the same symptom, it just feels different.

RLR also says the palpitations can not harm us.  I do not think he would say that for nothing.  He really knows what he is talking about!  He understands us and what we feel, so I trust him in that.

Now trainging myself to lessen my anxiety is the hard part for me.  Like you, I do not readily *feel* anxious, but I know the anxiety is chronically there from years of worry.  I am just so use to it.  

But what we have to keep reminding ourselves is that that: "We have been through these before in odd numbers, presentations, back to back ones, yada yada."  Nothing has happened to us and nothing will.  Our tests of the heart have come back fine.  And when it comes back negative for heart problems, then the test truly is negative like RLR says.

I know we can both could keep saying, "Well what if THIS caused it, or what about that?" etc, etc....  The truth is that the more we worry, the worse they will get.  

You really will be OK.  I know I am at the point where I am not worrying about them as much.  Sure a though crosses my mind when they feel different.  And feeling them is what we hate!  They feel uncomfortable!  BUT they cannot harm us.  

I am sorry you have these.  All of us on here understand what these are like, and we are also ALL being told the same things.  That we will be OK and to focus on correcting the anxiety.  Which in all reality is so much the truth (The anxiety)...

Please take care.  You will be ok!

Steff    

Hi Richard,

One of the more difficult concepts for folks to wrap their brain around is the fact that situational anxiety (the form you are referencing from your childhood) and anxiety disorder are two entirely separate issues from the standpoint of how they affect the body, one being acute in nature and the other chronic.

It's important to note that virtually all people experience situational anxiety and the sensations produced are the ones people most readily recognize and relate to for the most part. Anxiety disorder, however, arises from fears or apprehension of a nature sufficient enough to engage the fight or flight response by the body. It is the sensations of fight or flight that you and the others here are sensing. During a normal situational anxiety episode, the fight or flight response can typically be engaged at a point prior to or during a precipitating event, so limited that the affected person forms a temporal relationship between the salient features of their anxiety with the physical sensations. No concern ever arises that these sensations are not related to the anxiety or that they constitute some type of warning sign.

Not so with anxiety disorder. The faucet remains on so to speak and the original precipitating factors most often do not share the same close temporal relationship such that the affected person can make a logical association between the event and their fears or apprehension, which exists most often in a highly irrational form.

Let's form a hypothetical situation to better illustrate my point. Let's suppose that at some point earlier in life you were swimming with friends and for one reason or another took in some water the wrong way and began choking, subsequently struggling to get to the safety of the shore. And let's further suppose that your young friends didn't place the same emphasis on the event as you and began toying with you or trying to stall your efforts to reach the shoreline. Your mind is being subjected to a rather intense fear of drowning and further from your control, are the reckless musings of your friends who taunt you unaware of your imminent sense of incapacity and tragedy.

Understand that certain areas of the brain, the frontal lobe, the locus ceruleus and the amygdala are all reacting to your fear and deal with it according to the emphasis you place upon the event. Some young folks would laugh their way to shore, slightly nervous but nevertheless confident that no real harm will come to them. Others may fear that drowning and death was but a moment away and their fears were so intense that their ability to escape became hampered by panic. Still others may have never left the perilous circumstance at all, but merely worked to cough up the water and continue with the activity.

These selections are largely based upon the static and basic personality of the individual. Some people are more bold and assertive, with less concern for potential danger than the actual predicament itself, while others may have stretched their lack of confidence a bit too far in wanting to maintain equal pace among their peers. Finally others may have avoided the swimming event altogether, preferring the safety of the shoreline.

The important point here is that depending upon how one perceives the event, bears greatly upon how the brain records and instills safety factors to prevent future occurrences to the extent possible. For the individual who never felt harm was imminent, they might play even harder or swim father out on subsequent occasions, with no incorporation of the event. For the individual who felt that they narrowly escaped death, however, the brain vividly records these sensations and other aspects of the event in their entirety. It is a natural defense mechanism so that a person will be afforded insight to avoid the circumstances should they arise again.

So let's take the example of the individual who perceived the event as life-threatening and move them ahead in time from the original event to a point later in life. I'm going to steer this into a more abstract form from the original incident so that I can illustrate how the mind operates in such instances. Let's suppose that this individual is at home and lying back in his lounger, taking a long drink from his glass when suddenly some of the drink goes down the wrong way. From a rational standpoint, the individual is not necessarily in any danger, but the mind quickly associates the event with it's original patterns and says "THIS IS DANGER . . . . . REACT." There is instantanous fear,  the heart begins racing, they leap from the lounge chair struggling and grasping outwardly, forcefully drawing in air as confusion sets in and it is very much a repeat of the original instance. As they begin to recover, they are tremulous and weak and the body has responded to an extent far greater than was actually warranted, but nevertheless with an intensity relative to how the body perceived the event. See?

