Welcome, Guest. Please Login
YaBB - Yet another Bulletin Board
  News:
  HomeHelpSearchLogin  
 
Pages: 1 2 
Send Topic Print
New and hoping for some advice and reassurance (Read 14186 times)
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
New and hoping for some advice and reassurance
Sep 29th, 2008, 3:50am
 
Dear RLR, I'm new to this forum and have come here hoping to find some explanations to my symptoms. I have read yours and other people posts and already feel more positive about my PVCs but still have lots of questions and fears about them.
I'm 32 yo female, 172cm tall, 58kg, blood pressure is usually 90/60, sometimes 110/69. Resting pulse arond 48-50bpm, lowest 35bpm during sleep. I do not smoke (and never did), don't drink coffe, drink alcohol very very rarely (at the moment not at all as I'm breastfeeding my 1yo baby). I have a healthy diet and walk a lot.
I have atral gastritis diagnosed in 2006 by gastroscopy (helicobacter was not found).
It all started 10 years ago when after a period of prolonged suppressed stress i went to bed and felt strange sensations in my throat every 4th beat of the heart.The sensations were somewhat familiar (so i guess i must have had them before at some point) so i tried to ignore them and go to sleep.  It contimued for a couple of hours, I got scared and called the doctors. I was taken to hospital with PVCs every 4th beat and blood pressure 140/90 (which is very unusual for me). they did all the tests, found nothing and said it was stress related. Put me on beta blockers. I took beta blockers and antidepressants for a couple of years (which just slowed my pulse and lowered my blood pressure even further.
Since then PVCs have bothered me on and off, but I have struggled to find a pattern, sometimes I'd be in a stressful situation, having had no sleep at night, stressed and shiverring with nerves and have none, and then the following day have lots for no apparent reason. I have had 3 children with no or very little pain relieve and didn't have a single PVC in the process. My first baby was stillborn, i went through a lot of heartbreak and was a wreck for a long time, but didn't have many PVCs at that time at all.
I had a holter done in 2005, 2006 and 2008 (in march) and ECG and ECO also in 2008. Electrolyte and Thyroid tests also came back normal. I didn't have a stress test though, as they didn't see the need for one.

About a year ago i started having the frightening symptom described by some people here. The sudden irregular fluttering of the heart accompanied by fear, loss of sense of reality and shaking for some time after. It happened at rest mostly, and once when i bent down to get smth from a shelf in a shop. It really scares me, I asked a cardiologist in one of the forums i came across and he also said it was related to the Vagus nerve stimulation.
At the moment I am waiting for CBT sessions to try and help me to cope with these symptoms.
PVCs really affect my quality of life, every one is accompanied by fear and panic.

I am very anxious about the whole thing and not sure if I should try and request a stress test to provide further explanation for my heart's behaviour.

I have also noticed that i get more PVCs when i have a cold or a sore throat. Can there be a connection?

Also, I have a copy of my holter and although the cardiologist said everything was normal and opn that day they only registered 5 PVCs, they look different. Mostly the QRS complex looks the same - distorted and with sharp peaks, but one or two look differen, QRS looks like just slightly raised widened wave. Does this mean they are polymorphic and therefore dangerous?

Like many people on this forum, I feel them differently too. Some are very subtle, and some a very strong and almost painful. Is that bad? or just normal?
The cardiologists have discharged me but i still don't have full understanding as to what i should do, and i feel gaining this understanding will help me deal with them better.
Hoping for your reply and thank you in advance

Natalia
Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
RLR
YaBB Administrator
*****
Offline

Retired Physician

Posts: 2057

Gender: male
Re: New and hoping for some advice and reassurance
Reply #1 - Sep 29th, 2008, 3:50pm
 
Hi Natalia and welcome to the forum. Based upon your description, I will tell you that some time spent here talking with members who share your symptoms will go a long way to help relieve some of your anxiety and fears.

