Hey Jeff,

I just joined this forum today after being a visitor for months. This seems like an ideal post to begin my membership and add my voice.

I'm 42 and also struggling with rather regular pvcs. Back in May I caught a stomach virus that wiped me out. Unable to eat for weeks, I lost 35 lbs. On the tail end of my weight loss, my pvcs (beat, strong early beat, pause, stronger beat...) came regularly and sometimes furiously.

To answer your question: Yes, your weight loss may be contributing to all your new heart related sensations. There are several factors that may be causing this -- chiefly, electrolyte imbalance (especially loss of magnesium). Do not, however, seek to improve this imbalance with sports drinks. Instead, try a food based calcium, magnesium, and potassium supplement (from your local health food store).

Jeff, you are not alone. Stress and anxiety exacerbate the palpitations (and vice versa). It's a vicious circle -- one that I'm trying to escape. This forum is packed with heroic palp-fighters. I too have been told I'm "as fit as a fiddle" by general practitioners, cardiologists, and ER doctors -- all after a slew of exams (ekgs, echoes, stress test, blood tests, x-rays...); but at night, when I'm exhausted and vulnerable and trying to sleep, these pvcs tear into my psyche and send me into an emotional funk. At 2 a.m., while counting my skipped beats, I begin to doubt every doctor, every professional opinion, and my mortality. And yet, I'm still here; and so are you.

Try increasing your electrolytes (especially magnesium) and let us know if your palpitations abate.

I'm rooting for you. I'm rooting for everyone here.

All best,
Brian

Indeed, air or gas that briefly trapped within the intestinal lumen constitutes a type of inflammation of the pneumogastric nerve. It's important here to realize that the pneumogastric nerve becomes the vagus nerve proper as it ascends upward through the diaphragm.

Wayward nerve impulses travel along the nerve until they reach the terminal endings, one of which is the heart. You have to think of the subsequent palpitation events as a muscle twitch rather than any type of cardiac arrhythmia. Much like a bothersome eye twitch, wayward nerve impulses cause the muscles controlling the eyelid to twitch randomly.

The heart is as much a muscle as it is an organ and unlike any other in the body, is extremely dynamic. Wayward impulses are responded to by the heart muscle in very much the same way muscles in the eyelid respond to rogue evoked potentials, or nerve impulses. Realize that by walking fast, the palpitations aren't manifesting because it's challenging your heart, but rather because the contents of the abdomen are being jostled about by the movement of walking at a rapid pace. The notion that one's heart is under duress is reinforced in many instances by the change in frequency of the palpitations by walking slower or stopping altogether. In doing so, the individual believes the heart is no longer under the same workload and thus, the palpitations have abated as a direct consequence. This is entirely a misperception.

There are several factors which could be contributing to your circumstances. Persons who drink a lot of liquids either just prior to, or during, exercise are placing a liquid in the stomach which enhances peristalsis. You might well imagine what is occurring within the stomach and intestines by filling a balloon about halfway with water and the remaining space with air. Take the balloon for a walk with you and you'll be amazed at the level of agitation occurring within the balloon, which is precisely what is taking place in your gut.

Another factor is that people with anxiety tend to swallow copious amounts of air, predominantly when they consume food and/or beverages a phenomenon termed aerophagia. This tendency is enhanced when drinking directly from bottles or a cup versus a straw.

The result is mounting air that becomes trapped below the pyloric sphincter at the stomach, where some moves into the small intestine, duodenum and so on. This air applies upward pressure against the diaphragm and persons experiencing it often complain that they feel like they are unable to take a deep breath or even feel like they are not getting enough air. In fact, the diaphragm is experiencing difficulty drawing down the lungs in order to permit the type of full tidal respiration or inspirational breath which induces relaxation. Many persons also breathe more shallow as a result and this produces mild blood gas imbalance.

The last factor is predisposing conditions such as constipation or other irregular bowel function which produces and traps gas within the colon and intestine. Cholecystitis can indeed produce bloating following meals and result in the type of inflammation sufficient to produce the type of palpitations being discussed. I would mention here, however, that an asymptomatic gall bladder which produces abdominal distention and other clinical features is rather inconsistent. In other words, in the presence of abdominal distention and altered bowel movements, etc., a diseased gall bladder is also commonly producing rather significant upper right quadrant pain soon after a meal that may or may not demonstrate referred pain to the right scapula. Many middle-age individuals have "sludge" appearing in their gall bladder on imaging but it doesn't necessarily constitute anything diagnostic. The same type of discomfort can be evidenced in duodenal stasis, a condition wherein trapped air produces pressure against the retroperitoneal portion of the stomach where it joins the duodenum, causing abdominal distention, colic-type pain that is episodic and eructation or belching.

Regardless of the cause, careful attention and proper treatment of GI inflammation will directly correspond to a reduction in vagus nerve-induced palpitation events while exercising.

The bottom line here is that this particular type of palpitation event is entirely incapable of inducing any type of cardiac event whatsoever. It is the misinterpretation of the origin and implication of the events which sets in motion vigilance to one's heart function and the near constant worry that something is wrong with the heart itself.

You're going to be just fine and you're in no actual danger at all.

Best regards

Rutheford Rane, MD (ret.)

Atrial fibrillation is quite common among entirely healthy individuals and is not suggestive of underlying disease.

The response to A-fib is variable between patients and dealing with it in the aftermath can be challenging, most often with apprehension that subsequent episodes can occur just as randomly and unexpected as the original.

A-fib is not life-threatening and based upon the circumstances, it is rather unlikely that you will experience a repeat episode. It's important in any instance to refrain from establishing a course of life based on an all out effort to prevent recurrence. This approach typically involves any measure at all thought to be potentially contributory, when in fact most such presumptions are entirely inaccurate. The point is not to withdraw from life because of your perceptions that your life is at risk.

You'll be fine. I'd press the matter into the pages of history and continue practicing good health habits. You've got a long journey ahead.

Best regards,

Rutheford Rane, MD (ret.)