Science of Breath (Part II)

So it should now be clear that abdominal breathing is preferable to that of chest breathing. The following are breathing exercises designed to improve breathing and to reverse Sensory Motor Amnesia (aka residual tension).

Major Rules of Breathing:

1) Never fill your lungs more than 90% of their capacity. Your lungs are very delicate and are easily damaged.
2) Focus on exhaling completely!
3) Breathe in and out through the nose. But if you find it difficult to breathe through your nose, you should open your mouth and breathe normally.
4) Breathing should be comfortable, not forced. If you find that the breathing exercise you are practicing causes anxiety, panic, frustration, or other negative emotions, discontinue and let your body breathe in its own style until you feel calm and centered once again.

Diaphragmatic (Abdominal Breath) Exercise:Lay down flat on your back. Place your left hand (or small bag of rice or bean bag) on your abdomen the navel, and your right hand on your chest. As you breathe, notice whether there is more movement in the abdomen or the chest. Try to take your breath down deeper and deeper into the lungs so that you feel the abdomen lifting as you breathe in and falling as you breathe out. Gradually, you should begin to notice the abdomen moving more firmly and the chest moving less. Try to let your breathing become slower, deeper, smoother, and circular.

Complete Breath:
Exhale ALL of the air from your lungs in a gentle manner, then use the diaphragm to draw air into the bottom of the lungs first, then allow the lower ribs to expand filling the middle lungs, then allow the upper ribs and chest to expand, and finally, lift the shoulders to fill the topmost lobe under the collar bone with air (during this last phase the stomach and abdomen will be drawn up and in slightly). Breathe out in reverse order, starting by lowering the shoulders, contracting the upper chest, lower ribs, and lastly the diaphragm so that all air is again gently squeezed from the lungs. The whole process should be done smoothly, and effortlessly as a perfect yawn.

Take a couple complete breaths at least 3-4 times a day. I like to do this exercise when I first start experiencing heart palpitations.



Remember to keep you face and jaw relaxed while practicing your deep breathing!

My favorite restorative yoga poses:

Cat pose

Extended puppy pose

Locust pose

Happy baby pose

Child's pose

Bridge pose

Science of Breath (Part 1)

Several years a go, I attended an informal class at the University of Texas taught by my yoga instructor Charles MacInerney on the topic of A Matter of Life and Breath. The following is my attempt to summarize what I learned and practiced in that class. It has done wonders for me when I start experiencing high levels of stress and heart palpitations.

The relationship between tension and breathing:

Ideally muscles are designed to briefly tighten and relax until needed again. However, our modern culture is such that we undergo constant and repeated "red light" reflexes in which our muscles think we are threatened. Every time some one honks a car, slams a door, etc. our muscles tighten. And when we lose awareness of a tense muscle, it begins to hold onto the tension longer each time it contracts, until it holds a residual tension. It is this residual tension (Sensory Motor Amnesia) that transforms the rib cage into a straight jacket that prevents people from breathing freely. So the key to learning how to breathe (yes, we need to learn--it doesn't come naturally in a culture like ours anymore) is to reverse Sensory Motor Amnesia. How do we do that? I'll get to that in the next session but let's first look at the differences between Diaphragmatic (Abdominal) and Thoracic (Chest) breathing.

Diaphragmatic (Abdominal) Breathing:

Slow, and rhythmic breathing
Large, tidal volume
Decreased heart rate
Decreased blood sugar levels
Decreased muscle tension
Decreased fatigue
Increased blood and oxygen
Increase lymphatic flow
Increased relaxation response
Decreased cardiovascular risk
Decreased likelihood of major EEG abnormalities
Associated with normal blood pressure
Associated with absence of type A behavior

Thoracic (Chest) Breathing:

Rapid, irregular breathing
Associated with hyperventilation (O2 levels rise, CO2 levels fall)
Low tidal volume
Increased heart rate
Increased blood sugar levels
Increased muscle tension
Increased fatigue
Decreased blood and oxygen
Decreased lymphatic flow
Decreased relaxation response
Increased cardiovascular risk
Increased likelihood of major EEG abnormalities
Associated with high blood pressure
Associated with type A behavior

Okay, so which type of breathing do you think you do on a daily basis? Which type of breathing is best for you?

