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Ectopics? ...or something else? (Read 10370 times)
Ella
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Ectopics? ...or something else?
May 16th, 2010, 9:17am
 
Hi RLR

Over the past few months I've had 3 incidents where for about 3-4 minutes my heart would give a thump, a hard beat every couple of beats. Two out of the three times they have happened when I have been previously stressed or rushing around, the other time, I was lay down trying to sleep.

I've been seen by a cardiologist and had a number of tests carried out, ECG's, 24hour monitor, Echo etc. I got the all clear, but none of these incidents have ever been caught on an ECG or monitor.

My doctor reckons it's stress induced but I often think if it was then why would it have happened when I was trying to fall asleep where I was in a relaxed state of mind.

Are these beats just runs of Ectopics or could they possibly be something more, some kind of arrhythmia maybe? I am 21 years of age, and have no family history of cardiac problems.
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RLR
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Re: Ectopics? ...or something else?
Reply #1 - May 16th, 2010, 6:33pm
 
Okay, it's important to realize that the actual underlying mechanisms which ultimately produce palpitations of the type you are experiencing are rather complex in nature. Stress and anxiety can indeed establish physiological changes necessary for the palpitations to occur, but they do so in a manner that causes a parasympathetic evoked potential, or nervous impulse, from the vagus nerve. This can happen at rest and in many cases, occurs exclusively in some patients in this manner.

The palpitations are not occurring as a direct result of the stress, but as a consequence of the stimulation of the nervous system by stress or anxiety to the extent that it causes mild dysregulation. This change causes the parasympathetic nervous system to respond in a slightly erratic manner and the vagus nerve sends signals that are somewhat unintended. You only feel it in your heart because the heart is such a dynamic organ and muscle, constantly in motion. The impulses actually stimulate the spleen, the lungs and even the larnyx as well.

Most patients find it incredibly frustrating that the events will somehow magically evade detection on ECG. The patient feels this is an all-important necessity. It must be clearly understood that as physicians, we do not need to see these events whatsoever in order to determine their nature. It is only the patient's interpretation of how the ECG diagnostics work that makes it a requirement because they don't understand the vast basis by which the equipment actually functions.

You need to understand that it's what we don't see on the ECG that lets us know everything is okay. The equipment has functions known as algorithms which are based on actual disease, so the computer is capable of gathering various readings to see if it matches any one of the hundreds of combinations that indicate the presence of actual disease. The ECG absolutely does not need to "see" the palpitation events take place because arrthymias in the pathological sense are caused by underlying problems which the ECG is actually looking for and not simply the arrhythmia itself. Do you see my point here? Patients characteristically decide for themselves what is critical and feel disappointed if the test doesn't perform as they feel is necessary. This occurs despite the patient's absence of medical training, experience and knowledge of the equipment and its actual functions. They simply make interpretations that erroneously rise to the level of facts in their mind.

Incidentally, the palpitations of the type you are experiencing typically disappear when under medical evaluation and this is because sympathetic tone is increased, suppressing the signals by the parasympathetic nervous system through the vagus nerve which causes the palpitations to occur.

Finally, you're far too young to be contemplating heart disease for goodness sakes. The events you are experiencing are entirely harmless and are not originating from within the heart. It is merely stimulation by the vagus nerve in response to physiological changes which take place in the presence of stress and or anxiety.

You're just fine and there's nothing wrong with your heart.

Best regards and Good Health

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Ella
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Re: Ectopics? ...or something else?
Reply #2 - May 19th, 2010, 1:42pm
 
Thank you for the reply RLR. You have been most helpful.

The only thing that I am confused about is that you say these palpitations don't need to be caught by a physician to know that they are harmless, yet why are event monitors and holter monitors given to people with suspected arrhythmia? Is a resting ECG or an Echo not informative enough? The first thing my GP asked when I went to see him about my palpitations was if they were caught on the ECG that I had taken in the hospital. What do you think was behind his questioning?

And lastly, I know you're probably tired of people asking you questions that are very similar to this but I'm very confused when it comes to Sudden Arrhythmia Death Syndrome. I was told that a simple ECG can diagnose any conditions that may cause SADS (Long QT Syndrome etc...) yet I've read and been told conflicting information. With the tests that I have had, (Countless ECGs, holter, Echo etc) can I be safe to say that I'm not at risk of this happening to me?

Thanks RLR

I look forward to your reply.
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RLR
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Re: Ectopics? ...or something else?
Reply #3 - May 19th, 2010, 8:16pm
 
You can rest assured that your palpitations are in no way related to SADS.

Extended monitoring is peformed so that we can observe the dynamics of your heart under various conditions throughout a 24-hour period or longer. We don't have to observe any type of arrhythmia because its underlying cause is the most salient feature observed, not the resulting arrhythmia. It's also important for you to realize that the type of benign palpitations you are experiencing are not a true arrhythmia. They constitute overt and untimely stimulation of the heart by the vagus nerve. Nothing more.

The reason your physician likely posed the question is because benign palpitations characteristically disappear from detection during diagnostic evaluation. This is due to the increase in sympathetic tone which suppresses parasympathetic activity, ie vagus-induced palpitations. True arrhythmias don't respond in a similar manner because they are occurring as a consequence of an underlying pathology.

You're not going to die and you are at no risk whatsoever as a consequence of the presence of benign palpitations. None. As long as you remain convinced that some type or rare physical disease is causing the problem, your irrational fears will continue to persist, requiring a near-constant vigilence to be checked again and again.

Negative test results are negative. They don't overlook things and you don't have some hidden rare disease that cannot be detected. The tests are negative because nothing is wrong. You are experiencing vagus nerve-induced palpitations and it's merely an inappropriate signal occurring at the level of the vagus nerve and travels along until it reaches the terminal endings, one of which is the heart. This type of signal can never cause your heart to stop or induce any type of cardiac event.

