Okay, several points need to be made here. I want all of you to cease using the terms bigeminy and trigeminy, even quadgeminy for that matter. These are terms more strictly used to describe pathological arrhythmias associated with the sino-atrial node or other electroconductive events generated strictly by the heart itself. The production of perceived similar events in the case of vagus-induced palpitations is not equivalent. Do you see the difference? Vagus-induced palpitation events occur strictly as a consequence of electroconductive influence on the heart's pacers by the vagus nerve and originates from outside the heart. It is entirely non-pathological and for a comparison to be made by merely stating the events to be couplets or triplets is extremely misguided.

The second point is that the vagus nerve does not act independent of the central nervous system. It's being thought of as singular and separate and this is not the case at all. Generalized anxiety AND clinical depression can both produce chronic changes to the state of the body's nerve complex, merely including the vagus nerve. It is only by virtue of the sometimes dramatic effects produced by the vagus nerve that individuals feel it must somehow be singularly influenced.

Nicotine is a neurotransmitter and occurs naturally in the brain. The brain is unique in that when these neural transmitters are artificially introduced into the brain, the brain itself stops manufacturing them to varying degrees and comes to be dependent upon whichever source is most dominant, in this case the nicotine source from smoking cigarettes. The addition of nicotinic patches only serves to increase available levels of nicotine. While this circumstance can produce palpitations, it would not be considered any type of causal factor in of itself.

I don't know if you've more recently taken up smoking again, but I would comment here that the simultaneous use of nicotinic patches while smoking indicates a very limited comprehension of the actual function and prescribed use of the product, which suggests that your physician failed to adequately explain how to properly use the patches or that you alternatively chose to understand the nature of their use and influence based upon your own notions.

Finally, the particular characterization of vagus-induced palpitations, ie "fluttery ones" cannot be defined as though they constitute a particular associated event. Doing so is precisely the kind of cause-and-effect thinking practices that I've persistently tried to impress upon all of you. It is this very type of mental persuassion that leads you to where you are presently. People try desparately to make sense of events which are ill-understood otherwise by aggresively seeking to pair the awareness of any event within the temporal context another.

People with anxiety disorder fall prey to this phenomenon all too frequently. By common example, people with functional disorders, that is, people who demonstrate physical symptoms as a consequence of influence by purely cognitive and emotional factors, use the same logic to draw conclusions from nearly constant ruminative concerns in the absence of facts. This strategy is the very basis for how premises such a "triggers" manifest in people to the extent that they unswervingly consider it to be factual strictly upon the basis that the outcomes literally abide by their speculative belief. Do you understand what I'm  saying here?

There is absolutely no such thing as a trigger to any premise, whether psychological or physical in origin. People have unwittingly established it as a truth because a precipitating event, ie smoking while using a nicotine patch, has been paired with an outcome, ie non-remitting benign palpitation events. This is no different than persons with IBS eating a certain food and subequently experincing the debilitating effects of various GI sequelae. These pairings become extremely reinforced, despite the fact that no logical approach has been employed to discern the true nature of any association.

These rigid thought patterns are very pervasive throughout this forum and it is the direction that I've persistently been trying to lead all of you in discovering that it represents the basis for your difficulties. If you will peruse the forum, you will see the very evidence to support the fact as well. It is clear that folks with this difficulty are highly resistant to change. I cite the following common example:

Look for the postings wherein members are quite familiar with my comments in this regard and the constant imposition I place upon them to learn to recognize such patterns and alter them. They start their inquiry with something to the effect "This has been a wonderful forum and I truly have changed my way of thinking and no longer consider the palpitations to be dangerous. But I just have this one question that won't go away about a very unique and different sort of palpitation that is not like the ones you've been describing. This one is a bang-pop-bang rather than a flip-flop or a fluttery-thud one. Does this mean I have AF or God knows could it possibly be PVST or a symptom of Sudden Cardiac Death?"

This sort of clever disguise is something that I had encountered for years with my patients and it simply means that they only wish to obtain reassurance to resolve the crisis and have little interest otherwise.

CONTINUED.

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I had no idea of this. Outside of the palpitation discussions I am fascinated by how things work and am frustrated by my limited understanding.


I am coming to understand your message albeit that it is hard. The hardest thing to admit for me personally, is that I can be well, these things can go. I tend to feel safer with the negative if that makes sense.

I can see your message, and understand now why you are unable to say if you do this, or do that, they'll go. What you are saying, I think is, I  cant tell you what to do, I can only ask you to search yourself for what needs to change or be done? Is this correct?


The only reassurance I guess you could give me/us, is that you have witnessed patients recover and that recovery is not out of reach even though you cannot guide us to that recovery. Perhaps because it is so individual by nature. Perhaps each of us have to understand our own thought processes.

I thank you for both the explanation and the education