Okay, I've read your posts and it would not be uncommon of late for me to overlook some of the postings. My schedule over the past couple of months has left me with little time to devote to the forum. I apologize for not being able to address your concerns in a more practical timeframe.

Several comments in your posting require clarification. The vagus nerve does not become irritated by adrenaline either directly or indirectly. The vagus nerve is part of the parasympathetic nervous system and communicates via the neurotransmitter acetylcholine. The sympathetic nervous system and parasympathetic nervous system work in concert to provide equilibrium to the central nervous system in general, but there is no dominance which takes place. Any perception of such a premise is entirely due to subjective experience. Realize that the presence of each of these nervous system processes is critical and while mild variations in sympathetic or parasympathetic tone occur, there is no instance where one or the other becomes chronically dominant.

Catecholamines which influence the nervous system in general and for purposes of our discussion here would consist of epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine. Indeed, the production of catecholamines during stress play a role in subsequent physiological responses by the body. While constant elevated stress can impart exposure of greater than normal levels of catecholamines in some persons, there is little if any scientific evidence to support that their presence in increased quantities actually produces damage to the body in any respect. More often, it is the secondary factors to stress such as hypertensive states that can result in greater risk factors to persons predisposed to certain conditions. In other words, stress is a co-factor, but not a primary or direct cause of damage to the body and its systems.

Vagus nerve-induced palpitation events do not originate anywhere in the heart. My comments in that regard were speaking of the specific arrival of evoked potentials or nerve impulses by the vagus nerve at a particular point of the cardiac cycle, ie atrial depolarization, ventricular depolarization or ventricular repolarization. It is this point of inappropriate stimulation of the heart muscle by the vagus nerve which greatly influences the type of sensation felt by the patient. Since the atria are much smaller and less forceful than the ventricles, their actions are more subtle and wayward vagus stimulation more often produces the characteristic flutter or hollow sensation of benign palpitations that can sometimes extend upward into the neck or throat.

So it's important to realize the difference in both where vagus nerve-indiuced palpitations originate and how they come to impart variable sensations upon stimulating the heart muscle. The inappropriate nature of nerve stimulation in these instances is no different in characterization that wayward nerve impulses which affect muscle groups elsewhere in the body, the eyelids for instances, termed myokymia. In as much as the heart is a critical organ, it is also a muscle and as such, is exposed to the less than perfect nature of the human nervous system and particular in instances where nervous system function is in a state of mild dysfunction as a consequence of stress and/or anxiety.

Several factors can increase the potential for inappropriate evoked potentials or nerve impulses to travel along the vagus nerve to its terminal endings. GI disfunction or inflammation can easily produce such circumstances because the vagus nerve actually innervates the GI tract as the pneumogastric nerve at that level. Many patients will complain of increased palpitation events after eating or on an empty stomach, in the presence of bloating or indigestion, bending over, stretching or any other circumstance where general compression of the abdominal region is encountered. This connection between the GI tract and the heart via the vagus nerve complex is know as the gastro-cardiac response or reflex. In general, the state of the nervous system in general will serve to predict the likelihood of benign palpitation events.

Many persons use the terms bigeminy and trigeminy to describe vagus nerve-induced palpitation sequences and once again, I'll state here that it's inappropriate to do so. These clinical terms are more intended to describe actual patterns associated with known arrhythmias that produce such characteristics. While the more random and unpredictable nature of vagus nerve-induced palpitations can seem to the patient to express patterns, they are entirely subjective in nature and are in no way associated with actual implications of the clinical terms you and others here mention.

The fight-or-flight response induces many more changes to physiological function than mere increased adrenaline production. While it is not necessary for purpose of the discussion here, suffice it to say that adrenaline plays only a partial role in the overall functions related to a fight-or-flight response.  It's also important to note that panic threshold events and the fight-or-flight response are not one and the same. The fight-or-flight response is a genetically predisposed response to circumstances that are perceived to constitute a threat to the survival of the individual experiencing it. Irrational fears that do not actually threaten survival will nevertheless invoke the response because the brain cannot discern between the fear of a real, versus irrational, threat, ie children that react to the fear of monsters under their bed or in their closet.

