Really worried about irregular heart beat

[joeg]

Dear Doctor,

I'm 32, male. Four months ago, I felt sharp chest pains. I was panic for worrying about having a heart problem.

I went to see my doctor, and every test (EKG and X-ray) came out normal. He told me it was anxiety, but he would schedule me
for a stress test.  But I was still worried.  After about 2 weeks, I started to notice having early heart beats, at some time, I had about one early beat after every 5-6 normal beats.  I then went to see a cardiologist.  He also heard the early beats, and scheduled me on a Thallium and Echo tests.  Both tests
came out OK.  The report says there was RARE PVC in stress test as part of the Thallium test.  Though I did see many irregular heart beats on the screen during the Echo test, but the Echo test report didn't mention it. Why? After the tests, the cardiologist told me I should not worry about it, even though sometimes early beats may happen more freuently.  Now, after about 2 months, I have noticed I have more frequent early beats, every day, especially at night. Sometimes, there is an early (sometimes like skipped) heart beat in every 1-2 normal beats and that happens 3-4 times in a row. Whenever I have those early
beats, I would feel fluttering my chest. I am really worried.  

My question is: should I worry about those early beats even the doctors said my heart was normal after the Thellium and Echo tests?  There are times the early heart beats are much more frequent than the time I did those tests, so the tests may not catch everything. Is that possible? Do I need to see the doctor again?

Thanks a lot!

J

[CCF-M.D.-CRC]

Dear J,
Echocardiograms do not evaluate the electrical system so an "extra beat" would not change the echo report. Probably the best test to get at this point would be a 24-hour Holter monitor.  This is a 24 hour recording of your heart's electrical activity.  The number and type of extra beats can then be determined.  

In general, extra beats are benign in a normal heart.  However, if they are bothering you treatment may be indicated.  The first line therapy is usually medications such as beta-blockers and occasionally antiarrhythmics.  If these fail or if you want to avoid life-long medications a ablation procedure may be your best option.

[arthur]

Early beats with everything else normal is always tough to swallow...you'll probably see a lot of posts herein describing a  similar condition.  If all that's wrong are the skips and your doc says they are benign, believe it or not, they are benign.  He should also tell you they are a pain in the a**, but you probably figured that out already.

In my case, they showed up a couple of years ago along with something less benign, bouts of paroxysmal atrial fibrillation.  So in my case, my anxiety was boosted big time, since PACs and PVCs seem to herald the onset of PAF.  I had an ablation and the AF is gone, but the PACs remain...and after 1.5 years, I have actually gotten used to them (even at a clip of several a minute).  No more anxiety...I just had to put them out of my mind and stop them from running the show.  This was not easy, and the first step I found most useful, was to stop checking my pulse.  Once I achieved that, I became much less aware of skips.

Good luck!

[MennieBeats]

Has anyone here read PHOBIA FREE and SMART BUT FEELING DUMB by Harold N. Levinson MD?  Levinson links inner ear damage to panic attacks and a host of other neurological fallout, including arrhythmia.   Evidently, in evolutionary history, our brain grew out of our inner ear system.  As such the inner ear (vestibular system) is highly integrated with CENTRAL NERVOUS SYSTEM.  If the CVS (Cerebella Vestibular System) is damaged by 1) viral/bacteria (colds, flu, viruses, sinus infections, 2) trauma (head injury, whiplash, neck injury, blows to the jaw, explosions that blast the ear, TMJ, concussions) or 3) toxins (metabolic problems, poisons, hormonal imbalances) our entire nervous system can go wacky while the inner ear is trying to "balance" the CNS.

Dr. Bill Yates (along with about 17 other ENT's) has written a book called Vestibular Autonomic Regulation, which ties the vestibular (inner ear) system to our CNS system.  This includes the respiratory and cardiovascular systems.

Few doctors start checking the vestibular system when you have arrhythmia.  

It’s no coincidence that benign arrhythmias and panic attacks and “psychiatric” problems are co-morbid.  They appear to be cause by the same thing!  VESTIBULAR DAMAGE.

Hyperventilating so that you get muscle twitching, skipped heart beats, panic attacks, motion sickness…all caused by the same thing.   Severe fatigue, concentration problems, and sensitivity to light can also be caused by inner ear damage.  In my opinion Chronic Fatigue Syndrome is nothing more than vestibular damage.  Chronic Fatigue Syndrome has all the “ear’ markings of chronic vestibular damage, including ringing in the ears and balance problems.

I was going to write Bill Yates and ask him what to do about my one thousand neurological complaints, since he wrote a book on the subject, but noticed he is only a researcher. He doesn’t appear to be a medical doctor who gives health advice.  Levinson, on the other hand, suggests medications in his books, and say he has had good luck with them.  But medications  aren't fixing my problems which seem mechanical(TMJ and neck injury).  I've seen 34 doctors/dentists over the past 20 years and they haven't helped much either.  Things only seem to get worse and worse as more screwy CNS symptoms are added.

I'm putting this down so that you have something else to consider when you have arrythmia...vestibular damage.

