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Forum Name: Cardiology Symptoms

Question: Thump then a skipped beat?


 vikes09 - Wed Nov 11, 2009 5:07 pm

Hello, for the past few months I have been having these weird sensations where I will feel my hearth "thump and then there is like a pause before it starts beating again. And just in general I'm having heart palpitations quite frequently, I can feel my heart beat most of the time.

There are other symptoms too unrelated to the heart, I constantly am having a churning stomach and there are always very loud noises coming from all over my abdomen. Also, my breath has been very bad and there is a gurgling sound in my throat/espophogus from time to time. It's kind of like the feeling you get right before you vomit, but I'm not vomiting, I'm just getting that feeling in my throat.

I should mention that for whatever reason the heart sensations, stomach noises, and throat esophogus gurgling are definitely worst when I am laying down, either on my stomach or my back. I have a very difficult time sleeping since this has began.

I'm a 25 year old male, and I should mention I have battled anxiety problems in the past. In fact, just 2 years ago I had pretty much every possible test run on me to rule things out before the doc determined it was anxiety. Had an EKG and wore a holter monitor and both came back normal, in fact, the doc said that my heart looked "fantastic." I'm just really struggling to determine if this latest series of events is in fact more anxiety or if there is actually something to all this.

Again, biggest symptoms are heart palpitations, abdominal gurgling/noises, regurgitation feeling and bad breath, difficulty sleeping. Someone told me to get my thyroid checked, any possibility that's what it is?
 John Kenyon, CNA - Sat Nov 28, 2009 12:03 am

User avatar Hi -- This is simpler than it will seem before I'm finished explaining. See, the symptoms are quite real, but they not only can be caused by anxiety, once they start they can aggravate anxiety, which in turn aggravates more premature beats. That's the frustrating part, because the more they happen the more they happen unless the anxious person learns to ratchet down the anxiety an overlook (I won't say "ignore") the palpitations.

What happens -- and is perfectly normal and common in otherwise healthy people but especially in anxious people -- is a heartbeat will be triggered by an irritable spot somewhere in the heart other than the normal sinus pacemaking site (where all normal beats originate, or at least that's the plan). The early beat is then followed by a pause, because the heart was already going to beat, but the ectopic beat, um, beat it to it. So it waits a second, usually. If the ectopic beat comes from the lower part of the heart (ventricles) the pause is exactly long enough so the next sinus beat occurs right when it should and the overall rhythm isn't changed. If it comes from the upper chambers the pause may be a little shorter or longer. Either way it's harmless, normal, common, but feels really weird. Some lucky people are totally unaware of this happening. Others feel it but pay it no mind. Anxious people feel them, wonder what that was, become a little more anxious, and so release a little more adrenaline, which may cause even more of them. It still doesn't matter except that then a cycle of anticipation, increased anxiety, more "skipped" (actually early) beats, causing more anxiety, til the person is miserable and worried.

No need to be. This is harmless, normal and common.

Now then: You're also having some extra actvitity going on in your stomach. This can also be caused by anxiety, but could be some other minor GI thing. The problem is whichever the case, this peristaltic stomach action is activated by the vagus nerve, which also slows the heart rate. Vagal stimulation (digestion, stomach upset, fullness, etc.) often will trigger premature heartbeats. Again, this is normal, but when the stomach is upset or overactive the person may notice more premature beats. It follows, but unless you have this particular medical knowlege you're not likely to realize this. Also it sounds like you may have some gastroesophageal reflux (GERD) going along with whatever else is happening in your GI tract. It could be due to anxiety or not. Doesn't matter, when stomach contents moves up into the esophagus, there's one more thing tickling the heart (which is physically right next door to the esophagus), so more premature beats. It all goes together.

Getting the stomach settled might help reduce the number of premature beats, but all the symptoms could be due to anxiety as the first cause. The stomach issues should be explored because if that's at the bottom of all this, curing that will make everything else better. However, if anxiety came first and is causing the other stuff, you'll need to address that directly.The best way to do that (in my humble opinion) is to find someone who practices cogntive behavioral therapy (CBT), a self-limited form of interactive psychotherapy with "homework", which is known to be very effective in altering primal behavior and helping people control anxiety (and sometimes depression as well). It's worth a look, at least if all the GI things are corrected and the "skippped" beats and anxiety persist. Those beats will occasionally happen anyway, but if you're no longer anxious you may be unaware of them, so they wouldn't be an issue anymore. They're quite "real" (just because a symptom is caused by anxiety doesn't make it imaginary), they just don't really matter, except in terms of your perception of them.

I hope this helps. Please feel free to follow up with us here as needed. Good luck to you!
 vikes09 - Wed Dec 02, 2009 10:38 pm

Thank you so much. If nothing else this will put my mind at ease. The stomach issues are what happened first, then the heart palps followed. I always figured that the heart issues were from my anxiety, and you have further confirmed this.

As far as the stomach issues go, I have been to the doctor and he checked me out. He believes I'm suffering from either GERD, Hiatal Hernia or possibly an H Pylori infection, although he didn't seem to think there was much chance of it being the H Pylori. I'm on prescription meds for the reflux right now and they seem to be helping somewhat. I'm to check back with him in about a month to let him know if the meds are helping or if we need to explore other options.

The anxiety has definitely made this situation worse for sure. It's truly amazing the real physical symptoms anxiety can cause a person. I'd rather be ill with a virus any day than battle anxiety caused physical symptoms, they are a nightmare.
 John Kenyon, CNA - Tue Dec 08, 2009 12:27 am

User avatar I'm so glad I was able to help. I'm with you, too, on this, I would much prefer to endure a transient viral illness, even a severe one, than have to deal with an anxiety-producing-yet-totally benign nuisance.

Keep working at it. It's not easy, but eventually most people are able to get the attention off it long enough for it to become less intrusive. I wish there were a magic formula for that.

Stay in touch, please.

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