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Forum Name: Arrhythmias

Question: Frequent sensations of ectopic/skipped heartbeats


 davezmedz - Tue Nov 18, 2008 7:47 am

Hello there, my name is Dave and I am a 26 year old male. After witnessing a traumatic event in 2001 i started having panic attacks and generally just being very anxious about alot of things. This has steadily become worse over the course of 7 years and along with the mental strain, i have been suffering with physical symptoms aswell for many a year. Sometimes these symptoms are present when i am not even anxious so i am considering the possibility that years of relentless negative and stressful thoughts and long term affects of a heart being overworked during anxiety/panic attacks has caused damage to my heart.

As it regards my heart, it is hard to describe but it feels like it is enlarged or congested in some way. It is a scary sensation but it does feel like that. In addition i suffer with paused and skipped heartbeats very regularly with this occuring mostly after consuming food or a meal or after waking up. The heart can very regularly pause for 1-2 seconds and then start again beating normally for afew beats and then repeat the cycle. When the beats commence after a pause i experience what can only be described as a headrush sensation. Upon standing i also get frequent headrushes, even if i have only been seated for afew minutes.

With the aforementioned i also have trouble obtaining a proper breathe and sometimes concentrating on taking a deep breath results in a varying bradycardic and tachycardic heartbeat sensation occuring within inhalation and exhalation. It is not a gasping for air type of difficulty breathing but all the same, i can not gain a full deep breathe.

I don't know if this has any importance but for afew years now i also have a visible beating in my abdomen (seen clearest when laying on my back). These beats occur about an inch above my navel. I have had this now for at least 4 years. I am 5 foot 11 and 170lbs and some people say when you have a more slim build you will notice this more anyway. Anxiet sufferers are also said to have these pulsations.

I have not had any drastic change in weight at all. Now and again i will go up and down within afew days but there is no real change in weight. I have a home bp test kit and when i do check my bp i usually range between 120-135/72-90. My skipped heartbeat is see n on the display screen of the BP machine when i check my blood pressure.

Doctor, can you in any way advise me?? Should i be concerned? And is there anything i can do to aid myself re the arrythmias and palpitations?

Thankyou for taking the time to read and acknowledge my question.

Yours Sincerely

Dave S
Birmingham
UK
 John Kenyon, CNA - Tue Nov 18, 2008 10:10 pm

User avatar Hello Dave -

First of all, let me say that I sympathize with you regarding the anxiety problem. Chronic anxiety punctuated by panic attacks is a very common manifestation of post-traumatic stress disorder (PTSD), which is no doubt what has caused your lingering anxiety disorder. Although some people find this rather amazing, the problem usually does not resolve on its own over time, so it's not surprising that you continue to experience these symptoms.

The good news is that the problem will not, in itself, cause damage to the heart, even though many people also find this difficult to believe because of the way it makes them feel physically. The bad news, as you've learned, is that the heart learns a number of bad habits in reacting to the constant stress and higher levels of adrenaline in the bloodstream, and this makes it more difficult for the patient to differentiate between what is "normal" and what might actually warrant concern. Worse, it often makes it more difficult for clinical personnel to differentiate between the two also, and in some instances this results in the patient getting lumped into a subgroup of hypochondriacal patients, which is absolutely wrong. Still, it often happens. As a result, the patient with panic disorder, PTSD or generalized anxiety disorder (GAD) must become especially assertive with his healthcare providers if there are any unanswered questions.

Given all that you've described in your very well-worded post, you draw a classic picture of chronic anxiety and panic disorder, with a secondary tendency (almost unavoidable) toward somatic sensitivity (an unhelpful awareness of ordinary and common bodily behaviors). For instance, while you've mentioned having been told that anxious people often "have" the visible abdominal pulsation, in fact a great many people of all sorts have this phenomenon, and if a really trained eye is applied, virtually everyone has it. Anxious people are simply far more likely to notice it, focus on it, and wonder about it.

By the same token, there are other arcane symptoms you describe which also capture the attention of the anxious patient and while these are almost always benign, there is that layer of symptomology that just might be masking something else. It is an acquired art to learn when something rises above the daily, anxiety-rooted symptom to the level of something potentially wrong, since even anxious people can get sick. It's just harder for them to know when they are.

Again, everything you've described is classic for the problem from which you suffer. This doesn't mean there couldn't, at some time (most likely in the distant future) be something wrong which might otherwise cause some of these symptoms, but even so, most of them are so subjective that they really are easily explained away.