Now let's look at this rather odd example by comparison to the original instance during which an individual becomes aware of, and reacts to, a benign palpitation event as a consequence of an event that has no close temporal relationship. Rather than specify the original precipitating event in this case, let's leave it vague because that's oftentimes how it exists as time proceeds.

We'll continue in part 2

Hi dickyboy
I remember you - don't come on here much any more but have done today as my palps are back up there in the tens of thousands again for no discernable reason.

I am still putting up with them like you now - I have them all the time and don't expect them ever to go away after over two years of ectopics.

The rhythms you are explaining sound very familiar to me as I have those too. the variations in the way the ectopics show themselves change from day to day and week to week. I am okay about single ones, but still it is when I get them on constant - say every other beat for a set period that starts to bother me. Having a bad phase at the moment for no reason whatsoever.

anyway, what I really wanted to say is re exercise. I have been running at the gym and outdoors for about a year now (only twice a week but for about a mile and a half at a time). I am pretty proud of myself considering how scared I was of exercising. The ectopics only bother me when I stop. The ectopics only bother me in warm-up on the bike or on cool-down. I know why and I will try to explain.

when you start to exercise adrenaline increases and it starts those ectopics up just like in day to day life (adrenaline goes up and down without you noticing - in response to life situations subtle and not subtle) - this then is the trigger for your heart behaving badly! When you get up to peak exercise performance your sinus rhythm does take over and those pesky ectopics do not creep in - as will show if you have an exercise/treadmill ecg. When you start to wind down from exercise you will have a bit of free floating adrenaline knocking about in your system, and I think that causes an increased no of ectopics as your heartrate goes back down to normal. Until your body naturally disposes of this adrenaline again you are in for a few extra odd beats. But you will go back to your baseline again provided you are not worrying about the temporary increase.

I notice it every time I exercise. It is adrenaline related and my cardiologist told me to note that it would happen. Equally he told me to expect it if I suddenly drank a load of cold water directly after exercising.

Eating triggers my weird beats like nothing else at the moment.

Sorry for the lengthy reply but just wanted to help you out like you have helped me in the past. so that's it I'll go now.  

bead x

Hi everyone, (Steff, KC, RLR and Beadbabe!)

Thank you all for your comments, they are all reassuring.  It's taken me so long to read through them all and completely digest and undertand them, well RLRs I mean!  A very long and detailed post, RLR!!!  You really know how to explain things.  One thing that I never realised is that the sinus rythmn is constant at whatever rate or time the extra beat decides to occur.  Also I often feel what I call 'half beats' or light beats.  I now know that these are still actually premature beats, either PACs or PVCs but because ot the timing the heart does not fill up with blood and then give the pause and the big thud it just carries on with the normal sinus rythmn as if nothing has happened.  I used to think these were PACs because I thought that Atrial contractions did not cause the post thud!  But I think they can be either.  

Steff when did your symptoms first start and do you know what triggered them?  It's interesting that you get constant ectopics and runs as well like I do.  Thanks for your post.

RLR, well what can I say what a great and informative post.  You know that I'm going to say that what your saying doesn't apply to me don't you!  I know that you are probably correct with the anxiety bit but I still don't fully get it.  Here's my questions.

I never suffered a single ectopic till I was 19 then I had the motorcycle accident and I first noticed them and they went berserk.  Took Beta blockers they calmed down.  Had the waxing and waning the seeing of specialists for years and years. (over 20)  Then had a TEE and a couple of days later experience a rythmn of beats that I have never experienced before.  Over the next 4 years these slowly increase in frequency from one episode every 5 or 6 weeks till now when I am getting at least 20 episodes a day.  Yesterday and today have been the worst so far.  On exercise they start and do not go away until at least half an hour after I have stopped exercising.  If I get into an anxious situation, like an interview or some other fight or flight situation I can sometimes experience lots and lots of individual ectopics but I have hardly ever had the new rythmn during these times.  I haven't exercised properly for about 8 years even though I used to exercise well over the top as I explained in earlier posts.  I now have put on weight I also drink a glass of wine every evening and I do eat chocolate and my diet isnt brilliant.

So here's my questions.  Again could the TEE have caused this rythmn?Internet research shows that rarely it can cause the heart to go into an arrythmia because of the heat of the probe, the contriction in the esophagus and because the esophagus runs right behind the left atrium.  Also the manoevering of the probe and the insertion and retrieval can cause lessions.  OK I really don't think that this is the case with me, but could it be?

If all this is based on anxiety why has it taken 25 years to develop into the symptoms I have now.  My anxiety was sky high after the motorcycle accident and I first noticed these things.  It took me years to finally accept them and then years of up and downs as we all experience.  Why would I suddenly have a new symptom just days after the TEE examination.

Why can I no longer exercise without inducing back to back ectopics throughout whereas for years and years I would never have ectopics during exercise.  