A panic threshold event, or panic attack, is produced by dysfunctional sensory feedback as a result of anxiety and/or stress and exacerbated by the subsequent fear it invokes due to misinterpretation of what is taking place. The fight-or-flight response can be invoked by a panic threshold event, but they are separate events.

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Wow, Thank you so....so....much for the detailed reply.  I now understand that the fact that I even need to search for answers regarding physical symptoms is in itself the reason I feel the symptoms in the first place.  It makes sense that the brain cannot differentiate threats provoked by the mind and fear or imagination, and that the brains impact on the central nervous system is a normal response to threat.  And at the same time providing physical sensations that recycle the process of fear that started it in the first  place.  It really is nice to have it explained to me and at first I was confused, but after reading it again I was able to catch the point you were intending to get across.  The ectopics and symptoms in general will not vanish until the fear itself vanishes. Now , this probably wont happen overnight because 5 years of this has programed a regular fear that will probably need some time to fade away.  

There are a few concerns I still have.  One of them being the fact that it seems any exertion will create ectopics.  Hot shower, getting up to walk or take out the trash, exercising etc.. They now regularly cause this to occur .  Now a panic attack will certainly intensify the problem to a whole new level, but thats understandable.  I guess some of my fear is because of the fact that I have had panic disorder for 5 years , I have been extremely stressed, blood pressure spiking very high over those years during the panic attacks( 180/115 ) and yet only recently developed these symptoms of ectopics.  Could the constant stress and spikes in blood pressure caused any damage? (enlarged heart)etc.... It seems to me very unlikely because of the fact that during exercise your blood pressure increases to 200 over 90 or so.  

Can a hot shower really cause ectopics because I cant take one anymore without them occurring?  Im sure the vagus nerve is responsible I just don't understand the process.  Also the lower resting heart rate I understand is the effect of the temporary dysfunction of the central nervous system and will not go back to normal until the fear has completely vanished?   Maybe thats the reason ectopics occur during hot shower, (Hot water increases heart rate) that combined with a parasympathetic dominant nervous system could cause them?  (its so confusing) But I definitely feel much, much better , because I understand the process now.

Thank you again for the informative reply and I look forward to a response.  

Thank you again RLR for the reply.  I really appreciate the time you put into your answers.  It has helped me out a lot.  Thanks again

Okay the problem here is that regardless of the facts, you remain convinced that some type of consequence is possible by the presence of vagus nerve-induced palpitations. It's not medically possible.

Just as I have spoken about it in previous instances, the similarity of such persistence is very much like the fallible logic of young children who respond with hysteria to the notion that monsters are under their bed or in the closet. This phenomenon has far, far more relevance that one might imagine and it's irrespective of age.

When the brain believes that an imminent threat to survival exists, it responds in a very characteristic manner and will persist until the threat no longer exists. It's genetically engrained into all human beings and lower animal forms alike.

People with somatic features of anxiety, ie palpitations, are very often perplexed at how compelled and vigilant they remain to their worries despite anything about their condition which very plainly exposes the facts as they actually exist. People who feel so compelled typically feel pressed to try and attain as much information as possible in the continual effort to try and assess or gauge the level of the threat perceived. This usually comes in the form of scouring the internet in search of terminology which by their estimation, seems directly relevant. In most cases, however, such associations are mere speculation and guided by more instinctual inclinations than anything based in medical fact.

People often come to the forum armed with extended inquiry based entirely upon associations that they have managed to build that are accompanied by a series of questions to countermand the fears which the gathered information has produced. These associations do not make for a better informed decision platform, but rather an intensification of their apprehension and fears as though the information has only served to confirm what they feel is the case where their heart is concerned.

You might well know that such a labyrinth requires increasingly greater responses in order to unravel the misconceptions.