MVP & PVCs

All these abbreviations are starting to make me loopy. Ha!

I recently returned to a support group that I was a member of many years a go when I was still learning how to cope with my palpitations. Over 10 years a go, after finally getting up the courage to see a cardiologist, I was diagnosed with Mitral Valve Prolapse (MVP) after a routine cardiac ECHO (aka cardiac ultrasound). MVP is an abnormality of the mitral valve leaflets, or supporting chords. It is a well-recognized, clinical entity with a reported prevalence of 4% to 18%. MVP is frequently associated with a myriad of symptoms. The term MVP syndrome refers to the occurrence of symptoms unexplainable on the basis of the valvular abnormality. (That always seemed strange to me.) Common symptoms include: chest pain, fatigue, palpitations, lightheadedness, shortness of breath, anxiety/panic attacks, headaches, low exercise tolerance, and mood swings. Hello, all of the above, ME! I was glad to get a name for what I was experiencing and even more glad to find out that it wasn't suppose to kill me. I knew early on that my valve was floppy but my doctor didn't think I would ever have to have valve replacement surgery. The doctor just mumbled something about taking antibiotics before going to the dentist. I joined mvpsupport.com soon afterward and participated with others like me who had been diagnosed with MVP and its strange symptoms. The woman who started the support group, Lorelei, was a long time sufferer and had even written a book on the syndrome. For awhile, the support group had been a life line for me but eventually I felt like I no longer needed as much help and I gradually stopped coming to the site. A few years a go, I switched cardiologists and after doing another cardiac ultrasound, he determined that it looked like I didn't even have MVP! I didn't understand how at one time I had it and now I didn't. Also, if I didn't have MVP why did I have all its classic symptoms? Fast forward to today. I stumbled upon my old support group website today--only it looked very different. The moderator and creator, Lorelei, had left an important message.

Here is an excerpt of what she had written:

Times are changing; technologies are changing -- it's not surprising to find our health affected by these changes.

My journey with Mitral Valve Prolapse began 18 years ago, and in that time I've had multiple visits with cardiologists and had multiple echocardiograms confirming my diagnosis. Fast-forward all these years later and now cardiologists have more advanced machines and improved knowledge about the heart. I was just told that I actually do not have Mitral Valve Prolapse afterall.

Did I ever have it? Who knows. Or maybe it's just so mild that it's not labeled as Mitral Valve Prolapse, since only those patients who have severe prolapse are now considered to have the condition. Any case that's less severe is "not something to worry about," I'm told. I asked my cardiologist, "When you say my echocardiogram was 'normal', do you mean that the MVP is just so mild that it's nothing to worry about? Or do you mean there's nothing there at all?" Her response was that everyone's valve leaks to some degree, and it's perfectly normal. Not really an answer to my question, but the end result is the same: I don't have Mitral Valve Prolapse.
Here is So where does this leave me?

I've written a book about my experience with MVP; I've been running this web site for 13 years; I've provided this online support group for years as well. What service am I providing to all of you -- how can I be of any use -- if I don't even have the condition myself? My motivation is now gone. For this reason, I'm stepping down from my MVP soap-box.

What does this mean for you, you may be asking? Well, for starters, I will be taking down my web site. However, the message boards will remain. Too many of you have found a "home" here and I don't want to take that away.

--Lorelei

Too many people had found a home! Did you catch that? There are so many people out there like me that have had this strange diagnosis and felt the effects of its mysterious syndrome. There are a lot of confused souls out there who have heart palpitations and fatigue and anxiety and no proper diagnosis. You would think that if it is true and technology is more advanced and doctors know more about the heart then we would know more about why we suffer with real physiological (read--not psychological, as some would like us to believe) symptoms. I hope one day science and medicine will get to the bottom of this strange and complex disease.

Which Came First, the Fear or the Flutter?

