I was at work and felt a bit uneasy around solar plexus and took my pulse (not something i often do) and noticed my heart paused every third and fourth beat. Didn't make much of it until I came home. Lying on the sofa after getting all 5 kids 0-7 years to bed I told my wife (who is a Medical doctor) that my pulse seemed irregular. She listened to my chest and said I would need to have it checked out as it was all over the place.

I got anxious and went to the GP in the morning. Took an EKG that showed extrasystoles every third beat but nothing else wrong. Took my blood pressure that was high 160/104 and my heartrate was 107. Anxiety I thought but did a 24 hour blood pressure that averaged at 140/90. I was unfit and a bit overweight (190 cm and 107kg) and hereditarily disposed to hypertension (both parents). The GP attributed the blood pressure and the extrasystoles to life stress (child custody suit  for a 2 year old son, moving, new job etc) and said she could order a stress test if I wanted to but that there was no Medical reason for doing it. I felt reassured and decided I would take this as a sign i need to get back in shape and reduce emotional stress.

First thing I did when I got home was to to og for a jog and test my max pulse running some hills... "lets see if my heart is weak and I can bring on a heart attack!".. Got up to 190 but nothing bad from it. Have ran every other day since (something good out of it)...even though the first thought was "weak heart, be careful".

After 4-5 months now I am in much better shape, have lost 8 kg and have had periods of no extrasystoles (weeks). But they do come back, especially associated with emotional stress. I feel bloated (burp a lot) and this mild tingeling in my chest/abdomen. I would not have noticed this sensation (unlike some of the other posters here) if I did not check my pulse in the first case. Maybe that is because they are PAC's and not PVC's. But after Reading RMR's extremly informational course on palpations I realise it does not matter! I probably have thousands on bad days and work at not worrying when i become concious of them (have stopped taking the pulse). I think that is extremly important. Realize I am mortal, that there are no guarantees no matter what and that I must make the most of the one life I have (even though it is possible it will be short)...

The vagus nerve explanation makes a lot of sense and it should be something GP's should be able to inform their anxious patients about. Thank you again, I needed an understanding of the physiological mechanism to get more secure about the palpations!

Welcome to the forum and I've read your posting and concerns. I see nothing of your description to warrant any concern whatsoever and the nature of the palpitation events is purely a manifestation of vagus nerve-induced palpitation events as a consequence of significant stress and/or anxiety. Realize that such stressors induce mild dysregulation of the central nervous system, resulting in sensory disturbances and altered function.

You should also know that GI symptoms, ie trapped air, bloating, abdominal distention, can all produce mild inflammation and upward pressure against the diaphragm. The GI tract is innervated by the vagus nerve and is termed the pneumogastric nerve at that level. If sufficient pressure is present, it can induce wayward nerve impulses to travel along the vagus nerve to its terminal endings, one of which is naturally the heart, resulting in the variable sensations associated with the palpitation events. Remember that the heart is as much a muscle as it is an organ and will respond to stimulation just as any other muscle in the body. It is only due to the extremely dynamic nature of the heart that the sensations are so prominent.

These events can never cause you to experience any type of cardiac event, nor weaken your heart muscle or even shorten your life by even as much as a second in time. The events are very often misinterpreted to be associated with one of the classical arrhythmias when in fact they are extra-cardiac in nature, or in other words arise from outside the heart.

You'll find that once life stressors are no longer proximal and your GI disturbances have subsided, a corresponding reduction in both frequency and intensity of the palpitation events will occur as well.

From a psychological perspective, we're merely making reference here to the somatic features of anxiety and stress. It is also of interest to note that to some extent, the presence of apprehension is driven by vagus stimulation of the locus ceruleus and is partially responsible for the sometimes compelling efforts to seek reassurance and intervention of a manifestation which in actuality bears no capacity to do harm on the scale perceived. In fact, direct challenge to survival, whether real or perceived, induces the fight-or-flight response and along with it the driving need to identify and either overcome or escape the threat felt to be imminent. Unless resolved, vigilance is maintained. Such is the case for sufferers of health anxiety and the proclivity for attention to potentially life-threatening phenomenon.

You'll be just fine and there is no actual risk of any type associated with the presence of vagus nerve-induced palpitation events.

Best regards,

Rutheford Rane, MD (ret.)