What I would suggest, if you haven't explored it yet, is one or both of two approaches to managing (and possibly even curing) the underlying problem: first, the discipline of cognitive behavioral therapy (CBT) is a self-limited (that is, not never-ending) form of psychotherapy wherein the patient is taught how to recognize the symptoms, triggers, and overall mechanism of the problem and how to short-circuit the process, abort panic attacks, relieve chronic anxiety, and begin to live free of the dark cloud hovering over everything. The other possible approach, usually also temporary, is pharmaceutical, in that there are a number of medications which can be very effective in suppressing anxiety and preventing panic "seizures." These drugs do not, however, fix the problem, so they are best used in conjunction with a comprehensive CBT program, so that the patient can get immediate as well as long-term relief.

All in all I'd say you are very likely in perfect physical health, but you do owe it to yourself to be certain when there are questions lingering, and for that purpose this website can serve a unique purpose. Some of the symptoms you experience would happen anyway in a "normal" person (such as the premature heartbeats, which we all have from time to time anyway, and which are of no diagnostic nor prognostic value anyway). The goal is to reduce the frequency of these symptoms and, moreso, to reduce your awareness of and concern for them.

I hope this is helpful to you. This is not a simple problem, as I'm sure you know, but increased awareness of and sympathy for sufferers of this sort of problem have led to a huge opening up of the field in terms of management, treatment and even sometimes complete cure. If you have any further questions please don't hesitate to follow up with us here. Best of luck to you.
 davezmedz - Wed Nov 19, 2008 6:50 am

Thankyou Doctor for a very in depth and helpful response to my original post. For you to take the time to send such a detailed reply is sincerely appreciated!

If i may have a little more of your time however Doctor, alot of my negative worry has alot to do with specific scenarios and situations, most likely born of the panic and anxiety issues i have suffered. I have the physical symptoms i mentioned in my first message on this forum and my main worries that occupy most of my day are fainting in a public place (as this was my initial trigger back in 2001), being a victim of sudden death (hence my heart questions in the initial message about heart enlargement, skipped and paused heartbeats, congestive sensation in heart etc)
Another factor that bolsters my negative worries are the fact that alot of these cases occur in young people (usually between mid teens to late 30s) and this fear doesn't help matters whatsoever.

I know very frequently an anxiety sufferer can be their own worst enemy for escalating fears and thus feeling physical symptoms but i also have been told and have heard on many an occasion that if you have physical symptoms your body is trying to tell you something.

Doctor is there anything you know that could allay my concerns regarding those things mentioned in the second paragraph please?

Also if i may, is a normal/safe blood pressure reading indicative of a healthy heart or is there no way a home kit can give clarity to the health of the heart??

Thankyou again Doctor for your time. I have a job interview tomorrow and so i have
nerves about that and its at times like this the additional strain isn't warranted.

Yours Sincerely,

Dave S
Birmingham
UK
 John Kenyon, CNA - Wed Nov 19, 2008 3:00 pm

User avatar Hello again -

You're very welcome. We do what we can.

To respond to your specific concerns, you've posited the classic intellectual/existential basis for much anxiety and even depression. What sometimes sets the stage is intellectual doubt and questioning about the very nature and tenuousness of existence, bolstered by some incomplete medical information we've picked up along the way, and what "could" happen. If one is already wired to be inclined to experience more than the usual anxiety and perhaps panic attacks, this line of thinking will almost certainly help tip the balance in favor of dread and anticipation of events which are either out of the question or are statistically unlikely (and often even improbable). The fact that we hear about things that may have happened to others with whom we can relate really isn't helpful, and many people are skillful at tuning out this essentially useless information. Others, for various reasons, tend to go the opposite way and lock into them, matching them up with the subjective physical symptoms they feel and finding it difficult to disconnect the two. This is my aim: to try and help you understand why your concerns are unwarranted. Here we go:

Over the past six years you've entertained a fear of fainting in a public place. Has that ever, in those six years, ever actually happened? Apparently not, or you'd have mentioned that in your history. You've probably felt as though you would, ,but you haven't. The longer you go without having this happen, the less likely it is that you ever will, but the more likely you will anticipate it over and over again as "possible." Well yes, it is possible, as sometimes, for various (usually innocent) reasons, people sometimes do pass out. But more often than not they don't. That's the fact of the matter. That you haven't, even though you've feared you might based on symptoms not well understood by you, should be helpful in bringing you to the realization that while passing out in public would probably be inconvenient, embarrassing, etc., it's apparently not going to happpen, even when you feel it "should" happen. We latch onto the worst case and dread that. Same thing with sudden death. This is actually a pretty rare event among otherwise healthy individuals. Once we've done some pretty simple and straightforward tests (such as a resting EKG) we can pretty much rule out any chance that a person has one of the extremely rare conditions that can cause such an outrageous event. If your Q-T interval on EKG is normal then you're almost certainly not ever going to just spontaneously fall over dead. It's really as simple as that. The fact that many young athletes suffer from overdeveloped left ventricles or have electrical abnormalities in their hearts is overemphasized simply because it is so very unusual. That's why when it does happen we hear about it. If it were truly common it wouldn't be news. But it is not common, and again, it is very easily ruled out, usually by a simple EKG and sometimes also an echocardiogram. Every young athlete should be screened for these disorders, since if one in a million turns up with a potential problem (even though there is almost always a family history to suggest it anyway), then there's a life that can be saved. Otherwise it usually shows up in a routine physical. Anxious people actually have an advantage in this area, as they have eventually had pretty exhaustive cardiovascular workups which show there is nothing of the sort present. These are not conditions one can just suddenly acquire. They are almost always inherited. If you don't have one of them, you're not going to develop one later. If that were truly possible, no one could function without undue anxiety and dread. That many of us don't realize this leaves many crippled by their anxiety and anticipation of catastrophes that are almost impossible. It is easy to tell you this; it is not as easy for you to embrace it as truth and break the habit of reacting to your own thoughts and fears, which many times originate due to some other, more obscure psychological basis. Being prone to weird, scary symptoms doesn't help. However, understanding that almost everyone has the sensations from time to time can be helpful. Knowing that premature heartbeats, odd chest sensations, and even the occasional lightheadedness, can help put things into a more positive context. This is why cognitive behavioral therapy is often so wonderfully helpful, since it teaches the anxious patient how to recognize when he is headed into that psychological "house of mirrors" where he allows himself to become unhealthily aware of little things his body is doing that are basically normal. One concentrates, then, more on the apparent unhealthiness rather than the overall good health. The trick is to reverse this tendency, as we do need to be able to recognize when we have an actual problem, and anxiety just makes it very difficult to tell the difference. It makes life a lot less pleasurable when we're always feeling our pulse or waiting for that Sword of Damocles to fall on us.

Regarding blood pressure, in someone with a known heart problem (which you do not have) it is useful to check the blood pressure on an infrequent but regular basis. Also, if there is any remarkably different symptom taking place (such as lightheadedness, throbbing in the head, etc.), it may be useful to check, but a normal blood pressure (or a just slightly high or low one) tells us very little other than that the subject doesn't have the risk factor of high blood pressure. So checking it frequently without a concrete reason only causes more anxiety, since it can vary greatly during the day, from moment to moment, depending on one's activity or lack of it, and one's state of mind at any given moment. Not an extremely useful exercise, all in all. Another word about blood pressure: if you're feeling fine, it doesn't matter how low a figure you may read; if it's working fine for you, then it's fine. If it's not working for you, you'll already have passed out or at least sat down. If it's too high, a routine physical should uncover this and you'd then be put on medication to manage that. Again, although sometimes the numbers seem disturbingly low, if one is up and around and fine, then that is only something to make a casual mental note of, and perhaps check it again later to compare. Again, as long as it's working for you, it doesn't much matter what the reading is (and the equipment, especially home-use equipment, can be fooled and give erroneous readings).

There is the whole issue, also, of hyperventilation, which would take an entire additional post, but involves the sensation of not getting enough air when clearly everything is working correctly. This often causes lightheadedness and can even cause fainting, can also cause numbness and tingling around the mouth and in the hands, and can be very frightening. It's a product of faulty breathing, usually set off by (unconscious) deep sighing, which throws off the CO2 balance and tricks the brain and body into thinking it needs more air. It becomes a cycle which can be terrifying, but actually corrects itself or can be corrected by rebreathing into a simple paper bag to restore CO2 balance.

I hope all this is helpful. Please follow up as needed. It can sometimes take a while to properly address all the underlying questions. That's why we're here. Best of luck to you. Do stay in touch.

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