At some point, in light of the results of all the tests, you're going to have to ask yourself whether you could be wrong. I was a physician for more than 40 years and in all that time, I never once even heard of a patient subcumbing to some type of life-threatening event as a consequence of the type of palpitations you are experiencing. Not even once. It is a benign condition. No exceptions.

There's nothing wrong with your heart. Absolutely nothing.

Best regards and Good Health





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Ella
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Re: Ectopics? ...or something else?
Reply #4 - May 23rd, 2010, 5:46pm
 
Thanks again RLR. You've made things a lot clearer for me.

I do have another question which I hope you won't mind answering. I recently came across a video, it was a video put up by a charity (CRY) and this persons girlfriend died at the age of 27, due to sudden cardiac death. She had a holter monitor on for 2-3 days some time prior to her death as she had been complaining of palpitations, the holter never found any irregularieies.

CRY are urging people to have screenings, ECGs and so on so they can reduce the amount of people that die from silent heart conditions. But this lady had no problems found, not even in her post mortem. Is this quite rare?

Surely peoples heart don't just stop for no reason, or would I be wrong in thinking that? Seeing this video really concerned me and made me feel really anxious as obviously I've been complaining about palps and nothing has been found, you can see where I'm going with this. Probably just being anxious.

But are there heart conditions that don't show up on an ECG or Echo? Can sudden cardiac death just happen without any major heart problem or Arrhythmia? I know I'm rambling on but hopefully you can help me.

Thank you.
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Re: Ectopics? ...or something else?
Reply #5 - May 24th, 2010, 3:55am
 
Okay, now I've encountered a number of posts over the years wherein it's explained to me that someone suddenly died in the presence of palpitations, that nothing could be detected on diagnostic following and that there was no pathology present.

I'm not certain who this charity is, but I'm here to tell you that something is "dead" wrong with that account. I was a practicing specialist for more than 40 years and while cases exist for sudden cardiac death, the reasons are absoluetly identifiable both prior to the event and post-mortum. There is no way, and when I tell you no way I specifically mean no way, that this sort of thing occurs and subsequently the individual is found to be totally healthy with no evidence of causative factors.

There is nothing wrong with your heart. The above account is a measure of what the individual with anxiety fears most; the steadfast belief that something sinister is wrong with their heart and each palpitation constitutes a potential brush with death. Their is a stubborn denial of all the facts, tests and professional reassurance in favor of the patient's compelling gut instinct that everyone is wrong about them, that their situation is not the normal account but rather something strange and unique.

The portrayal you have provided is inaccurate whether based upon the original information provided to you, or your interpretation of it.

You are not going to die and in fact, you're no closer to death as a result of the type of palpitations you are experiencing than you would be suddenly winning the lottery. You also keep confusing this type of palpitation with pathological arrhythmias and they are altogether something different from one another.

You need to try and relax. You have a long, long life ahead of you and constantly trying to manifest circumstances that represent imminent and sudden death is going to make it a long and troublesome path.

Lastly, there is more to an organization's merely urging people to have "screenings." There is a fortune at hand in the rather newly formed practice of medical marketing. Fees and reimbursement have changed dramatically over the years and the medical community must now seek ample compensation and reimbursement through increased volume. If they aren't simply walking through the door, then something needs to be done to encourage them, ie "you could die just like this person unless you rush in here for a full screening."

You're just fine and nothing like this is ever going to befall you. Take a breath.

Best regards and Good Health
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Kalah
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Re: Ectopics? ...or something else?
Reply #6 - May 24th, 2010, 10:33am
 
Trying to get people in to get screenings by citing a case where someone died and no one could detect what was wrong with her before or after smells like bull, to me, for seemingly obvious reasons.

The girl had obviously gone to a doctor and been screened if she was on a holter. What kind of screening is this charity offering that they think this girl didn't get... psychic? Wink
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Ella
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Re: Ectopics? ...or something else?
Reply #7 - May 24th, 2010, 1:58pm
 
Thanks once again RLR, what would I do without you? Smiley

Kalah, I see why you may have see it as suspicious but the video was one of many from people who lost loved ones to sudden cardiac death, CRY were just using them to demonstrate that this does happen and people should be tested although it did specifically say in the video that she had a holter monitor for 2-3 days which would contradict their theory really I suppose, but it does seem genuine. The link to the video from their youtube channel is below and the website is http://www.c-r-y.org.uk/ Let me know what you think.

http://www.youtube.com/user/cryvideos#p/f/7/_jJJ4US2DKA

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Re: Ectopics? ...or something else?
Reply #8 - May 24th, 2010, 6:24pm
 
I'm not suggesting that the event itself is necessarily fictitious, but rather the circumstances regarding the diagnostics and medical history are entirely inaccurate. It just doesn't happen in the manner the organization is proposing.

In any event, you don't have circumstances even remotely approaching risk to your heart, or your life for that matter.

Best regards and Good Health
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bexy1984
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Re: Ectopics? ...or something else?
Reply #9 - May 28th, 2010, 12:11am
 
hello ella..... i am also woryed about SADS but if u look at the video he says she had the monitor for 2-3 days but if u go on the actual website on her story it says she had the monitor for a week and a half....... in this case it wouldnt have recorded any thing as it would only have been activated by the girl when she had the palps ...... as she didnt have n e palps when she was on in , it wont have recoreded anything not even her normal heart rytham....it is called an event monitor and activated by the patient.... also she didnt have an echo  ..... i understand your worries because i have the same worries ...... but this girl also had a history of heart problems on her fathers side.... dont think the video is telling the whole story xxx
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