Let's talk a minute or so about some physiology and a common misinterpretation made by so many sufferers who experience this type of palpitation syndrome. Benign palpitations are actually a part of normal variation in human physiology and do not constitute a sign of an impending cardiac event, nor are they capable of actually interrupting the normal function of the heart from a conductive or mechanical standpoint.

What typically occurs is that the first experience can lead to vigilance if it's prominent enough and from that point forward, there is a concern that the heart is not functioning properly. The pulse is checked regularly, along with blood pressure and sense of general well-being in order to determine if something is possibly going wrong.

This type of vigilence usually leads to a health anxiety disorder, wherein the patient becomes far more aware and vigilent to their physiology, particularly the heart. It's important to understand here that if anxiety is chronic and intense enough, it can invoke the fight or flight response that over time begins to demonstrate mild dysregulation of the autonomic nervous system in some regards. The physical changes that occur under these circumstances are often misinterpreted as symptoms of a disease or disorder. In other words, there is an immediate association between the experience of physical symptoms and some type of underlying physical disease.

This erroneous association occurs because in fact, the constant presentation of physiological response to fear can make a person feel ill in the general sense, with lethargy, numbness and tingling of the extremities, increased heart rate, bradycardia, palpitations, sweating, weakness, changes in vision, GI complaints and a host of other symptoms as a consequence of stimulation by the autonomic nervous system in response to fear.

It's also important to realize that many people who suffer from this syndrome adamantly state that they are not anxious or afraid and draw a clear distinction between their physical symptoms and the possibility that the underlying cause is actually being induced by something other than physical disease. To this extent, it is this almost innate and stubborn perspective which sends patients time and again to their doctor to have tests run that repeatedly turn out negative, a consequence that typically only serves to increase frustration and fears that the cause cannot be located and that the patient's sanity is slowly coming under suspicion.

When a person becomes fearful that something imminent is about to happen to them, it establishes a response by the brain to prepare the person to either repel the threat or escape from it. In order to do so, stark changes are made in the base physiology that increase muscle tone, heart rate, respiration and enhance alertness. These are just some of the changes made by the sympathetic nervous system and it's sort of the accelerator pedal of the body. Once the brain receives feedback that the threat is diminished, the parasympathetic nervous system slows the heart rate and respiration through the vagus nerve and together with other systems, the body returns to normal baseline function.

Surely you've experienced these symptoms under conditions when frightened or suddenly startled. Many persons feel their heart skip a beat or pound hard and steady, maybe sense a lump in their throat, breathe heavily and other physiological changes that are entirely normal under the circumstances. The trouble lies in the case where the response is invoked but there is no readily apparent threat with which to make a direct association. In other words, to experience a palpitation when frightened does not conjure thoughts that something is wrong with the heart, yet it's the very same physiological activity that is causing you to presently experience them. What you are experiencing has nothing to do with a physical disease, therefore all of the tests which are based upon algorithms of disease will turn up negative results for a very good reason.

The variation in presentation of the palpitations does not suggest something more sinister. The variation occurs for a variety of reasons, but mostly because of the precise entry point of vagus nerve stimulation upon the heart during the cardiac cycle. In other words, if it is superimposed upon atrial contraction, you may sense it as a flutter, whereas if it imposes upon ventricular contraction, you may feel it as a significant thud, or even during repolarization wherein some sufferers claim their heart paused for an extended period. In all cases, the underlying cause is the same and entirely harmless from a physiological standpoint. Realize that vagus nerve stimulation is incapable of interrupting the normal pacer of the heart. It's not physically possible.

So the key to a better understanding is avoiding the pitfalls of misinterpreting symptoms for something other than what they truly represent and realizing what's actually occuring during a palpitation event. Your heart is perfectly fine and you're in no danger.

We'll talk more.

