Opinions.. Why do you think palpitations are so scary to patients?

[CollegeGirl143]

Ive noticed alot, and even the own forum doctors have mentioned, how patients presenting with benign palpitations are so afraid they are dying, and yet the seriously ill patients with prior MI's or are at very high risk, dont worry about this at all.. Does any one have any personal insight or opinion as to why this may be? Its always made me wonder..

[Barbarella]

Dr. Claire Weeks

[anacyde]

I'm going to say something that's probably not going to earn me the popular vote.  By no means does this apply universally, but it definitely applies in my family.

A lot of people who develop CAD don't care in the first place.  They eat the wrong things, smoke cigarettes despite the risks (and often continue to smoke following their heart attacks) and don't exercise.  Thus, having a serious illness doesn't typically prompt such people to care much more than they did before.  As I said, I'm not saying all CAD patients are this way, and I don't mean to offend.  I recognize that some people DO everything right and still become ill, but those are also the ones who do have concern about their health and DO make positive changes and have fears and concerns, rightly so.

Now, PAC/PVC sufferers tend to be more anxious and/or in tune with their bodies anyhow.  They notice these things without medical intervention because they're paying attention and care what it means.  Hence they're naturally going to care more than someone who learned they had them but never noticed.  People who take care of themselves and/or are anxious typically fear negative consequences more than those who do not, so unsurprisingly, we fear these more.

The other thing is the unknown.  I think the very common fear among sufferers is "what if my heart skips and skips and just flips out and keeps going until I die?"  There was an amazing post on that one time, where one of the doctors explained why that won't happen.  If I find it I will repost it.

[Ccck]

Palpitations can be caused by excessive adrenaline, which can cause you to feel all scared. Adrenaline is the flight-and-fight hormone after all. That's why patients with Pheochromocytoma (a rare adrenaline producing tumour) usually have feelings of doom, especailly when they get their palpitations. It's an affect of the hormone.

[Ccck]

Palpitations can be caused by excessive adrenaline, which can cause you to feel all scared. Adrenaline is the flight-and-fight hormone after all. That's why patients with Pheochromocytoma (a rare adrenaline producing tumour) usually have feelings of doom, especailly when they get their palpitations. It's an affect of the hormone.

[liamn56]

Would you please let me know what the authors name is that wrote the books on anxiety
Thank you

[PghPanther]

Okay...whenever I get a PVC or two.....PACs or any kind of palp.......I hate it because I suffer from lone a fib of the vagal type...

Now I can control it with diet and lowering the intensity of my exercise.......

But when I get these palps usually when I lay down or after eating (mostly breakfast as it is my biggest meal of the day) they freak me out because a few lengthy violent a fid episodes started with those buggers coming in a row and then bam!....I stuck in 4 hours or more of irregular mice fighting inside my chest........and if it comes at night then no sleep and I miss work........I have to practically sit up to sleep......and every darn drug they give me makes all the palps far worse!

So........PVCs don't brother me....its what they could signal or turn into for me....that really worries me...

and the more afib episode attacks you have the more it could become permanent and also begin to alter the form of your heart leading to heart structure issues.......I never get A fib without having those palps as the instigators of it....

So there is reason for them to be scary for me........

[CollegeGirl143]

Yea its very interesting! and i think if we could figure out WHY, it would help so many..I think theres definatly something here that would turn into a great study in the psychology/phsychiatric field.

[fearfactor]

I know...it does seem like so many people are absolutely TERRIFIED of their palpitations.  I know, because I am one of them!  Maybe we are "hard-wired" somehow to be attuned to problems with our hearts, because it is such an important and vital organ.  I also have severe headaches, and when I get one, I don't go into panic mode and start thinking it's a brain tumor, an aneurysm, etc.  But when I get a palp, it automatically sends me into terror.  That is very odd...it seems to be quite unique to the experience of palps and is very interesting.

[fwilson4]

For me, the intensity of the fear was proportional to the intensity of the pain, modified somewhat by the frequency of the pain and the latency from the last pain stimulus.

I think it is a classic pain adaptive behavior.

[CollegeGirl143]

Thats another interesting perspective.. I know alot of patients complain of some kind of chest discomfort with palpitations, whether it be mild or severe.. I wonder if these feelings of pain from the palpitations repeaditly is enough to induce some kind of secondary mental trauma, then at the same time that leaves the door open to the idea that just the fluttering feeling in itself may be traumatic..

