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Question for RLR (Read 4042 times)
dbranden
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Question for RLR
Sep 30th, 2008, 11:01am
 
This site is helping me tremendously and I appreciate the time and care that is given to answer every post.

As mentioned in my first post on thsi forum, I too suffer from frequent PVC's and PAC's, with bigeminy occurring at least once daily. I have always had stomach problems (heartburn, gastritis, had my gallbladder removed at age 20) and I do know there is a strong relationship between the palps and my stomach. Last year I noticed an increase in my palpitations and they felt different, so I saw my EP and did a 24 hour Holter as well as a stress echo. The odd thing was that I had a relatively "quiet" 24 hours with the Holter, but I did feel a few skips or jumps and noted them and the time that they happened. Upon follow up visit with my doctor, I was shocked to learn that I'd had zero skipped beats during the Holtor. When I talked to my doctor and told him how sure I was that I'd felt them, he said something about a "gateway" theory where the body starts to interpret other body sensations as all being caused or originating from the heart. He said that my PVC's and bigeminy have been clearly documented in the past, but for whatever reason my body was tricking me sometimes into thinking I was experiencing skipped beats when I was not. Any thoughts on this or further explanation of how this happens? I have a great doctor, but he doesn't always explain things as clearly to me as I'd like! I only bring up this question because just this morning I felt like I was having lots of skips, but as I felt my pulse, I could not feel them.
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Siamouno
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Re: Question for RLR
Reply #1 - Sep 30th, 2008, 4:13pm
 
I would like an answer to this too, for although I have had many skipped beats documented on a monitor, there have also been times when I was monitored and thought for sure I was feeling PVC's, but the dr. said that the monitor showed normal sinus rhythm. And at that time, I was a having the weird, fluttery scary beats and yet the monitor showed I was not having them. Can you explain it?
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RLR
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Re: Question for RLR
Reply #2 - Sep 30th, 2008, 5:16pm
 
Well, the answer takes us fairly deep into neurology and I think it's best to illustrate it by the following response; Every person is born with something known as synaesthesia. It's sort of the rudimentary sensory system that in an infant stage, sort of gets mixed signals as feedback information is interpreted. It's sort of like smelling colors and that sort of thing. As the nervous system matures, these systems become more oriented and singular in their abilities.

The sensory systems function by virtue of feedback that is sometimes referred to as a gateway theory(not to be confused with the drug theory by the same title) and works by letting certain information be sent to the brain for processing based upon the particular characteristics of the stimulus. These systems develop sensory memories. Let's use an example to illustrate: When a young child gets burned by something hot, their sensory systems do not proactively respond because the ambient heat and other factors do not represent a warning sign as it would in an older person who has been burned before. The memory of sensory events associated with getting burned are incorporated into sensory memory. When being burned has been experienced previously, subsequent occasions almost produce a premonistic sense and the hand many times is immeidiately drawn back prior to the actual burn event based upon sensory features assoicated with hot things. The sensory fibers in the hand which send tactile and pain information recognize patterns from the original burn event and cause the brain to respond by activating motor fibers to respond with almost reflex-like activity to avoid harm. Visual sensory fibers might recognize the orange glow of an extremely hot object that causes the person to pause or become extremely vigilent to the source. Olfactory sensory fibers might detect the smell of ozone or carbon combustion, both of which are frequent by-products of very hot or burning objects. Begin to see the relationship here?

Okay, so let's take the instance of sensory feedback that allows you to feel a palpitation occur. Realize that you are able to sense your heart beat because of sensory fibers that send information to the brain that tell you your heart is in motion inside your body. When you focus on events related to either the normal sinus rhythm of the heart or an anomoly such as a benign palpitation, the event is recorded from a sensory standpoint, but far more importantly, is recorded together with the sensory gateway being associated by two parts of the brain known as the amygdala and the locus ceruleus. These brain areas process factors relative to how you deal with fear or emotional factors related to the sensory experience. If you sense fear from the palpitation, the brain incorporates all of the sensory and processing data into memory. Upon any subsequent experience that is recognized as equivalent or proximal, the mind perceives and responds to it in a certain characteristic fashion.

So when you experience something of a sensory nature that frightens you, subsequent eqivalent or proximal sensory feedback will produce the fear with a very high degree of anticipation, almost in a proactive manner. This is gateway sensory memory at work. An ultimate example would be phantom limb pain where persons with an amputated arm or leg still feel sensations associated with the limb.

Also realize that many sensory activities occur in the body that can be misinterpreted. Many times, patients who have pressure at the esophageal sphincter, with intermittent reflux, might sense this action as being associated with the heart because of the tympanic nature of the thoracic cavity. Muscle spasm or movement can also cause a person to briefly lose sensory continuity of monitoring the heart and subseuently interpret it as a potential skip or absence beat.

For persons with anxiety disorder, it's critical to understand that sensory systems in general may not be 100% reliable because the autonomic nervous system is in a mild state of dysregulation. By simple example, if you're spun round and round and then released to stand erect, your vestibular system is temporarily disturbed and yet people struggle to innately depend upon it nevertheless to accurately correct the posture. You might have noted under such conditions that the typical outcome is to move in directions often counterproductive to what is actually required to correct the balance and stumbling or falling often occurs.

The same is true for your senses while under the influence of anxiety disorder wherein physical symptoms have manifested as a consequence of fight or flight engagement, symptoms which patients misinterpret as signs of disease. This is why patients often complain of tingling, crawling sensations, hold/cold sensory confusion, feelings of being touched and other disturbances. This dysregulation further confuses patients because they are attempting to make reasonable assessments based upon faulty sensory information.  

So it's important to realize that vigilence under such circumstances can be a double-edged sword. You must learn that very much like the airplane pilot who must trust his instruments over his gut instincts, you must learn to trust the logic of the diagnostic tests which are negative rather than your instincts, which under the influence of slight dysregulation, are telling you something very bad is wrong.

Best regards and Good Health
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« Last Edit: Sep 30th, 2008, 7:17pm by RLR »  

Best Regards and Good Health
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dbranden
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Re: Question for RLR
Reply #3 - Oct 1st, 2008, 11:13am
 
Thank you, RLR, for the explanation. It finally makes more sense to me. I truly appreciate your expertise and your kindness and gentleness while helping those of us who struggle with palpitations.
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Natalia
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Re: Question for RLR
Reply #4 - Oct 1st, 2008, 12:27pm
 
Dbranden,

I couldn't believe it when I was reading your post. I had exactly the same thing happen to me this year. I noted some skipped beats in the diary and the holter didn't register any. I had a talk about it with the cardiologist and he couldn't explain anything apart from saying if i've started imagining them it means I'm losing perspective and should see a shrink.

RLR, thank you for the explanation.
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I'm not tense, I'm just very very alert
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