I believe a stressful first year of college along with genetics and the death of my beloved cousin was the catalyst in the beginning of my heart palpitations. I feared them and had a couple panic attacks after experiencing many in a row. So I believe my panic attacks started when I first got the dance in my heart. In fact, most of my panic attacks today still revolve around when anticipating or experiencing a bad round of PVCs. About 5 years a go, I was in the midst of the hardest year of my life--my first year teaching. Up until Christmas of that first year I was just trying to stay afloat. I got up early, taught seven year old children, pacified crazy parents, worked late, and came home only to crash on the couch. I dropped below 100 pounds that year. In the Spring of that year, I was driving to Target on the highway and thought I felt a couple flip flops. My heart started to race and I panicked. I started to hyperventilate and the only thing I could think of was to get off that highway as quickly as possible. As soon as I exited, my heart started to calm down, and I was able to complete my shopping trip taking side streets on the way home. Little did I know that that event would trigger one of my biggest anxieties that I deal with to date. Driving on the highway. I can get around okay for the most part and even a couple years a go, I thought I had it beat because I drove all the way to Austin from San Antonio by myself. But I got pregnant and for whatever reason toting a child and being responsible for her safety made me fear the highway again. I had a big panic attack last Summer while getting on the highway and I haven't been on it since.

So that leads me to the important question: Which came first, the panic or the heart flutters? It seems like if you look at my history, the heart flutters began while I was driving on the highway. Then the panic set in. But I can see it the other way around, too. The stress of driving that day 5 years a go caused the palpitations. And now I associate the highway with palpitations--the two linked with fear and loss of control.

I've come so far at accepting my heart palpitations. And overall I think I'm a highly functioning person. I don't let my fear of highway driving stop me from going out. In fact sometimes I think I even overcompensate by making sure I don't close myself off from the world like Paula Deen did. I'm pretty social and I definitely want my daughter to see me driving around and going places. Currently I'm on a new found quest to start driving on highways again. I'm looking into a trying out a highly recommended source--"The Original Driving Fear Program" at http://www.drivingfear.com/index.php. I'm also working on trying not to feel embarassed or ashamed that I'm not comfortable driving on highways. There are certain people in my life that I would still like to tell and have them offer me support.

Maybe one day I'll be that annoying girl cruising on the highway--windows opened, music blaring, singing loudly, and hair flying.

Do You Need an AED?

I mentioned in a previous post, that my beautiful older cousin died of a rare heart arrhythmia. It is still uncertain why she died of sudden cardiac arrest at such a young age of 30. Very few young people die of cardiac arrest but when they do the causes vary. Some specific causes of sudden cardiac death in young people include:

Hypertrophic cardiomyopathy (HCM): This is a disease in which the heart muscle (myocardium) becomes abnormally thick, making it harder for the heart to pump blood. Hypertrophic cardiomyopathy, while usually not fatal in most people, is the most common cause of heart-related sudden death in people under 30. It's the most common cause of sudden death in athletes. HCM often goes undetected.

Coronary artery abnormalities: Sometimes people are born with heart arteries (coronary arteries) that are connected abnormally to the heart. The arteries can become compressed during exercise and not provide proper blood flow to the heart.

Long QT syndrome (LQTS): Long QT syndrome (LQTS) is an inherited heart rhythm disorder that can cause fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the part of your heart that causes it to beat, may lead to fainting, which can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death. Young people with long QT syndrome have an increased risk of sudden death.

Beth was plagued by PVCs but I am certain that they alone are not what killed her. Many doctors believe that premature ventricular contractions do not necessarily cause ventricular tachycardias or ventricular fibrillations, but they could be an indicator of serious heart disease or electrical abnormality.

So now that Home Automated External Defibrillators (AEDS) are available over-the-counter without a prescription, I've often wondered if it would be wise for me to purchase one? The Mayo Clinic has written an excellent article on this topic. An AED certainly would have helped save my cousin's life. But since I'm fairly confident that my PVCs are benign after undergoing extensive testing and I have no other known heart condition, I don't think I need a home AED. Would it give me peace of mind? Maybe. Just as it might give anyone.

What Causes Heart Palpitations?