We are told from a very young age our heart is our most important organ..It doesnt suprise me at all palpitation patients are concerned about their hearts..What concerns me is where the intensity is coming from in some of the patients.. In my own personal experience with palpitations, i know that fear for me was blind and i couldnt rationalize it, but i was still irrationally scared to death.. I want to know where that comes from. I think it could help many people.

[Barbarella]

My grandma was born in 1886, NOT 1986

[Momto3]

I completely agree that despite any internal, external,environmental or other factors, each patient should be considered as a whole person in need of answers.

I have a doctor who says that each time a new patient arrives in her office, she considers him/her as a special package (gift) to open.  You can begin by reading the card (chart), untying the ribbons (listening to the patient's symptoms, and learning as much as you can about the contents.  She said that it makes every patient special! What a great way to meet a new doctor -- as if you were a gift, something very, very special!

[Barbarella]

Because of the way I was treated either no understanding at all, or scaring the hell out of me as I stated in my post above, or humiliated (see post above) or making fun of, or just brushed off with a 3 minute visit because of that I stopped going to doctors for 8 yrs.  I could not take it anymore, not understanding my phobia, I came to the point that I was willing to play Russian Roulette with my body/health that is how bad it became.

I stopped it all.  No more visits not even to the Gynecologist, ALL doctors, everywhere where there was a BP measurement involved I did not go.  Only to the eye doctor, I thought no BP measurement, so I thought.  At one particular eye exam the eye doctor found a small bleeding blood vessel in the back of my eye, and went and got the blood pressure cuff, and I got so high anxiety that my BP shut over 200 again.  I could not leave the office until the BP was 170 syst. which was still way to high, but I told her that it wont go down until I leave her office.  She urged me to see a Cardiologist, she too never heard of my phobia. BTW, the bleeding blood vessel was from high blood pressure.

I made an appointment with a Cardiologist and the rest is history as I stated above what he said/did and "why" he understood.

But because of this no understanding and unprofessional behavior, scaring me instead of trying to take the fear out of me I gambled with my health for 8 yrs by not seing any doctor.

[Pepperliveson]

Sometimes it can be the "life context" of the patient.  In my situation, I was diagnosed with familial hypercholesterolemia when I was very young (5 years old).  I was diagnosed after my Dad had a heart attack at 45 yrs old - I inherited it from him.  Unfortunately, my Dad did not take very good care of himself - he wouldn't take his medicine, wouldn't go to doctors, continued to smoke and eat whatever he wanted.  I lived in constant fear that I would lose him as did my Mom and sisters.  When he was 60, he had to have quadruple bypass surgery as well as carotid bypass surgery (he passed out at the dinner table) - it was a very scary time for all of us.  I was the closest to him so I was his caretaker during all of this.  Unfortunately, all of this took a toll on me and I started to worry that this was what in store for me in the future.  He came through the bypass surgery but began to smoke again as soon as he could take a deep breath.  We again lived in fear of losing him to heart disease and I felt helpless.  8 years later at the age of 68 he developed endocarditis (infection on his heart) following a dental procedure.  He didn't tell me he was sick until he was very sick.  We took him to the emergency room and they transported him to Boston immediately.  Because the endocarditis was so advanced, they had to do valve replacement surgery on him.  Unfortunately, he was over anti-coagulated and had a massive cerebral hemmorhage during the surgery.  He survived but was paralyzed on his right side as a result.  This was devestating to him and to all who loved him.  It was very difficult to watch.  He never really recovered from this and died about 9 months later from a heart attack.  During this final period in his life, I was his constant caretaker.  I continued to worry that things like this were in my future although I have lived my life very differently than my Dad.  The trauma of losing him the way that I did has stayed with me.  I loved him more than anything in the world.  Fast forward 7 years - following a very stressful time at work, I developed PVCs.  I have had them for 4 years and I have learned to accept them.  But for me, the feeling of a PVC was particularly scary because for some reason, it brought back memories of my Dad and all of his struggles.  It was a reminder of how devestating heart disease can be and a reminder that I carry a higher risk even though I clearly understand that my PVCs are benign.  When my heart skips around, I seem to relive some of the bad times - I wish I didn't but I do.  I guess anything heart related is difficult for me.  So I wonder if some of the people that are very afraid of palpitations are afraid because they trigger a memory.