You have to realize that I was a physician and specialist for more than 40 years and in all that time, I saw literally thousands of patients who demonstrated the exact same symptoms and coping patterns you and the others here demonstrate with precisely equal terms.

Your quest for greater understanding of your circumstances must at some point unavoidably include insight regarding my previous discussions. By illustration, there is nothing actually wrong with your heart whatsoever and vagus nerve-induced palpitations are medically incapable of inducing even the slightest risk of harm to your health, or life for that matter. In all my former years in practice, and even prior to such a time, there has never been even one recorded case where an individual suffering the exact symptom patterns as yours, and those on this forum, has ever come to even a moment of harm or risk of harm.

Now that is an undeniable medical fact. It can neither be challenged nor suppressed in favor of your own inclinations which are derived strictly by subjective interpretation and the erroneous conclusions you are making by gathering random information from medical literature or health-related websites.  

Your questions remain entirely within the medical realm, despite my direct and thorough explanation that the palpitation events have absolutely no origin whatsoever in pathology and do not originate from within the heart. You have to break the fixation that you've come to employ in trying to resolve your circumstances. I can explain all the medical terminology and rebuff any incorrect associations you are making, but it will only serve to increase the exchange where you remain fearful of a medical condition and subsequent harmful consequence. It is a battle which I am unable to outdistance by any stretch of my capacity and the more I provide, the more expansive your search becomes.

Put as succinctly and diplomatically as I can, you are wrong. Do you understand? You are in error. You are basing your assumptions and source of the conflict entirely upon subjective measures that you instinctually believe to be accurate despite repeated medical tests which speak to the contrary. You are immersing yourself and your difficulty into a realm incompatible with reality and logic. You must ask yourself why the medical tests of every person here are incapable of finding the problem which you know in your own mind must exist. You must ask yourself that despite increasingly in-depth medical evaluations, the result is always negative and calls your own interpretations and suspicions into constant question. You must ask yourself why you have become so compelled to ignore the facts and instead choose to repeatedly seek out reassurance that only serves to draw more suspicion that the problem remains hidden.

I am naturally unable to command you to divorce yourself from your present course, but I can take the opportunity here to tell you that you haven't the slightest degree of accuracy in the direction you persist in taking. Prolonged Q-T intervals and any other electrophysiological context is entirely unrelated to your difficulty. It is absolutely impossible to seek out seemingly direct correlations among information you read in the attempt to apply it to you own circumstances because you are doing so in the clear absence of the requisite and necessary background skills and training. Medical science is in no way based upon the simplicity of drawing lines between symptoms and clinical discourse because it smacks of similarity in some regard. It's impossible and I implore you to examine your course in trying to do so because of the absolute implausibility.

You are not sick. Your heart is functioning just fine. You are in no way incapacitated from exercise.

Best regards and Good Health

Hi RLR, I was wondering if you could explain to me why my resting heart rate has decreased since I started having ectopics.  My resting heart rate used to always be above 100, and now its always around 70 or lower.  I am 100 percent positive this is accurate.  And also I understand increased vagal tone can reduce your heartrate cause ectopics.  I know as one becomes more physically active and in shape there resting rates lower.  Is that similar to anxiety?  Does the constant high heart rate cause someone to become more fit?  Athletes develop ectopics when there heart rate is decreased usually after a run or other activity.  Mine occur the opposite , more when active , none when relaxed.  Why is it that I have increased vagal tone but only ectopics at high heart rates when Increased vagal tone causes them to occur at slow heart rates ?  Please explain this to me.  I am really confused and definitely would appreciate the input.  Also I keep reading that causes of ectopics include Increased adrenaline caused by anxiety , exercise etc.  But you said adrenaline does not cause ectopics?  Im very confused.  Even my doctor says the adrenaline is causing them by irritating my heart.  My latest ekg stated Left atrial abnormality, could this be a concern.  My doc isn't concerned and im not either , but he is not a cardiologist.  Thank you again and your responses are always appreciated.