Tuesday, January 4, 2011

We interrupt this program...

for the BEST article on heart palpitations that I've ever read!!! No kidding. I'm so excited to share this letter from a real medical doctor. It's long but well worth it!!! (My favorite part? The comparison of PVCs to an awkward dance.)

Thank you to www.pvcgroup.webs.com for sharing it!

To Those Concerned With Heart Palpitations

(Letter from MD)

I want to start by talking about a very special part of the human anatomy that does not seem to appear in the collective messages I've reviewed; The VAGUS nerve. The vagus nerve, also referred to as the 10th cranial nerve, is appropriately termed a "mixed" nerve. It provides a sort of two-way communication of nerve impulses back and forth between the brain and the pharnyx,larynx, esophagus, stomach and associated abdominal viscera(basically, your throat, windpipe, your tummy and guts), the heart, lungs and several more complex but irrelevant body organs or functions. The vagus nerve is the longest and most complex of the cranial nerves in the body.

The key point here is to make note that this nerve involves the "heart," the "lungs" and basically the whole digestive system of your tummy and intestines. Now let's pair that with some real specific and limited physiology about the heart and its rhythm.

We also need to bring clarity to some of the medical jargon being talked about by many of you in your messages. The term PVC, or Premature Ventricular Contraction, is just one of many arrythmias and not necessarily isolated to what many term as "palpitations." When we speak of palpitations, what we really mean is the presence of "ectopic" beats(heartbeats where there should not normally be)and the precise induction of these beats is felt by us as dancing of our heart or a flutter sensation in our chest, the prominence or intensity of which is determined by the precise moment of the extrabeats in proximity to the most recent beat and the upcoming beat or contraction of the heart ventricles or atria. Think of it in relation to your memory of your worst date, where the guy you're with has no rhythm whatsoever but wants to impress you with all the right moves and clumsily tries to introduce his own dance-step into your otherwise smoothly flowing and natural pace with the music.Depending upon his rather untimely entry, he can cause awkwardness that either simply causes you to quickly pause and regain your rhythm or literally trip you repeatedly until you're forced to leave the dancefloor. Well, the same holds true for the heart in our example. The extra beat, or palpitation might come at a point that's subtle, or it might be at a point where the heart stumbles repeatedly until normal sinus rhythm is regained. Now let's get to "why" palpitations occur.

The heart has a natural pacemaker called the sinoatrial node among several less distinct and similar pacers, which is stimulated by guess which nerve? You guessed it; The VAGUS nerve.

The vagus nerve helps regulate the heart in comparison to other functions taking place with other areas and is doing its job right now in each and every one of us. In fact, the variability of your heart rate during inspiration and expiration of your lungs is an effect of the vagus nerve. We've all noticed that when we take a breath in, our heart tends to beat just a little faster and when we breath out, a little slower. It's an entirely normal bodily function and is connected to the need by the body's system to respond to the environment.

Now that we kind of have a little medical background under our belts, let's take one of the complaints by many of you regarding the proximity or timely appearance of palpatations and indigestion. Remember that we said the vagus nerve is linked to both the tummy, the throat and the heart. Let's assume that we've eaten meal and it's caused us to experience some gastrointestinal discomfort, or in other words, gas. The irregular presence and activity by your tummy and intestines stimulates, more appropriately irritates, the vagus nerve which sends a rather inappropriate signal back along the pathway to guess where? That's right! The heart. Move to the head of the class. The heart is busy pacing away regularly and is relatively unconcerned with all the food you poured into your tummy, when all of a sudden in comes a signal from the vagus nerve because it has been inappropriately stimulated and tells the heart to beat. Well, just like our bad date example, the signal to beat is rather untimely and awkward but the heart has to accept it and respond. The result is extra beats that make the heart feel like it is stumbling. The degree to which it stumbles oftentimes depends upon the extent to which the vagus nerve is irritated and the relative state of indigestion present as the causitive agent.

There is most often no pain assoicated with this occurrence because it is not the result of a lack of blood or oxygen that creates the palpatation, but rather just a simple additional electrical impulse or series of impulses. Pericardial pain, or pain adjacent to the heart, can sometimes accompany palpatations or exist exclusive of any arrythmia, but is not necessarily considered pathologic or harmful to us. Remember that we're dealing with inappropriate electrical impulses and muscle tissue other than the heart that is partially innervated by the vagus nerve and can respond inappropriately, causing a jabbing or shooting pain than many describe as a "catch" in their chest. We'll talk more about chest pain in a bit.