[Barbarella]

YES, YES, YES to your very last question.  I was hospitalized for one solid year at the age of 3 because of severe TB that almost killed me, that was before TB meds.  I did not know and understand why I could not go home to be with my family.  Ever since then I developed a phobia of doctors and hospital.  My mom told me that when I was little and she had to take me to the doctor the first thing I said was "will this doctor send me to the hospital again"?  My mom said "no" but even at a very young age like 4, 5, and 6 I already said to my mom "but what if they will find that I am sick, I then will have to go to the hospital again for a long time".

You see, the "what if" and "what will they find" stayed in my head all through my life.

Then there was my grandma.  She was born in 1986, and when she started to have high BP later on that was still before BP meds, home monitors, holters etc, she never even got an EKG that I remember.  Her blood pressure at times got so high, she got short of breath, her face beet red, the whole nine yards.  I  remember seing her walking around with her hand on the left side of her chest saying "I wish these heart pains would go away"   All the doctor ever gave her were some "drops", herbal stuff or whatever.  I was 10 yrs old at the time and took care of her because my mom worked full time, my Dad took a hike when I was 6, they divorced.  I took care of my grandma when she was sick.  She used to say "hurry, hurry get my drops, my heart is beating out of my chest". My own heart started to pound like a maniac out of fear she'd die.

When I walked home from school my heart was pounding whether I would find my grandma dead.

That and the one year in the hospital causes/caused my phobia. I found this out on my own, no Therapist or shrink agreed with me that these are the reasons, but I know better.

BTW, my grandma despite her severe high BP at times and heart problems died in her sleep at the age of 83 from cancer. She had these BP and heart problems for 30 yrs.

[Al Dente]

This is an interesting question, and I think alot of people have hit on some very good reasons.

I think it is important to look at people, even if they smoke or have depression or anxiety problems with heart conditions, as heart patients.  They shouldn't be looked down upon, or treated poorly because they smoke--most likely they want to quit, given that nicotine is next to heroin in terms of addiction.

Heart patients might not pay as much attention to skips, but it is something in the back of their minds.  The real question lies in that doctors don't even know what causes these nasty skips, so it begs the question as how can they dismiss them so quickly....there lies a major issue.

PVCs and other arrythymias in people with structurally abnormal hearts including coronary artery disease do have risk.

People that have skips that have had family members drop dead on them from sudden heart attacks question this even moreso.

Cardiologists want to treat the easy cases--obvious blockages, defects, etc.  These are the garden variety cases.  It takes a cardiologist with interest and dedication to talk with the patient and walk through their symptoms, rather than a terse, "you're not going to die" reply.

Patients will further have questions and anxiety once they are told, not to worry and they keep having symptoms--this will keep rolling like a snowball until a person comes to grip, gets better/worse.

[Pepperliveson]

I can really relate to what you have gone through.  Once they found out that I had FH, I had to go to Boston Children's hospital every month to have my blood drawn and other tests done.  Childhood is such an impressionable time and those things stay with us.  The fear of losing someone you love is very powerful.  I think it's very difficult to unlearn fears that were set in place at a young age.  

[CollegeGirl143]

This is very interesting to me.. I really want to see what part of the brain is active immediatly following the palpitation.. I think figuring out exactly what physical reaction is happening and WHY its happening (whether it be triggered memory, predisposition to anxiety or depression) could greatly help patients suffering from obsessive thoughts and anxiety due to the palps.. Imagine if medicine could identify exactly the reactions happening in the brain that are causing patients to obsess on this one thing, how many people could be treated through medication or CBT and be spared so much grief.. Palps would only be the start!

Thanks for everyones input! Ide love to see more if anyone has anything else to add

[fearfactor]

I think your idea for a study would be great.  I am a sufferer of health anxiety and have PACs and PVCs.  I guess what scares me most is the thought I will go into atrial fib.  The idea of atrial fib seems horrible to me because it could go on and on for long periods and be incapacitating.  I realize I probably won't drop dead from these things, though I thought I would for a long time.  Now, it's just the idea that they will be incapacitating.  I worry I will develop bigeminy, a-fib or even just frequent palps and my fear will get so bad and I may even be physically incapacitated, unable to work, to be with my family, to have a life.  To think I'll be an invalid and just have to sit in the house and/or go to doctors and hospitals all the time (I hate going to doctors).  That is just a look into the thoughts going through my head when the palps start.  Hope it's enlightening in some way!

[CollegeGirl143]

Ugh i know!  Ive been there!! And being there didnt help me figure it out either! Just being on the otherside of that horrible part of my life made me realize how much needs to be done to help people suffering from these things mentally as well as physically :)

[fwilson4]

In my case the fear fell into two categories.

