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Palps mostly at night and morning. (Read 3558 times)
RShuler
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Palps mostly at night and morning.
Jan 01st, 2012, 9:41pm
 
Hello and thank you for this forum. New here so I will give you my story. Back in Feb. I had a bad sinus infection. Stuffy head and extreme head aches. The Dr. gave me antibiotics (Amoxicillin 500mg) and Tramadol 50mg for the headache. The Amoxicillin really tore up my stomach and had diarrhea for the whole 2 weeks. A few weeks later is when my palps started. A few here and there. The Dr couldn't find anything so I was not too concerned. About July I had a week where they were brutal(to me) having  them when I sat down, laid down or sometimes driving. Maybe a 100 or so a day. Dr ran an EKG and was normal. Said they may have been stress or from the Tramadol. I stopped the Tramadol and he gave me 20 Xanax.
   Fast foward to now. Been living with them off and on until Christmas week. Came back worse than ever. Yesterday I went to the VA emergency room. EKG was fine. I had 7 while I was there but none showed on paper even though I could see them on the monitor. All blood work was fine, no cardio markers. Only thing they found was my Potassium was at 3.4 should be 3.5 to 5.0. He gave me Potassium and sent me home. Not another until that night when I went to bed. Today was ok, just a few but tonight they are back. These things freak me out.
 My questions Sir- Could the Amoxicillin or the tramadol have started all this? Also whey are they soo bad when I lie down or in the morning. On a bad day I can not wait untol around 11 when they calm down. I cut out coffee, thought that may have been it but no.
 Thanks in advance.
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RLR
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Re: Palps mostly at night and morning.
Reply #1 - Jan 2nd, 2012, 2:00pm
 
Hello and welcome to the forum. Neither the Amoxicillin nor the Tramadol would have been the direct cause for vagus nerve-induced palpitations.

The Amoxicillin likely affected the balance of intestinal flora, or bacteria, in your intestines and typically results in temporary GI upset in the way of frank diarrhea. While this response is common, it also self-resolves within a few days or so. The problem, however, is that during such time a good deal of gas and GI inflammation can occur, either singularly or together and it is this inflammation response which induces the palpitation events to arise. The GI tract is innervated by the vagus nerve, which at that level is termed the pneumogastric nerve and inflammation in the gut can actually produce mild fluctuations in cardiac activity, among them vagus nerve-induced palpitation events.

The sort of wayward evoked potential, or nerve impulse, caused by GI inflammation travels upward along the vagus nerve proper until it reaches all of the terminal points, causing variable response depending upon the organ system. Remember that the heart is as much a muscle as it is an organ and because it is so dynamic in performance, any nerve impulse which enters amidst the cardiac cycle can produce a range of responses, from mild fluttering effects more associated with the atria, or very prominent thumps more consistent with the force of the ventricles. Even what appears to be an absence of heart beat or long pause can be experienced if the impulse arrives during ventricular repolarization, which is the only brief instant when the heart is entirely still before repeating the cycle.

You can think of vagus nerve-induced palpitations as a rough equivalent of a mere muscle twitch of the sort many people experience with an eyelid from time to time, known as myokymia. Just as such a muscle twitch can do absolutely nothing to interfere with or damage eyesight, neither can the introduction of wayward nerve impulses into the cardiac cycle cause interference, damage or risk of harm in any manner whatsoever.

GI inflammation which causes abdominal distention can induce compression against against the diaphragmatic musculature or the gastro-esophageal junction is absolutely sufficient to produce the kind of irritation and subsequent wayward nerve impulse which results in the palpitations. Sitting down, lying down or bending over can have a similar effect and women who are pregnant commonly experience this type of palpitation as a consequence of compression against the abdominal cavity and diaphragm by the growing fetus.

The reason that many people become vigilant to the presence of vagus nerve-induced palpitations is that they misinterpret them to be capable of inducing some type of harm. The instant fear which is often invoked during the events is much like the physiological response to a panic threshold and it is the changes in physiology which cause the individual to feel as though they are on the cusp of some type of cardiac event or, at the very least, at closer risk of one. Actually, nothing could be further from the truth and vagus nerve-induced palpitations can no more transform into something life-threatening than a giraffe can transform into a lion. It's simply not possible because of the distinct origin from which these specific palpitation events arise. They are not intra-cardiac and do not suggest that the heart is experiencing any type of difficulty whatsoever.

The fear, however, that the palpitations can cause such harm arises from irrational beliefs about their character and capacity, often erroneously associated directly with pathological forms of arrhythmias known to produce stroke or heart attacks. Despite this common tendency, there is no such association at all and yet it constitutes the very reason that patients begin the constant trips to their doctor to obtain in-depth testing in order to find the cause which they believe exists. They need to feel safe and until the cause is located or the symptoms abate, they often continue the vigilant search to find a physical cause and cure.

Caffeinated products do not cause such palpitations but can exacerbate their tendency because of the influence upon the central nervous system. Coffee and tea are also highly acidic and can often induce increased acidity in the gut, indigestion or gas and it is this influence which gives rise to the palpitation events.

Incidentally, your K+ or potassium level is not even noteworthy and these small departures from clinical lab standards occur quite commonly and are asymptomatic. It would not have any effect upon the presence or absence of the palpitation events.

The problem which has arisen subsequent to detecting the palpitations is that a stark misinterpretation of this kind produces a very characteristic type of fear that causes the brain to respond in a very special way to ensure survival. In other words, if an individual experiences an event which they believe to be potentially life-threatening, it causes the brain to engage what is known as the fight-or-flight response. This series of physiological change permit the increased ability to fend off a threat or alternatively escape from it.

As long as the brain is receiving feedback that survival is at risk in some way, it will become highly vigilant and literally compel the constant attempt to identify and rationalize the threat in order to overcome it. The inability to find the cause and be able to predict its presence only drives this mechanism to compel the individual even further to overcome or escape the threat. People often feel helpless as they enter a cycle within the healthcare system where all tests to determine the cause are negative and the symptom cannot be abated by way of pharmacological intervention.

CONTINUED BELOW
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RLR
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Re: Palps mostly at night and morning.
Reply #2 - Jan 2nd, 2012, 2:03pm
 
CONTINUED FROM ABOVE

The brain responds in this manner regardless of whether the threat is actual or merely perceived and as long as you continue to believe that the events can harm you in some way, the brain is going to continue in the constant drive to protect survival.

It is the clear and convincing knowledge of the events and the adoption of facts and logic over irrational fear that will impart the necessary change.


You're going to be just fine. We'll talk more but the take-away message here is that the remedy is a very complex undoing of what took place to originally induce the pattern and subsequent palpitation events.

Best regards,


Rutheford Rane, MD (ret.)
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