Best regards and Good Health

Back to top
 
 

Best Regards and Good Health
  IP Logged
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
Re: New and hoping for some advice and reassurance
Reply #2 - Sep 30th, 2008, 5:27am
 
RLR wrote on Sep 29th, 2008, 3:50pm:
What typically occurs is that the first experience can lead to vigilance if it's prominent enough and from that point forward, there is a concern that the heart is not functioning properly. The pulse is checked regularly, along with blood pressure and sense of general well-being in order to determine if something is possibly going wrong.

This type of vigilence usually leads to a health anxiety disorder, wherein the patient becomes far more aware and vigilent to their physiology, particularly the heart. It's important to understand here that if anxiety is chronic and intense enough, it can invoke the fight or flight response that over time begins to demonstrate mild dysregulation of the autonomic nervous system in some regards. The physical changes that occur under these circumstances are often misinterpreted as symptoms of a disease or disorder. In other words, there is an immediate association between the experience of physical symptoms and some type of underlying physical disease.

This erroneous association occurs because in fact, the constant presentation of physiological response to fear can make a person feel ill in the general sense, with lethargy, numbness and tingling of the extremities, increased heart rate, bradycardia, palpitations, sweating, weakness, changes in vision, GI complaints and a host of other symptoms as a consequence of stimulation by the autonomic nervous system in response to fear.

It's also important to realize that many people who suffer from this syndrome adamantly state that they are not anxious or afraid and draw a clear distinction between their physical symptoms and the possibility that the underlying cause is actually being induced by something other than physical disease. To this extent, it is this almost innate and stubborn perspective which sends patients time and again to their doctor to have tests run that repeatedly turn out negative, a consequence that typically only serves to increase frustration and fears that the cause cannot be located and that the patient's sanity is slowly coming under suspicion.





Hi RLR, Thank you for a quick response!
Everything you have said is so accurate. I sometimes have felt that I was slowly losing my mind and that something bad was going on with my heart and the Holter just didn't catch it. i was even thinking of asking to do an EP study.
You explanation really helps. The only thing that still bothers me is the frightening irregular flutters. They differ in severity and sometimes feel like they are somewhere on the top of the heart, almost overlapping with the normal rythm. In fact, I had one today, at the time i was sat down talking to a friend, the subject was quite touching though and i was a bit excited, but remembering your advice i did nothing, tried not to panic and it did pass. Lasted only a couple of seconds but felt nothing like a PVC.
My question is about those scary irregulat flutters. I have only been aware of them for the last year or so (I had the first episode when about 32 weeks pr with my 3rd baby) and am quite worried as to what might have brought them on, I don't remember ever having them before, and because they feel somewhat different compared to the usual PVCs I think I would have noticed them.  Is there a reason for them and do they ever go away? First time i had one i thought it was Vtach or smth like that. Scared me a lot.
Do you think there is any point doing a stress test in my situation?

Thank you
Natalia

Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
RLR
YaBB Administrator
*****
Offline

Retired Physician

Posts: 2057

Gender: male
Re: New and hoping for some advice and reassurance
Reply #3 - Sep 30th, 2008, 4:20pm
 
Well, again remember that the quality of this type of palpitation can vary to a great degree depending upon a number of factors, but it doesn't equate with new symptoms or an indicator that something else is happening.

This is a major stumbling block for many patients who experience this type of palpitation because just when they think they can get used to one presentation, an altogether different sensation arises that starts the anxiety cycle all over again. You must realize that the underlying physiology with respect to the palpitations is quite dynamic and it's not possible for it to appear the same way each time.

It's the unfamiliarity that scares most patients and they feel compelled to have it evaluated because they are unable to trust the fact that the palpitations are harmless. I have had countless patients argue that their symptoms are unique and therefore, constitute something other than benign palpitations. This compelling drive that these patients demonstrate is overwhelming evidence that they've become obsessed about the symptoms and are compelled to keep having it tested merely to quell the irrational fears that have developed.

Once you understand that these palpitations, regardless of their presenation, are harmless then you will be able to exert more influence over them. In order to reduce the fight or flight response, you must begin to override your fears with logical understanding about how the palpitations occur and what their absolute capabilities are with regard to the potential for harm. Indeed, they are entirely harmless and under no circumstances, regardless of how you feel you must make them distinct or unique, will the palpitations represent anything that can pose a risk to you. It's not physiologically possible and that's where you must focus your efforts.

