The topic of your posting as a question by comparison to the question in the body of the posting would suggest the common contemplation "Well what if my palpitations are not the benign variety?  Since my doctor has never mentioned any connection with the vagus nerve, mine must be potentially caused by something else."

This is but one of the very common perspectives which regularly prevails in persons with anxiety and who experience somatic features such as vagus nerve-induced palpitation events. Regardless of the benign features of the palpitations, most of those who experience them persist in the belief that there is an underlying organic cause which is placing them in peril. This notion remains firm regardless of the number of tests and repeated tests, all of which produce negative results. It is the near endless pursuit in some instances to find and successfully treat a physical cause for the palpitations.

To address the question, palpitations are not universal at all and those which are pathological in nature fall within a very characteristic pattern that are always accompanied by clinical evidence of any underlying organic cause. If such clinical evidence is absent, it literally means absent, not hidden or evading detection or insensitive to all the tests being run or even that which requires far more definitive testing capable of reaching to an infinite depth such that certainty of its presence or absence can be attained.

Physical symptoms in the absence of physical disease is not only possible, but extremely common. Simply because the symptoms persist, in no way affirms that they are the result of an underlying physical cause. Vagus nerve-induced palpitations are an extremely common feature of anxiety and constitute an entirely benign premise which cannot damage or weaken the heart muscle, nor transform into some type of dangerous arrhythmia.

Whether it is an accepted practice by physicians to describe the underlying nature of benign ectopic events is not as much the issue as it is the constant scrutiny by patients to question their harmless nature.

Best regards,

Rutheford Rane, MD (ret.)

Okay, we need to differentiate between some of your illustrations in order to provide an appropriate response. All people who believe they are experiencing some type of irregularity of heartbeat will typically seek medical help. The problem in the case of those with benign palpitations is that they are not satisfied with the diagnosis provided as by comparison to their own interpretations and apprehensions thought relevant to the cause. Individuals with a-fib are treated and released, whereas those with palpitations of benign origin are merely released with no objective course of treatment or sufficient explanation of the cause. Unlike the individuals with a-fib, whose symptoms abate once treated, the sufferer of benign palpitations additionally leaves the hospital or clinic setting still dealing with their symptoms and absent any answers to relieve their irrational fears.

The differential characterization you seek is not in determining when to seek medical attention and evaluation, but rather when to stop doing so and when to accept medical facts and test results over and above subjective speculation and unfounded fears. For the person with a-fib, repeated intervention represents more of a nuisance, seldom accompanied by greater concerns than that possible by the event as explained by their healthcare professional. In the case of those experiencing significant benign palpitation events, it most often produces unregulated fear that a consequence other than the symptoms of the palpitations can potentially arise, most often in the form of a life-threatening event. This fear presides, regardless of how many times they seek medical intervention and they are compelled to seek an underlying medical cause and become increasingly frustrated and even angry if anxiety is suggested to be the cause.

So the answer is that people who suffer from benign palpitations in all the variable contexts that they arise already know the correct answer to the question. The problem is that they cannot accept it when the symptoms occur. They resort to cause-and-effect thinking strategies and although they try to avoid seeking medical attention, ultimately give way to the fear that their hesitance in any instance could most likely constitute the very occasion when the event really does require prompt intervention. These individuals are incapable of trusting the facts to feel safe and must ultimately seek evaluation once again in order to extinguish the long list of possible consequences which might arise.

It is more than simply knowing from an informational standpoint or the acquisition of knowledge which medically explains the events. It must be the assimilation of these facts such that it no longer produces fear or apprehension that something could occur as a consequence to threaten their very survival. Only then will the brain's response to such fears be altered.

There is no instance of vagus nerve-induced palpitations which is different than the other, no transformation to some dangerous arrhythmia, no damage to the heart muscle, no imminent presence of cardiac failure or disruption of the cardiac cycle. All of these potential consequences are unreal and are manufactured in the presence of irrational fears combined with the tendency to make associations which do not exist. It is the erroneous application of simplicity in drawing connections between symptoms described in medical literature to their own symptomatic experiences and trusting more in their instincts in doing so rather than in the medical facts being portrayed time and again when interfacing with the medical community for evaluation of a problem which will remain forever unchanged by using such an approach. In other words, these individuals create the compelling need to be reassured that their interpretations are erroneous and yet continue to make the identical presumptions which ultimately require reassurance. They ultimately become more afraid of not seeking evaluation than to risk applying the necessary logic to circumstances verified time and again as benign and harmless. It becomes the inability to judge right from wrong in such instances, whether to seek help or ride it out, whether to trust themselves or trust their doctor, whether they can gain insight from the fact that every test result and evaluation directly contradicts their own interpretations without exception.

Indeed, the wisdom and insight to know the difference has already come and gone repeatedly, steadfastly being ignored because there remains a persistent doubt in accepting the facts as they truly exist and being able to place trust in irrefutable medical evidence and facts.

Those who can instrument logic and acceptance of the repeated diagnosis already in evidence can move beyond their own prison walls at any time they choose, for regardless of the endless range of speculative possibilities, their own circumstances will forever remain benign and without incident even remotely rising to state of risk in any manner.

In the context described, the response above is the impasse at hand and not the wisdom to know when to act in one's own behalf regarding healthcare concerns.

Best regards,

Rutheford Rane, MD (ret.)