Here is a list of possible causes:

* Ischemia (restriction of blood supply)
* Certain medicines such as digoxin, which increases heart contraction
* Myocarditis (inflammation of heart muscle)
* Cardiomyopathy (heart muscles disease)
* Myocardial contusion (v-fib)
* Hypoxia (deprivation of oxygen)
* Hypercapnia (CO2 poisoning)
* Mitral valve prolapse
* Smoking
* Alcohol
* Drugs such as cocaine
* Caffeine
* Tricyclic antidepressants
* Magnesium and potassium deficiency
* Calcium excess
* Thyroid problems
* Chemical (electrolyte) problems in the blood
* Heart attack
* Adrenaline excess
* Lack of sleep/exhaustion (aka having a newborn-ha!)
* Stress

Remember, if you have occasional extra beats, but you are an otherwise healthy person, there's generally no reason for concern, and no treatment is needed. If you have frequent symptoms or you have underlying heart disease, you may need treatment to help you feel better and treat underlying heart problems.

A Little Clarification

When people say they are experiencing heart palpitations it can mean many different things. Some people (my mom for example) think of palpitations as feeling as if your heart is pounding or racing (tachycardia). You may simply have an unpleasant awareness of your own heartbeat. When I refer to heart palpitations in my blog, I'm usually referring to a sensation of a skipped or stopped beats. Sometimes they feel like a flip-flop or a flutter. Of course, your heart does not stop. A premature ventricular contraction (PVC) or a premature atrial contraction (PAC) is simply the heart's ventricle or atrium prematurely contracting before the normal electrical discharges arrive from the SA node (or pacemaker of the heart). Immediately after a premature contraction, the electrical system of the heart resets. This resetting causes a brief pause in heartbeat (as the heart refills with blood). It's usually the normal after beat (and sometimes it can feel very strong) that one feels and not the actual pause. Also, it may be useful to note that it is very hard to distinguish a PVC or PAC unless a trained technician is watching your heart palpitations on an EKG. Some people claim they can tell a difference between the sensations of a PVC or PAC, but I generally cannot.

The intensity and frequency of my PVCs differ greatly. Sometimes I feel single mild misbeats. These I have learned to live with. Other times, I will have one really strong one that I can feel in my chest, throat, or neck. These sometimes make me feel a bit queasy or short of breath. A lot of times, these intense single palpitations cause me to panic causing my adrenaline to surge and my heart to race (but I attribute this to the anxiety and not the actual palpitation). Sometimes, I go into bigeminy where one PVC occurs after every normal beat, in an alternating pattern, or trigeminy where one PVC occurs after every two normal beats. These have usually only occurred when I was dealing with a major life stressor (like a loss of a job or continual lack of sleep). Going into bigeminy or trigeminy is no fun for me. But supposedly there are thousands of people (especially older people) that experience bigeminy and trigeminy on a daily basis and can't even feel them! There is no prognostic difference between the PVCs that are felt by the patient and those that are not. Obviously the symptomatic PVCs are of more concern to the patient because they can be annoying and distracting. Beyond that, the PVCs are all the same, prognostically. In most patients who are otherwise healthy, PVCs on a Holter are of little prognostic value regardless of whether they're experienced or not.

And the million dollar question? How many is too many heart palpitations? According to a Cleveland Clinic doctor, generally in a normal heart there is no "maximum limit" to PVCs; although in someone with underlying heart disease, doctors are somewhat more concerned if they are occurring more that 6 times a minute.

Lady Gaga: "I have heart palpitations"

Lady Gaga has revealed she suffers from heart palpitations.

The singer, real name Stefani Germanotta, says she needed medical attention after a recent gig.

'I have heart palpitations and... things,' says Lady Gaga, 24.

'But it's OK. It's just from fatigue and other things...

'The other day...in Tokyo, I was having trouble breathing. I had a little oxygen, then I went on stage. I was OK. But like I say, I don't want anyone to worry.'

Lady Gaga admits she's also been tested for lupus, because her aunt died from the disease in 1976.

'I'm very connected to my aunt, Joanne, who died of lupus,' she tells The Times Magazine.

'It's a very personal thing. I don't want my fans to be worried about me.'

