I've had years of episodes of skipped beats, which built up and lasted several weeks before slowly fading away for months at a time.  Now, I've had it going on for about 6 months with no respite.  I feel them any time in the day and night, but seem to notice them more at night when my heart seems to stop, thump, shiver......and I get more and more scared.  Saw my doctor today, but of course nothing happened when she was listening!  Typical!  Pulse around 90.  BP low (always is).  She's sending me for thyroid tests again, and an ECG and says she thinks I should see a cardiologist - all of which is good.  What should I ask the cardio in order to really be reassured?  I should be used to all this, but I can't stop the worry when it's bad....

Hi Rosekay,

I'm sure RLR will be along to offer some input, but I was exactly the same when I went for an ECG.

Many years ago when I first started having these beats they absolutely terrified me. One day my heart was skipping all day long and I felt awful, felt sick, incredibly panicky and went to A&E.

Lo and behold, the 30 seconds I spent on the ECG, no skips!!

I don't think this is a coincidence - it just so happens that it doesn't skip when we actually want it to! That's a strong suggestion that a huge part of these missed beats is down to our anxiety.

Hope that reassures you somewhat  

Well, RLR, you've put into words what has been sort of lurking at the back of my mind.  I totally understand what you say about the palpitations easing when in a "safe" setting.... I have actually noticed myself that they begin to ease even after making an appointment with my doctor, it's like giving myself permission to relax, in a way.  They had been bad for so long, then during the couple of days after phoning the surgery I actually noticed improvement.  I sort of feel like I've passed the burden of them onto someone else and I can let go.
I really don't panic about them all the time, don't even think about them until they kick off for some reason, then the cycle begins.  It's such a very unpleasant feeling.  I don't want to waste my life worrying about it all, and I am really making an effort now not to panic.  I can feel the skips at the moment but I think I can ignore them - maybe I feel safe because I'm talking to you!  Thank you for your real good sense, and I hope I can continue to progress - I will certainly try my best!  Thank you again - you help such a lot!

Please feel free to post the Holter monitor results and I'll be glad to discuss them with you.

You're going to be fine, Rosekay.

Best regards,

Rutheford Rane, MD (ret.)

Well, you nee to relax. The tests will turn out negative but if nothing else, serve to provide reassurance.

Best regards,

Rutheford Rane, MD (ret.)

halfway through my monitor week, and just started to have lots of bumps and thumps for it to pick up.  Not as bad as a couple of weeks ago when it was really violent for a day and a half - one gap between beats then was so long I honestly thought it wasn't going to pick up again.  So hoping this is going to help to alleviate symptoms!

Am quite upset today.  Took the monitor back to the hospital yesterday morning, as I said it did catch some bumps and thumps etc over the week.  Went to bed last night and my heart went into skipped beat overdrive -  it was just awful.  Every other beat was followed by huge gaps, the beats were very strong.... I lay there for ages trying not to panic, but it really felt as though my heart was just faltering the whole time.  Why on earth would it do that as soon as I had no monitor?  I hadn't been worried about taking it back (was glad to be rid of all the wires, actually).  During the week I had done everything I could to try to set them off - overate, had wine in the evenings, spicy food, nothing make it really bad.  Last night returned to normal eating, no alcohol, and bang, there it was.  Feel like I just can't win.  :'(

Okay, you're misinterpreting the circumstances Rosekay. You have to understand how much your brain has to do with influencing the palpitation events.

When patients wear holter monitors, it provides a sense of safety because they believe that it's going to determine the cause for the events that will hopefully lead to their successful treatment, or at the very least satisfy the patient that the holter has recorded the events. During this time period  the patient is typically under a different state of mind than without the recorder, producing less incidence of palpitations in most instances.

When the monitor is no longer worn, apprehension slowly begins to return and the safety net of the holter no longer represents comfort, ultimately producing the same circumstances previous to wearing the holter and increasing the incidence of palpitation events.

I'm constrained to point out here that as physicians, we do not need to "catch" the events on the recorder to determine their nature. When we review an ECG, we are looking for the characteristic signs which produce arrhythmias which are of concern. In the absence of such signs, the patient's complaint of palpitation events can only represent those which are entirely benign in nature. It is only the patient who establishes the need for the events to be directly recorded in order to satisfy their unending worry that the events are both pathological and dangerous. Let me provide you with a common scenario from memory that typifies how patients are compelled to respond when discussing holter monitor results:

"There! Right There! Did you catch that one? I just had one. Is it showing up? Now what is it? Is that just the harmless kind? I've read that V-fib is dangerous and it has me concerned that the could be signs of V-fib. but you're saying mine are harmless, right? So they're definitely not V-fib, correct? What's weird is that I don't have near as many of these darn things when I wear the monitor as I do without it and it really frustrates me. You should see when they're really bad, like every 2 or 3 seconds or sometimes and it makes me light-headed like I'm going to faint. Is that normal? Can the dangerous kind do that as well? So then how do we know that the ones not being caught on the monitor are the same as the one it just recorded? I'm confused. Can you tell me for certain that these others are harmless too? I mean I know you've already said that, but you have no idea how much these darn things worry me. I just want to be sure. I can't even go do things that I used to always do because I'm so afraid that something is going to happen. I try and stay calm, but my thoughts just take off and I'm right back where I started. Is there anything we can do for it?"

So that's a brief example of the typical conversation from a patient wearing a holter. It's a struggle by the patient for reassurance which extends all the way to the events being potentially deadly. They just want the symptoms to go away and because the symptoms remain present, the patient once again becomes reinforced that something is wrong. Desperation can sometimes take shape because the patient can't seem to get relief from the unpredictable nature of the events and the sort of captivity it places upon them from being able to enjoy their life.

As long as you feel that these palpitations are dangerous or that they can somehow do harm, they will remain present. Only when you come to realize that firmly understanding the events to be entirely harmless with changes take place that cause the palpitations to diminish, sometimes entirely. There is no pill you can take to make them go away and regardless of how many times you have tests run, the results will always be negative because the relevant test equipment is designed to detect conditions which are harmful or that put the patient at risk.

You're going to be fine, but you have to begin looking to methods that will help restore your life once again and not persist in the belief that you are in danger or that more tests are simply needed to find the nature of the problem.

Best regards,

Rutheford Rane, MD (ret.)