You're going to be just fine. The road to getting control over the circumstances is educating yourself about the nature of the syndrome.

The stress test can examine the heart under exertion to determine if there is any insufficiency either conductive or mechanical in nature. If you feel that you must have the test for comfort and reassurance, then by all means do so. But you have to understand that palpitations of the type you're experiencing are not a sign of heart trouble or even that the heart is experiencing difficulty of any kind. This is an entirely subjective positioin that patients take and they firmly believe that any physical symptom of the heart is a direct result of an underlying physical disease. This is absolutely false.

We'll talk more.

Best regards and Good Health
Back to top
 
 

Best Regards and Good Health
  IP Logged
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
Re: New and hoping for some advice and reassurance
Reply #4 - Oct 1st, 2008, 6:12am
 
RLR,
Thank you again for the explanation and advice. I feel that I am not as scared of them since i have started reading this forum.
A cardiologist I know suggested to me  a few months ago that the vagus nerve may be responsible. But when i asked the cardiologist at the hospital where i had my holter done this year and who I saw after having all the test done, he just looked at me funny and said he'd never heard of Vagus nerve related causes for PVCs. This really threw me and I started worrying even more.
I am now trying not to panic when i get them and sometimes my attempts are successful.
I have also noticed (thinking about it I think I have had this since i was a child) whenever i get a sore throat it seems to bring the PVCs on, they are a bit muffled and felt in the throat. i'm a trained singer so any cold I catch gets to my throat first. Can there be the Vagus nerve connection in this case also?
I'm really sorry I keep asking all sorts of silly questions...  Sad but at the moment your answers are the only ones that make sense to me and help me deal with this.
Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
kchendrix
Senior Member
****
Offline

I Love YaBB 2!

Posts: 117
Maryland
Gender: male
Re: New and hoping for some advice and reassurance
Reply #5 - Oct 1st, 2008, 8:25am
 
Hey Natalia:

RLR is right....  you will be just fine,,   one thing I found that once I decided to accept the word of the Cardiologist and trust him and his experience over my emotions ,  I started to feel much better, and when you feel less stress and get regular sleep,  things start to return to normal ... so hang in there, your going to be cool but it just may take some time

Best regards
Kevin
Back to top
 
 

If livin' don't come easy , don't stop your own voice, cause the worst part of living is having no choice. (America)
WWW   IP Logged
Dux
Forum Newbies
*
Offline

I Love YaBB 2!

Posts: 2

Re: New and hoping for some advice and reassurance
Reply #6 - Oct 1st, 2008, 9:33am
 
RLR

WOW

Thank you so much for taking the time to post all the information above, I came to this site looking for the exact information I just read.
Every time I have a heart palpation it sets me off into a panic state.
I have been suffering from Health Anxiety for over a year and your post so far has truly given me more assurance everything is going to be ok Smiley

Doug/Dux
Back to top
 
 
  IP Logged
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
Re: New and hoping for some advice and reassurance
Reply #7 - Oct 1st, 2008, 10:34am
 
Thanks Kevin,

In my case the first people who I came across 10 years ago when having the very first episode were the ambulance crew and one told me and PVCs are nasty and lead to a "straight line", which, needless to say sent me into a state of panic. Later the cardiologists in hosp did the tests and concluded they were benign. But I was already scared.