Let's discuss the sensation that some of you described as a warm flushing sensation of your face and perhaps other body areas that accompanies the palpitations. Recall our anatomy lesson. The vagus nerve stimulates many areas of the body in response to our environment or internal conditions caused by the outside environment, ie. a meal that produces indigestion. The vagus nerve provides all of us with a stable process called vagal tone. This tone or stability keeps us in a state of balance so to speak with our environment. In response to environmental cues or situations, that tone or stability changes to prepare for what may be required. You've probably all seen a guy that makes your heart "skip a beat." Ever wonder why that phrase ever came about? Think for a moment. If you've ever been emotionally overcome, your heart races or feels like it pounds in your chest, we begin sweating, our blood pressure rises, we feel nervous and at some point our face is overcome by a warm flushing sensation that we attribute to nervousness or embarrassment. Well, guess what nerve plays a very big role in that entire process?
Right Again!!! The VAGUS nerve.

The above scenario would be a case of increased vagal tone. Well, if there's an increase, there's likely to be a case of decreased vagal tone as well. Indeed there is. decreased vagal tone can make us weak, nauseated, tremble, and even faint. It happens in cases of being excessively startled or frightened. Other conditions, such as diabetes can cause decreased vagal tone, but for our purposes we'll stick to conditions that by what I've read from all of you are non-disease provoking conditions, with the exception of one individual with Mitral Valve Prolapse but we'll touch on that in a bit.

Anyway, the point is that our body doesn't always accurately recognize proper environmental cues and the vagus nerve doesn't always know when and how to act. In other words, it misbehaves once in a while as a result of inappropriate stimulation. All sorts of things make the vagus nerve act out, including stress, anxiety, depression, illness and even ideopathic causes(origin or cause is unknown). In fact, there is work going on right now using electrical vagus nerve stimulation to treat depression, anxiety and even seizures.

And here's a little extra for those who cough when experiencing a palpitation. Recall your anatomy lesson again. Remember we said the vagus nerve stimulate the pharnyx, larynx, bronchi and esophagus. Well, what do you know. Those are exactly the processes involved in the cough reflex. So when the vagus nerve inappropriately stimulates the heart and causes a palpitation it also stimulates in some cases the cough reflex. How about that!

So we begin to see that the cause for palpitations and the palpitation itself is not a life-threatening occurrence at all. It concerns us for several reasons. First, it has to do with our heart and hey, that's the thing that keeps us alive basically. Big concern! Secondly, we've been bombarded by all the medical revelations and awareness about heart disease. But a case for heart disease does not make for every condition the heart demonstrates, especially palpitations. If you've ever had a cramp in your hand from typing too much, it probably never gave you pause to think you might not make it, so to speak. You reason in your mind that the cramp is caused by repetition fatigue and you need to take a break, massage your hand and rest momentarily. Well, palpitations can be considered sort of a cramp and nothing more. Under stress and other factors we talked about, the vagus nerve gets irritated or fatigued and acts out. Just because the heart is affected, doesn't mean that you've got heart disease or vascular problems that are looming. They're annoying,
worrisome and even frightening, but knowing where they come from and why will help go a long way in knowing that they are non-injurous and if we respond appropriately, will subside and we can go about our lives with far less worry.

Let's touch on anxiety for a moment. Anxiety, and depression too, can definitely cause a state of dysfunction in many areas of our body. Many patients who have these disorders are exhausted from constantly presenting themselves to the medical community with real and valid symptoms of pain, fatigue, bowel problems, vision problems, tinnitus or ringing in the ears, difficulty swallowing, excessive saliva, dry mouth, sore or sensitive tongue, and many many more troublesome circumstances only to have repeated tests all return normal. How can that possibly be?!! It's there, we feel it, we experience it, we hate it. Why doesn't the test confirm that it's there? How frustrating is that????

Well, here's some news that should make you feel a bit less frustrated and even comfort you. Most all tests are based upon the algorithmic, or sequential processing, of certain symptoms and signs that are all conclusive of various disease and illness. When someone with anxiety, depression or other condition that has somatic features (felt physically)undergoes these tests, the components that underlie the actual diseases which have similar symptoms simply does not add up and no presence of the actual disease is evident. So it's a case of false identity, sort of like having a biopsy of a mole that turns out to be benign. Looks like cancer, but is not cancer. Well, that same thing can happen to us with regard to all sorts of disorders and diseases. They look similar in presentation, but one reveals true disease and the other a nonpathologic condition or illness. So the next time your doctor tells you he can't find anything wrong, be glad for that much at least. Many people get far worse news!