When you are experiencing heart palpitations

In a previous post, I discussed all the things I do to be healthy and prevent heart palpitations. But sometimes no matter how well I try to take care of myself, I'll still get those pesky misbeats. This has been an important realization as I used to get very depressed when I thought I was doing everything right and still got them. Now I just know that no matter how well I think I'm doing taking care of myself, life will inevitably get in the way and shake things up. Unexpected events, changes, chasing a toddler, fluctuating hormones, getting cut off on the road, etc. These are things that we have no control over and normal if we are to live full lives. Some stress is good. If we didn't have any, we'd be dead. But what do you do when you are stressed out and feeling the effects of heart palpitations? Here's what has worked for me:

--a glass of water
--splashing my face with cool water
--getting on the floor on my yoga mat and doing some gentle stretches (cat stretch, sun salutation, rock the baby pose)
--deep breathing (you can add meditative music, but sometimes I find it distracting)
--reaching deep inside myself and trusting my heart/body/soul
--reciting the mantra "This too shall pass."

But sometimes just trying to calm down, actually makes me panic more. Sometimes if the above doesn't work, the alternative is to get up and move. Go on a walk. Even if you're experiencing heart palpitations at 2 a.m., get up and start walking circles around your dining room table. Keep breathing slowly. In through your nose, out through your mouth. Or change up the scenery and go outside. You can enlist the help of a friend or spouse, but I've noticed that I really am the only person to help me through a bad episode. And when you have a history of being the one helping you through your panic, you don't have to rely on anyone else in the future.

[Disclaimer: If you have never experienced heart palpitations or have an underlying heart condition, please inform your doctor if you start experiencing them. I've had mine diagnosed as benign PVCs via EKG; thus there is no need for me to go to the hospital when they start bothering me. Of course, if my symptoms ever change or I start to feel lightheaded, I would immediately consult my cardiologist. But I've done the hospital thing in the middle of the night, and all they've ever done is hook me up, say yep you're experiencing palpitations, and send me on my way with a prescription for beta blockers (which I have never filled but that's another topic). So now I know when I start feeling them again, that it's best for me to stay home and work through them on my own.]

My New Hero is...

a butter-loving, finger-licking, joke-cracking queen of melt-in-your mouth Southern cuisine...Paula Deen!



I picked up her book It Ain't All About the Cookin' because I heard that at one point in her life she suffered from a debilitating agoraphobia whereby she didn't leave her house for years. Fortunately I've never suffered from full blown agoraphobia but there have been times in my life when I haven't wanted to be in public because I was either experiencing uncomfortable PVCs or afraid I would start to get them outside my comfort zone. Paula Deen suffered from intense anxiety for over 20 years before she finally came to the end of her rope and realized that she had to start living. One morning she got out of bed and like a thunderclap heard the words to the Serenity Prayer--the ones that alcoholics use at Alcoholics Anonymous: God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. At last she had got it. Deen writes, "Sure, I'm gonna die, I said to myself. My children are gonna die. Everyone I love is gonna die. But today has given me today and I'm gonna go out and live today. I won't die today." She started slowly and got better and better. She went on to start her own catering business, open two hugely successful restaurants, publish numerous cookbooks, have her own cooking show, star in a movie, and appear on Oprah! But through it all, she would still carry a brown paper bag in case she started to hyperventilate. Of course, she seldom needed it. And when life challenges presented themselves and she too began to suffer heart palpitations, she was smart enough to go to the doctor right away and tell him that her nerves were shot. She got on Zoloft and started feeling better. She is a shining example of a strong woman who has experienced intense anxiety and its effects, but has gone on to be successful and happily fulfilled.