Over the years I saw a number of cardiologists, including 3 in the UK where i have been living for 8 years now, one of them explained my PVCs as shortcircuiting of the heart due to very low resting heart rate. (?). Then a card I know suggested it was Vagus nerve. The last cardiologist I saw earlier this year said he's never heard of Vagus nerve connection to PVCs which threw me a bit as I was just starting to convince myself of their harmless nature.
This forum and reading all the posts really helped. I now am much closer to understanding their nature and find they don't scare me quite as much.
If RLR answers my throat question I will be even closer to learning to ignore them. Smiley

To RLR
Thank you  for taking the time and explaining all the mechanisms at lengh. It really does help so much!
Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
RLR
YaBB Administrator
*****
Offline

Retired Physician

Posts: 2057

Gender: male
Re: New and hoping for some advice and reassurance
Reply #8 - Oct 1st, 2008, 3:47pm
 
Why certainly the "throat" can be related to the onset of palpitations.

As I've stated, it's very important for you to go online and learn about the sympathetic and parasympathetic nervous systems and how they relate to physiology. The vagus nerve innervates the larnyx, as well as the heart, lungs, GI tract, etc.

Inappropriate vagus nerve response can occur at the level of the larnyx as easily as it can the GI tract. Persons with GERD and general esophageal inflammation regularly complain of benign palpitations.

You're going to be just fine. Take some time and read a little bit about how the vagus nerve works and it'll help you to better understand what's taking place when you experience a palpitation of the type being discussed here on the forum.

Best regards and Good Health
Back to top
 
 

Best Regards and Good Health
  IP Logged
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
Re: New and hoping for some advice and reassurance
Reply #9 - Oct 3rd, 2008, 5:39am
 
RLR,
Thank you for your advice. Reading thisand ther posts really helps. I have read about the Vagus nerve as you suggested using the links you posted in another thread. I understand better now how these PVCs originate  and although still a bit scary, they don't frighten me as much.
Thanks a lot! Smiley
Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
carol
Junior Member
**
Offline

I Love YaBB 2!

Posts: 39

Re: New and hoping for some advice and reassurance
Reply #10 - Oct 5th, 2008, 10:00pm
 
I also had an ambulance paramedic scare me to death when I was being transported to ER the first time. He said at one point that I had "no pulse" ... and that what was happening to me (he said my heart was speeding up then slowing down) could be something really serious -- he even gave me some kind of medical name for it which I can't remember. The last thing I needed to hear, obviously ... it led to a huge amount of needless anxiety for me, and probably made my symptoms much worse.

Carol
Back to top
 
 
  IP Logged
Natalia
Senior Member
****
Offline

I Love YaBB 2!

Posts: 110
UK
Gender: female
Re: New and hoping for some advice and reassurance
Reply #11 - Oct 6th, 2008, 2:39pm
 
Those paramedics should have kept ther mouthsshut instead of trying to shine and share their knowledge of cardiology.
I guess some just can't resist it.
I've been having PVCs again in the last few days and they scare me still as they have change again in perception, I can almost hear my heart make a little grunting noise  Huh
I spoke to my GP and requested a stress test but they are not promising anything plus absolutely dismissing the possibility of vagus nerve having anything to do with the PVCs Sad
RLR, can you help with any links where this relationship or any trials have been described? I have tried to find some online but if anything, every cardiologist is denying the connection. Undecided
Back to top
 
 

I'm not tense, I'm just very very alert
Natalia   IP Logged
RLR
YaBB Administrator
*****
Offline

Retired Physician

Posts: 2057

Gender: male
Re: New and hoping for some advice and reassurance
Reply #12 - Oct 6th, 2008, 3:45pm
 
Natalia,

I'll be glad to foward you some literature when I have the time, but your path is very characteristic of a person who is compelled to believe that their symptoms have an underlying physical cause related to heart disease or anomoly. You can continue with tests to whatever extent you feel necessary, but the results will always turn out negative because the problem has nothing to do with your heart.

As I've stated before, one of the greatest hurdles to overcome is the compulsory efforts to seek a physical cause for the palpitations and it can lead to a good deal of frustration.

The reason I must forward you particular information is because the medical community relies heavily upon well-researched professional literature. Palpitations are entirely harmless in nature and therefore, cannot merit any funding for further studies. Nevertheless, information is available and we'll see that it's made available.

