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Have a Couple Questions (Read 4616 times)
Ongy
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Have a Couple Questions
Jul 06th, 2011, 3:51pm
 
Just want to start by saying I really enjoy the forum and it has been very comforting reading all the threads.  I really can't find much about my current situation so I figured I'd ask since everyone seems so helpful on this forum.

I started getting palpitations about a year and a half ago when some pretty traumatic family news caused me to have a pretty severe panic attack.  After that I continued to get panic attacks and palpitations.  Eventually I went to a cardiologist who performed a resting EKG both while my heart rate was normal and while I happened to be having a panic attack.  However, I did not actually have any skipped beats or palpitations at this time.  He also performed an echo.  He said both the EKG and echo were perfectly normally.  When I questioned him about the palpitations he said that I did not need any further testing since I had a normal resting EKG and a structurally normal heart.

So a year later I'm still having pretty bad skipped beats.  They can come in groups up to a minute or two or just happen randomly through out the day.  What concerns me is that they happen while I'm resting after exercise or when I take very deep breaths while just sitting there at work.  I also notice that I tend to get them a lot more when I'm very hungry and then they seem to reduce significantly after I eat something.  I never get short of breath during them or exhibit any other symptoms except maybe some slight chest tightness.  So my question is, do you think that I should request more tests done or should I trust my doctor and just try to ignore them.

Sorry for the long post and thank you for all your help.  

Edit:  I thought I should add that I'm a 22 year old male and I almost never get panic attacks anymore since seeing the cardiologist.
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RLR
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Re: Have a Couple Questions
Reply #1 - Jul 6th, 2011, 5:55pm
 
Okay, welcome to the forum. It's very important for you to realize that palpitation events of the type you are experiencing do not originate from within the heart, but rather as an external event related to the vagus nerve which merely stimulates the heart much like a muscle twitch might affect a muscle elsewhere in your body.

Benign palpitations happen all too frequently to persons experiencing significant emotional trauma, as well as within the context of an acute fear response. Perhaps you've heard people exclaim just after being suddenly startled or frightened that the event made their heart "skip a beat" or that their heart was up in their throat or even paused briefly.

All of these descriptions are testimonials to experiencing benign palpitations of the very same type as you yourself describe. It is a common reaction by the body to a fear stimulus or even significantly elevated stress, GI difficulties and other stressors on the nervous system. People very often confuse this phenomenon with true cardiac arrhythmias because of generalized warnings issued in public service messages and other communication as part of efforts to increase public awareness and education.

The problem is that these messages are highly generalized and thus people tend to universally misinterpret such messages. Consequently, when an individual experiences the harmless effects of benign palpitations, they can only presume that it must be evidence similar to that which has been issued in public educational messages and similar venues regarding heart health.

Benign palpitations such as those you are experiencing can never harm you or damage your heart in any manner. They are incapable of interfering with the heart's normal pacers and what you sense or experience is far more dramatic than what actually takes place at the level of the heart.

You should also realize that the vagus nerve, the component responsible for initiating the palpitations, also innervates the lungs among other terminal points such as GI tract, the spleen, even the larnyx. When you take a deep inspirational breath, it causes the diaphragm muscles to stretch far downward to permit the lungs to fully expand. Any disturbance or unusual influence upon the diaphragm, the GI tract or the esophagus can ultimately produce an evoked potential, or nerve impulse, at the vagus nerve which is considered inappropriate or untimely. The signal travels to all terminal points, one of which is the heart. You sense the arrival of this signal as a response by the heart muscle. Depending upon the precise moment the signal stimulates the heart muscle during the cardiac cycle, you might experience the sensation as a thump, a flutter or sometimes what even feels like the absence of a beat. Again, all of these disturbances having nothing at all to do with the health and performance of your heart. It is merely a muscle twitch in response to a wayward nerve impulse.

As mentioned, the vagus nerve also innervates the larnyx and this is why some persons with panic disorder or significant anxiety often describe a sensation in their throat as though something is lodged there or that their airway is somehow restricted, sometimes with difficulty swallowing. The sensation is merely due to stimulation of the musculature at the level of the larnyx and no actual restriction of the airway is occurring.  

The reason that palpitation events often linger is due in part to the persistent and compelling belief by the sufferer that the events represent potential harm or impending cardiac event. Thus, they remain vigilant and on alert for signs of trouble in that regard. This vigilance actually produces a sort of chronic fear response that establishes a long-term engagement of processes by the body capable of inducing palpitation events. The more they occur, the more convinced the individual becomes that something is wrong and possibly being overlooked until it may be too late. These are simply irrational fears and no such risk actually exists at all. It is misperception of what is actually taking place.

You're going to be just fine. There is nothing wrong with your heart and the tests performed would have easily detected any signs of trouble.

Take a breath and relax. The more you come to understand the true nature of the events and the fact that they are actually incapable of ever harming you, the less pronounced the events will become, soon thereafter resolving to variable degrees and in the instance of some persons here, disappear altogether. A reduction in the chronic fear that something is wrong or that you are unsafe, will produce a commensurate reduction in your symptoms.

Best regards,

Rutheford Rane, MD (ret.)
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Best Regards and Good Health
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