First, my PVCs caused severe pain.  Pain is an unpleasant stimulus and thus a fear of the trigger of that pain is a natural reaction.

Secondly, my aforementioned belief that PVCs are a marker of more serious heart troubles causes a desire to avoid such consequences.

[kitcurious]

As you know, my son has over a thousand PVC/PACs a day, anyone listening can detect them, and he doesn't notice. His heart is not structurally "normal" (exactly) but he isn't on meds, is fully informed and doesn't worry about them.

The FACT of them isn't the problem for people, it's the sensitivity to the sensation.

The cardiologist is out of the picture (or in an ideal world ought to be) once there is nothing determined to be wrong with the heart. They cannot explain exactly why people behave differently in response to their bodily sensations, no.  

If people read up on the biology of stress they might discover some things they find interesting and useful.

We also don't address the people who have these screening heart exams, pass them with flying colors, and do NOT become obsessed with their hearts. Reading the boards is highlighting a subset of patients who are particularly disturbed by them. What do the people able to accept have in common ?

Often, the doctors try to give stressed patients something that may diminish their symptoms, rather than tell them they have anxiety, because many patients cannot adapt to the sensations and insist it's caused by some disease. Since everybody gets some ectopics, the causes are either numerous or common and, except in rare instances, ultimately not indicative of a disease. It seems the more honest the physician is with the patient about the topic, the worse response they sometimes get.

At some point, the continued pursuit of a medical problem may involve injured pride and dignity as well.

Making light of it, as some doctors do, (however tempting it may be) may work with some people but offend others. The internalized anger after taking offense may only make the person more likely to continue to concentrate on the topic, to seek validation.

Emotional needs are very powerful and legitimate too.

[Momto3]

I thought about that, the addiction part.  I would agree that it is probably the reason people ignore the warnings. But, some of theose same people are TERRIFIED of palps despite the doctor's reassurance. I can't figure out why.  If you REALLY thought something was wrong with your heart to the point of chasing down doctors for risky treatments, why would you continue to smoke?  Of course, there's where the addiction cycle kicks back in....definitely a tough one.

My dad had a similar experience to your husband...only his was a heart scare.  At 48, he was in the ER with chest pains. The doctor asked him if he smoked.  My dad said, "Yes, I do."  And the doctor said, "You did."  He had always told us he would quit if the doctor told him to. I guess he wasn't going to do it on his own though.  The ER doctor's words (and the chest pain) were enough for him - he was one of the lucky one who was able to quit even after smoking for about 25 years. Like your husband, my dad still craves a cigarette now and again, but he says he's not sure he wouldn't start up the habit again. So he refrains. I'm so glad to hear that your husband was able to kick the habit.  Kudos to him!  I can't even imagine how difficult that must have been.  

What's interesting is that since my dad's bypass about 9 years ago, he worries a LOT less about aches and pains, palps, SOB, etc. He does as the doctor tells him and lives his life. Before the surgery, he worried about a lot more!  

As for doctor's having a better understanding when they can relate to the problem, I agree.  I think that's probably true for all of us...I know it helped raising 3 teenagers...I could look back and remember how things were when I was growing up and it helped explain why they did the things they did...hahahaha

Collegegirl -- You're onto something here!  GREAT research project idea!! You're gonna do just fine with medicine :)

Have a great day everyone!

[Barbarella]

Could it be because cigarettes are an addiction?  People know what cigarettes can cause yet they can't stop just like drug users, and unless they get help can't quit.  I know some of them can quit cold turkey but many can't.

My husband tried for many years and always start smoking again.  He smoked 4 packs for 45 yrs.  Four yrs ago he had a lung cancer scare and the Lung Specialist told him if he doesn't quit smoking it will turn into lung cancer.  He had a benigh nodule on his lung.  Even with that lung cancer scare it took one year of pills (Welbutrin) for him to stop smoking, and he tells me several times a week he dreams about wanting a cigarette, smoking a cigarette, two nights ago he dreamed that he bought 4 cartons of Marlboro, and this after over 3 yrs since he quit smoking.

I guess if you have a severe addiction you can't quit, no matter how many warnings, people keep on smoking and worry more about palps unless they get help to kick the smoking habit.  Its a very rough road.  I never smoked but I witnessed my husband what he went through, the urges, the shaking of his hands because he wanted a cigarette so bad.  Nicotine gum did not take the urge away only the Welbutrin but not 100% he still got the shakes.  And working with co-workers who all smoke does not help either.