Lastly, if you're unable to break from your position that the palpitations are harmless, then the only alternative is to continue seeking an underlying medical cause. I'd ask you to please pause long enough to speak directly to others on the forum such as KCHendrix and several others who were in the same position you now find yourself.

I've been in practice for more than 40 years and I'm here to tell you that your condition is entirely harmless and diagnostic tests will forever dictate that no underlying physical disease such as heart problems are responsible for the palpitations. It's just a fact that's never going to change, regardless of how many times the tests are repeated.

I'll be in touch soon and provide you with some information but be forewarned that convincing your medical team is of little value since there is no available treatment for benign palpitations. Your problem is that you are unable to control your fears about the condition and feel compelled to have it evaluated time and again. This can only reasonably continue to the point that you must logically examine whether you are correct in your assumptions.

Best regards and Good Health
Back to top
 
 

Best Regards and Good Health
  IP Logged
Steff1573
Senior Member
****
Offline

I Love YaBB 2!

Posts: 200
Montana
Gender: female
Re: New and hoping for some advice and reassurance
Reply #13 - Oct 6th, 2008, 7:34pm
 
Hi Natalia,

I understand your concerns.  I have been getting nearly NON-STOP PVC's for going on 3 months straight.  This morning I was getting what I think is bigimeny (beat, pvc, beat, pvc,) and it was like that most of the day.  I was getting lightheaded from it!  I hope this is not dangerous either RLR?

But my point here is that I have had 2 echo's, 1 stress test and numerous EKG's and everything always turns out normal.  My Cardiologist has not recorded the frequent (the beat, pvc, beat, pvc) and I declined the holter monitor which would pick them up.  The reason I declined the holter monitor (my previous holter recorded only 4,280, and I know I must be getting 10 times that amount now, not kidding!) because I did NOT want to know "how many" I am getting because that would only worry me.

So I try and deal with them, even though they are starting to get to me again and working on the anxiety in my life, stressors, etc.  The more I focuse on them the more agitated I get that they won't go away.

I truly think you will be fine.   Any Dr. I have asked about the vagus nerve disagrees too, but they do not spend as much time with us listening like RLR does and he certainly knows his stuff I can tell you that!

Hang in there and focus on the anxiety and how you can lessen it.

I am trying to do just that, but for me the pvc's continue on with such high frequency and they irritate me!  So I understand....

Hugs.

Steff
Back to top
 
 
  IP Logged
Actonmom3
Forum Newbies
*
Offline

I Love YaBB 2!

Posts: 10

Re: New and hoping for some advice and reassurance
Reply #14 - Oct 7th, 2008, 2:42pm
 
Dear RLR,

I have just read your information in response to Natalia.  I too have found very similar symptoms, and been frustrated with the randomness of the PVC occurences.  I have had multiple medical work-ups to include EKG, stress EKG, echocardiogram, stress echocardiogram, event monitors, and Holter monitors.  I have tried changing my diet, adding Revival Soy, exercise, magnesium, potassium, etc. etc. etc.

All of the work-ups show nothing but occasional PVC's and I am told to go home and not worry about it.  Despite the reassurance, I have found that the fearful response to having these occasional occurances has significantly disrupted my life.  I am fearful about going off on my own, my confidence has been eroded, and I have most definitely developed what you have termed a "health anxiety" disorder.  In fact, I haven't been to a physician for 2 years because when I have an appt., my heart pounds out of my chest, my blood pressure is elevated, and I am just beside myself with fear and dread.

This is particularly difficult as I feel quite isolated with this problem.  My husband is wonderful but just cannot understand why these palpitations send me into a tailspin whenever they occur.  The irregularity of symptoms is additionally frustrating.  I can go several days without any palps at all, then I will go 7 - 10 days straight having palps multiple times each days.  

Will this ever stop?  Is it hormonally based?  Is there any way to learn to cope with this onslaught without the accompanying terror??

Actonmom3


Back to top
 
 
  IP Logged
Pages: 1 2 
Send Topic Print