So with regard to depression and anxiety, these conditions impart disturbance upon body functions. I suppose you're already guessing that the vagus nerve is not exempt from those circumstances and you're exactly right. So when you have an episode of anxiety, rest easy when you have a palpitation or two, or three or even four. The vagus nerve is irritated and needs a break or to reset. No problem whatsoever and you needn't worry any longer that a palpitation is sure indication of worse things to come. Nothing else happens. Just an extra heartbeat or two where there should not normally be. What a relief!!!!!

And the caveat I promised to the one individual with Mitral Valve Prolapse, your heart condition, while not necessarily life-threatening at all, does predispose you to panic disorder which I'm sure you are probably already aware.

Okay, so now we know what these palpitations are and what causes them. What the heck do we do about th'em? Well, there are several techniques that can help. Firstly, let me say that if a run of palpitations makes you feel faint or weak, don't panic and try to make it somewhere less embarrassing. Be safe and think smart. Squat to your knees or sit down until the feeling subsides. No sense in cracking open your skull by trying to make a mad dash for privacy. Anyone can feel faint and people in your company will always rally to your aid more often than not. So relax. The conditions will quickly pass and you'll be back to yourself in a jiffy.

Secondly, if you sense indigestion and gas, discomfort and bloating when the palpitations are present, try merely changing positions which often causes the distention to realign from its offending position proximal to the vagus nerve.

If you're pregnant, well indigestion or gestation. It doesn't matter. What's important to realize is that both conditions represent a temporary rearrangement and limited space downstairs. That means proximity or closeness to the nerve receptors of the VAGUS nerve and you're going to get palpitations when conditions are right.

As for the palpitations themselves, taking slow, deep breaths repeatedly will typically cause the palpitations to cease. Recall your anatomy lesson. The vagus nerve stimulates the lungs as well as the heart, so this purposeful stimulating of intention-breathing will often interrupt the irritation signal.

If you're experiencing tachycardia(racing heart), then if a fountain or bathroom is nearby, apply cold water from your hands to your face and while holding your hands against your face, press gently, repeat GENTLY, on your eyes. This will invoke what is termed the "dive reflex" and will cause your heart rate to decrease in most cases. Regardless, tachycardia, like palpitations is not harmful in of itself, just a bit unnerving.

The key in all cases is to do your best to remain calm and rational. Know from our little lesson what it actually taking place and that you'll be fine.

Finally, we'll save a lot of space here by simply stating that with regard to any of the conditions either described or that you're experiencing, do not substitute a support group for responsible notification of your symptoms to your personal primary care doctor. We live in an age where medicine is oftentimes scoffed at by many who fail to realize the benefits they expect. Yes, it's true that medicine is not a perfect science, but neither are human beings. It is difficult at best to create perfection from imperfection. But even so, we all must give recognition that many thousands of people are being cured of certain cancers that just a decade ago would have meant their demise. Simple penicillin saves hundreds of thousands in third world countries that would otherwise perish from infection.

So don't become discouraged that medicine doesn't find something wrong with you. Feel blessed that they don't have less encouraging news for you. I exist in an occupational environment where disease and illness is very concentrated. It is of great joy and optimism that I can walk from conditions such as those to the sanctuary of my private life and know that I'll return tomorrow.

You too, all of you, need to be thankful that your condition is benign and that you have the power of influence over its effects.

So kick up your heel, give a shout, grab the keys and your husband's credit cards with the highest limit and PREPARE TO SHOP! Those pesky palpitations are but a mere nuisance and you have the rest of your life to live, so get busy and do the voodoo that you do best!

best regards and good health. Feel free to write if you care to and I'll do my best to answer, but no promises.

and this is for all the attorneys circling overhead who strive for a willing plaintiff, or even an unwilling one.



JM said...

Hi Ali, this is a great post, thank you so much for sharing. I have mitral valve prolapse and have experienced everything described in this letter. I live with palps on a daily basis. Also, I think you blog is great.

Dianne said...

This is the most encouraging thing I've read on pvcs!! Thank you for posting!!

Ali said...

I'm so glad you found the article helpful. Keep the words close to your heart, and remember to live life fully.

Scharlene said...

Yes Ali this is a great article. Thank you so much for sharing. I also have Mitral Valve Prolapse, and there is rarely a day that goes by that I don't have palpitations.

Gina said...

Thank you, thank you for this article...informative and therefore very calming. This explains why I feel those pesky palpitations in my stomach and my throat! Darn that too playful vagus nerve! Stress does me in, and lately I'm done in a lot.

debikil said...