These are not a comprehensive list of questions and I don't specifically require them to be answered as I think I know in my heart (get it) that they can never be answered.  No one seems to really know why these pesky things start in the first place and except for beta blockers there doesn't seem to be any cure for them.  But if I could have one wish it wouldn't be for money or success it would be for my heart to beat regularly without any ectopics (that I can feel).  That would really be a miracle.

Anyway I am just ranting again as usual.  I am very calm about my symtoms and have been for years.  I've given up even telling my wife because she just doesn't want to hear about it.  As far as she is concerned I've had all the tests they have come back normal so I should just forget about them.  I can understand her point of veiw but for anyone who knows what these feel like it is very very hard to ignore them.  I don't worry about them anymore it's just like having hiccups of the heart and it is so irritating!!!!! By the way RLR, have you ever suffered with them yourself?  I can't remember if you have told us.

Well I'm going to go now and stop my ramblings, it's a cracking day outside really hot for once and we have an airshow all this weekend to go to! Can't wait the Eurofighter (Typhoon) is flying!  

Thanks RLR and everyone for all your brilliant and detailed comments I have read them over and over and have taken a lot from them.

Also Beadbabe,  Hi!!!  It's really good to hear from you again!!  I'm so sorry that you are having a bad time again.  You seem to be in the same phase as me at the moment having hundreds!!!  I hope they subside real soon.  Nice to see you on here.  Will stay in touch.

Best wishes to you all

Have a great weekend

Rich

Okay, we're sort of heading down an old and familiar path with this thread.

First let me answer your question. Ectopics of this type don't necessarily disappear under exertion or exercise. Patients have experienced them both while at rest and during exertion of various types. The reason for their presence under both conditions has to do with dysregulation of the sympathetic and parasympathetic nervous system as a consequence of physiological symptoms due to chronic stress or anxiety. These symptoms can vary greatly between individuals because of factors like genetic predisposition, the relative nature of environmental or internal stress factors and how the individual deals with them. In other words, the ectopics may disappear under exertion in your case, but that does not constitute the standard.

Secondly, I'm not here "theorizing" anything. I've been in practice as a physician for more than 40 years and certainly not contributing to the forum in order to compare notes.

Lastly, I've worked to great lengths on the forum to explain my reasons for the care that needs to be taken when trying to post certain information. This portion of the posting is for all members or guests:

When you post comments that state that you know why something is happening and then paraphrase something told to you, it can be read by anyone visiting the site looking for answers to medical questions.

Some people do not look upon such information with any scrutiny and therefore, can potentially take it to be accurate when in fact, it may be absolutely baseless from that standpoint.

So again, I'm urging everyone who posts here who is not a licensed medical doctor to be very explicit in your postings. If your cardiologist or primary care physician told you something, then state that you heard it from your cardiologist or doctor. By doing so, readers can place the proper amount of credibility to the statement rather than make a false assumption that it is coming from a first-hand professional source on the forum.

I do not mind in the least that guests or members raise challenge to anything I post here. But what will not take place here is any display of competing persuassion toward guests or members regarding answers to their inquiry. I've visited such a forum not too long ago at the request of some members here. In only a matter of days, my postings in answer to the member's medical questions were overcome by a multitude of responses by certain members to that forum that had absolutely no basis in medical fact and in some cases, were an outright challenge to my postings. I have little patience for folks who wish to practice medicine without a license and feel that an internet forum is the best method to succeed in doing so.

To permit such circumstances to exist only serves to offer further confusion and obvuscation to people looking for answers to certain medical concerns.

So when crafting responses or comments, it's important to refrain from telling anyone what to do or that you know how to correct their problem. In other words, forum responses as means of support to others should not include sending them for certain tests, advocating medications, or attempting to explain the underlying cause in medical terms in such a manner as to infer some type of specialized knowledge, training or licensure to practice in the field of medicine. It is perfectly fine to state that you've had certain tests or treatment and that it either worked or didn't work, but the boundary line is extending comments that instruct or advise others to have the test or treatment.

Experiencing a medical condition does not confer ability to treat it.

Please realize that member support is an extermely valuable tool and it must come from the members on the site. I am unable to provide this type of support because I don't suffer from the symptoms and therefore, can only relate to a certain extent.

So members need to assume their rightful place to provide critical support and refrain from crossing into the realm of medical advice.

I hope this helps place the forum in its proper perspective so that guests and members can achieve maximum benefit.

Best regards and Good Health

It is fine to share your doctor's comments with others as long as it's stated in that context. If you'll refer back to your posting where mention was made, you'll see what I'm referencing.

It's simply necessary to explain where your comments are originating from to avoid confusion for new members or guests. Otherwise, it's a pleasure having you on the forum to provide the kind of support that has been evident thus far.

Best regards and Good Health