Jogging with heart rate monitors

I've been doing P90X for the past couple months, but it has become increasingly difficult to get in the 1-1.5 hours daily to accomplish the DVD program with a little one. So the easiest way to get exercise with a toddler, is to put him/her in a jogging stroller and start jogging. I've been jogging early in the morning (before it gets too hot) three times a week for about half an hour. (Of course, I would encourage anyone with heart problems to consult their doctor first.) I also thought it was important that I bought a heart rate monitor watch to monitor my heart rate while I jog. While these watches are useful for a lot of reasons (distance, calorie count, staying in the zone, etc.), I think it has been most beneficial because it gives me reassurance that I'm not overdoing it and putting too much stress on my heart. Before I got the watch, I think I pushed it too far because after the jog, I would start to get a lot of very quick palpitations. This caused me some concern. But once I got the heart rate monitor watch, and simulated the same run I had been doing, I noticed that my heart rate was going way over 80-90% of my HR max. That's a pretty hard intensity and one that is recommended occasionally for fit people. And since I was just starting out, I knew I was pushing it too hard. Ideally, I should jog in a moderate intensity zone or about 70-80% of my HR max. Definitely not over 90% or 171 beats per minute. And now that I own the watch, I can easily do that. I simply notice when my heart goes over 162 bpm, and then I back off (usually I stop jogging and start walking or I take good deep breaths) to about 148 bpm. And once I reach that number, I'll start to jog again until I again reach my max and then I back off again. I keep this up for 30 minutes and then I do a cool down. The good news. This type of interval jogging is the best for losing weight. And I'm still trying to lose my post baby tummy. The results? I am no longer experiencing palpitations after jogging. Plus, I have recently discovered something I had never experienced before but heard so much about. Runner's high. The endorphins being released at the end of my jog makes me feel wonderful. I can already feel it working on my nervous system.

I'm pretty proud of myself thus far. When I first started experiencing palpitations over 10 years a go, I was so scared, I was even afraid to go on a walk. Anything that would raise my heart rate, scared me. I've come a long way. My advice is to go slowly at first and trust that what you're doing is very good for your heart. And not to sound morbid, but since I've started jogging, I've even thought to myself on occasion if I were to die while running (although I now know that's highly unlikely), at least I know I tried. I got out there and took control of my health and my heart.

I still have tummy to lose, but a girlfriend of mine, just commented that my legs look so good and toned. That was awfully nice of her to notice but I'm just glad that my heart is getting stronger every day.

Target heart rates
Polar heart rate monitor
My new jogging stroller

Middlesex

I've recently been reading Middlesex by Jeffery Eugenides. The story is about Calliope Stephanides and three generations of his/her Greek-American family, who travel from a tiny village in Greece to Prohibition-era Detroit. I got to page 20 and nearly fell out of my chair. Here it was. A perfect description of a woman living in fear of her heart. It had me written all over it.

In the late summer of 1922, my grandmother Desdemona Stephanides wasn't predicting births but deaths, specifically, her own. She was in her silkworm cocoonery, high on the slope of Mount Olympus in Asia Minor, when her heart, without warning, missed a beat. It was a distinct sensation: she felt her heart stop and squeeze into a ball. Then, as she stiffened, it began to race, thumping against her ribs. She let out a small astonished cry. Her twenty thousand silkworms, sensitive to human emotion, stopped spinning cocoons. Squinting in the dim light, my grandmother looked down to see the front of her tunic visibly fluttering; and in that instant, as she recognized the insurrection inside her, Desdemona became what she'd remain for the rest of her life: a sick person imprisoned in a healthy body. Nevertheless, unable to believe in her own endurance, despite her already quieting heart, she stepped out of the cocoonery to take a last look at the world she wouldn't be leaving for another fifty-eight years.

Every time I read this, it makes me want to cry. How many times have I not fully lived because I thought I was about to die. And if I am fortunate to live another fifty-eight years, when I do die will I laugh to myself and think "Gosh, I was healthy all along. Why did I give all those heart palpitations so much power?" Interestingly, after a recent conversation with my mother, she said that her grandmother always complained about her heart and feared it was going to kill her. She lived well into her 80's. So were we all crazy? I think not. It's just that when your life organ is awry it's only natural to fear. And when norepinephrine is being released, it's doing what it's suppose to be doing. Fight or flight kicks in. Fighting and stressing over your heart makes it worse, and it's awfully hard to flee from your own body. So the only thing you can do is counter intuitive. You have to relax and accept. So no wander it's so darn hard not to care about those pesky misbeats. You literally have to turn off the protective mechanism your body was designed to do. But you have to if you want to live a full and happy life. I'm working on it.