Thank you for all the info! Called my doctor today because my stomach has been killing me! And the PVCs - all day, all night - not a lot of sleep. So, I appreciate all the info! The right side of my neck started to hurt today, too, so I googled vagus nerve (knowing it was a cranial and right-side neck nerve), and there was your blog! Good info. I'll keep working on the breathing - hasn't helped yet, but I'm trying a different OTC GERD med, too.

PrestonsVintage said...

Great Blog I have suffered from svt since I was 14 Im 30 now. Just recently devolped vt. I have went without meds untill now doing the beta blockers. So far working great. Still get vt after I eat a large meal. Its too bad more Dr's dont know about this vagus nerve!

sallybroes said...

Very informative blog. I've suffered with irregular heartbeat and shortness of breath since gall bladder surgery last September. Sometimes the episodes are so bad I'm thoroughly exhausted by them. I'm wondering if this isn't caused by the stress involved. Caffeine and other stimulants seem to affect or bring on episodes so I've eliminated caffeine from my diet. At other times, I can't pinpoint a cause. This article explains so much more than my doctor did. Thank you.

robert JASON fagan said...

I just found this blog while searching for info on PVCs. Its always great to find a community of people who understand about PVCs, especially since I have never actually met anyone that suffers from them, aside from a sporadic one here and there. I have had PVCs daily for the past year and on and off for the last 6 years. I have had all tests and my heart is supposedly fine, except for daily PVCs...hmmm. Anyway, I avoid all known triggers, take supplements and a beta blocker without much success. I am trying to learn to live with them but it is not easy. Thanks for posting the article, it is very informative. I just wish doctors knew of a reliable way to stop PVCs safely, whatever the cause.

Sasha said...

Thank you very much for this post, it really made me feel much better, I've been suffering from Palpitations since I was 14 and I am 27 at the moment. I basically discovered my condition myself, and pushed the doctors to look into my stomach, after which a battle of about 4-5 years (while in college) Hiatal Hernia, and I knew that there was something strange and wrong with me but no doctor could ever detect anything.. I am very fit healthy and tall individual and really suffering from Stress / Anxiety Disorder in addition to bloating which I long ago realized that it's somehow associated with the palpitations that I am having.

I just hope that I can think a bit more positively about the state of health that I find myself in.

Thank you very much. I would love to learn more about how to treat and help the Vagus Nerve to relax itself a bit more.


Dara Smith said...

This is by far the best article I have read that connects the dots between anxiety, GERD and palpitations. I had never before read an explanation of why I feel the need to cough when I get the palpitations. I feel so much more at ease now! THANK YOU!!!

cassi said...

Awesome article. I have MVP too and the holidays have played havoc with my stomach (naughty foods, cider, no exercise, weight gain)and now I am having palps to the extreme - I made the connection that they are worse when I have a bit of gas and doing some research has led me to the vagus nerve - and now to this awesome article. I definitely see the connection. I cant see my cardiologist for a check up till next week but today I have taken the day off work and will be fasting and cleansing my tummy of the holidays, getting back to my no sugar diet and hopefully I will see some improvement.

A.Rose said...

Ali, can everything you explained also be true if you have episodes of atrial fibrillation?

bonnie said...

Wow what an amazing article! Ive had PACS for about a year and have done nothing but worry not sleep panicvand worry some more! This has mafe me feel so much better! Thankyou and well done :)

Delon Ridke said...

I've always felt that palpitations were cause by something else other than anxiety. I handle stress quite well even though that can be a silent killer along with my pre hypertensive condition.(Wink). I've been a paramedic and nurse for a number of years and that was always the diagnosis I received. I've had all the work ups ecg's, echos, halter monitors, etc... Given everything from zanax rx, with I never filled, to beta blockers. I will get palp's if I'm sitting and looking down or have my head resting to the side like I'm constricting my carotid artery or my Vagus nerve with my double chin. Lol. However when I look up or change positions it stops. As well as, more importantly, I can be looking down at my phone or reading and look up or away from the task at hand and pow, the palp's start. It seems it's when my eyes are not focusing properly and then refocus. I do need glasses for driving so I wonder if my vision is too connected to this nerve stimulation. This would explain a lot of things. If I lay on my left side it exacerbates it. So I have to sleep on my right side only. Which accounts for restless nights more often then not. I've always suspected the Vagus nerve from my own previous knowledge by my own studies so it's great to hear of someone giving their insight on this. This is the first time in almost 10 years that an article has touched upon this that I've come across. Where else does awareness and studies begin if we don't all comment and discuss all options. Even though self diagnosis is not key, trust me, how else is it going to be brought to the forefront if we don't challenge our medical direction. I believe these discussions will eventually lead to an appropriate treatment. Way to go doc!

Cabonia D Crawford said...

Does the Vagus Nerve show during the process of straining the neck? The pattern of nerves/veins and muscle tissue in my neck used to be symmetrical but no longer is.

Tiffany Woodland said...

This is a great article. I've been suffering with PVCs for 5 years now. I was recently diagnosed with a wheat allergy. The allergy causes bloathing and gas. I noticed once I cut wheat products completely out of my diet the PVCs disappeared. This article helped me unsterdand why I was having them so frequently. I'm a medic and will definitely pass this info to my anxiety patients experiencing the same problems. :)

Unknown said...

What a relief,i guessed it right,i knew that stomach instability because of excessive gas can affect the hearts rythm,and this "vagus nerve is the main culprit!!thanks a lot!!

Sydney Beltran said...

What a relief,i guessed it right,i knew that stomach instability because of excessive gas can affect the hearts rythm,and this "vagus nerve is the main culprit!!thanks a lot!!

deborah foord said...

Brilliant article...very reassuring Thank you!

Tracy Crispin said...

How do we know we aren't having A-Fib during a run? Which puts us at high risk of stroke...unfortunately holters have never caught my runs so I'm left wondering if these, which are different from my normal PVC's, are indeed A Fib

Unknown said...

It's so nice to see an article that explains the correlation with the vagus nerve to so many things, especially PVCs. I've always had a hunch, but found little to back it up. Both my GI and Cardio Dr.s won't even consider the idea. I've had them on and off for years, but they've come to be a daily part of my life for the last 2 years. During my halter monitors I'm anywhere from 18-28%, however benign. I've been recommended to have the cardiac ablation. Does anyone have an opinion on that? I'm a bit freaked out to have it done because it's a heart procedure and I'm only 43. And I'm also afraid of having it and it not working and then what. Any feedback would be greatly appreciated and hooray for this article helping people understand this better!

James Stewart said...

It's interesting that it's been suggested to you to have this procedure; I've had PVCs for about for years or so now, and I've been to a few doctors about them, and they've never, ever once mentioned surgery (or even medication for that matter). I don't want to scare you, but if they're offering surgery - a minimally-invasive one, to be sure, but still it is heart surgery - you should probably talk it over with them and find out why.

DoubleEmA said...

I'm 18 and have just recently started experiencing PVC's, I thought my heart was gonna stop on me when I first started having them! I have them now just at random times with no anxiety or indigestion and they're very uncomfortable! Take my breath away and stimulate the cough reflex! I read this every time I have doubts that I'm actually ok, nice to know I'm not the only one who experiences them.

Hayley M said...

When I experience irregular beats, I get a strange sensation in my neck and stomach. I've always suspected that there was a link with indigestion. I am 63 and had triple heart bypass surgery, eight years ago, but docs and cardiologists say these irregular beats are nothing to worry abouT. However, I always freak out when I get them, fearing that they will turn into AF. The last time I had AF was in December 2015. The article was so very helpful, and I will read it when the pals start, the morbid thoughts set in and I feel that I will explode with anxiety. Irregular heartbeats get me down so much, but the article and posts have really helped me. Thank you so much.

Unknown said...

Thank y for your article ....i have these symptomes since 2 years ago and finally discovered after the 2nd Endoscopy that i have hiatal hernia that cause GERD and vagal ner e irrotation

Unknown said...

Thank y for your article ....i have these symptomes since 2 years ago and finally discovered after the 2nd Endoscopy that i have hiatal hernia that cause GERD and vagal ner e irrotation

Unknown said...

I'm 38 and just had ablation in June (4 months ago). While it was not a fun procedure, it did work for me, and stopped my palpitations. I compare it to child birth- it is one unpleasant day of your life but then it's over and you can move on. My problem, however, is that about 6 weeks after the procedure I developed gluten intolerance. I landed on this webpage because recently I had accidentally eaten food with gluten and aside from the stomach issues, my palpitations started back up again so I was trying to understand if they could be linked. Based on this article, it seems like inflammation from a food intolerance could stimulate the vagus nerve and jump start my palpitations again.

Jumpyheart said...

Ablation is offered when the person is experiencing symptoms that interfere with your normal life and meds don't work. For instance, I took flecainide for 18 months to stop the PVCs but then decided to have an ablation procedure because the long term safety of the drug was too dangerous in my opinion and being off medicine I would feel dizzy, tired, and sick to my stomach, and all that then spawned a ton of anxiety (which had never been an issue for me before). So to be the procedure was a no brainer, but each person needs to make his own decision for his own situation.