[pikamom]

Hi. I can tell you are quite concerned about your heart beats. You could ask your doctor if a medicine could help control them. I started noticing PVC's in my middle twenties, my stress levels and caffiene consumption were high. But my family doctor reassured me the early beats were harmless. Then a year ago (I'm now 37) I had my first episode of tachycardia/angina. Had the tests, EKG changes led to an echo and stress test. Everything came back normal except the PVC's were noted. The cardiologist gave me nitrostat to use for the angina and recommended a catheterization. I didn't have the test but continued with racing heart, chest pain, short of breath. Then just three weeks ago the symptoms were so bad I thought I was having a heart attack and my husband took me to the hospital where they said by my blood test I hadn't had one yet but my very abnormal EKG indicated I could have one. I had an emergency cath that revealed a normal heart. The cardiologist then told me that my EKG would be worrysome in someone with an underlying heart disease and that's why he pursued the test. He says I have an electrical problem causing almost constant tachycardia that left untreated could result in a weak heart. Also he feels the angina is a coronary artery spasm. So, he prescribed cardizem which will treat both problems. The reason I'm telling you all this is that the PVC's I've had for years are now gone! It has to be from the medicine. It's cardizem CD, you just take it once a day. Ask your doctor about it and see if it's right for you.

[arthur]

The comments re. disturbances of vestibular autonomic regulation as being a possible cause of arrhythmia are quite interesting.  I'll be sure to check out the literature and your references.

I'm interested because I was convinced that a viral infection of my inner ear had somehow precipitated a series of events leading to PACs and even PAF.  I know that these arrhythmias are produced directly by PV foci, however, if I always had these PV foci, what exactly "uncovered" them?  I recall having a prolonged viral infection of my right ear...with an extremely odd presentation which made music sound very dissonant for weeks.  Weeks later, this was followed by a bout of PAF and a growing number of PACs.  In the same period I experienced very odd, slow, undulating "twitches" of my abdominal muscles.  All this suggested to me, was that something was travelling downward from my ear.  Months later, I was left with a constant inner "buzz" (centered in the chest, not ectopic) and PACs and PAF.  So, I am of the opinion that a viral factor entered the scene early on, and set up the conditions (affected some part of the nervous system)  which allowed the PV foci to disturb my heart rhythm.  The only problem is, not a single doctor has taken this progression seriously, not even several ENTs.  So, thanks for the post.  I'll definitely check out the scientific literature as well as your references.

[Mr. Know it all]

Since the tests were normal, it appears you may have a deficeny in magnesium and potasium, these vital nutrients regulate the electrical activities in the body and too little will cause pvc's and other symtoms.  Dr's today are trained to sell drugs from the pharmicutical corps and would never prescribe a cheap mineral to cure you. I had pvc's, eye twitches, sometimes discomfort in my leg bone, intermittent racing heart for a few minutes, it all went away when I began taking magnesium/potasium suppliments, I cut out using Tums for sour stomach, they loaded w/calicum, too much no good. it may take a few days to work and upto a month to replenish your bodies supply of mg and potas.
***@****

[arthur]

Mg is well-noted for its use in re-establishing sinus rhythm in individuals with Mg depletion.  The mode normally used is IV.  The stuff you buy in stores is usually a relatively insoluble salt or admixed with other minerals, and as a result, tends to get flushed out of the system before it can do any good.  What form of Mg do you take and how much per day?

[Mr. Know it all]

I suggest purchasing the very best magnesium and potassium you can get your hands on, Solarray magnesium and potassium with bromelain is good. the bromelain helps to absorb these nutrients. a little birdie told me the FDA may raise its recommended allowance. to 700mg for magnesium.  Keep in mind that serum level and intracelluar levels of mg may differ and only a handful of MDs know which labs offter this type of test
***@****

[arthur]

You still did not specify the form of Mg you are using.  Is it a soluble salt like magnesium acetate? or glutamate? or what?
And How Much....are you taking (mg/day)?

I know that serum levels will be different from tissue levels...it's the big hook that puts the doubt in those folks that want to believe that Mg may be the problem inspite of normal serum levels.

"Solarray magnesium and potassium with bromelain" doesn't tell me anything.  Is Solarray a name brand of some kind?  What's the story with bromelain (it's a mix of protein-digesting and milk-clotting enzymes generally derived from pineapples)? How is that supposed to help you?

[Sam R]

Minnie:
      I've got some oceanfront property in Arizona I'd like to sell YOU !!

[arthur]

Don't knock it till you tried it.  I just started up a search of the medical literature re. the vestibular autonomic system and arrhythmias.  There surely is a relationship, however, I haven't given it a fair shot yet.  The problem is, that the autonomic nervous system(s) plays a large role in how susceptible the heart is to rate changes and arrhythmia brought on by PV focal noise.  The whole subject is difficult to follow or understand for the non-medical scientist, since there are relationships established between separate nervous systems in a ying-yang kind of way (eg, efferent/afferent; sympathetic/parasympathetic) and many of these systems have trunk lines running down from the brain stem along the esophagus and around and behind the heart...so who's to say what's really going on when they start talking to each other?
This is almost as much fun as believing a magnesium deficiency explains everything.

[Sam R]

No offense intended,  however,  did you read her entire post?  She blames everything from baldness to cancer on vestibular damage.  Also,  she has been to 34 MD's.  THIRTY-FOUR!!  Where the hell did she get the time to go to 34 docs?  Sounds like she needs a job or a hobby.  Perhaps she can take up curling and try for the 2006 U.S Olympic curling team.  Anyway, the part of her body that needs to be examined is NOT her ear but slightly higher!

[arthur]

Just remember the ole saying, "... just because you are paranoid, doesn't mean there's no one trying to get you..."

[MennieBeats]

VESTIBULAR AUTONOMIC REGULATION
CUTTING-EDGE INFORMATION

… new and exciting investigative area emerging from recent data suggesting that the vestibular system contributes to the maintenance of stable blood pressure and respiration during movement and postural changes. While it has long been known that vestibular disturbances can result in motion sickness, these new findings link vestibular dysfunction to autonomic disturbances, such as orthostatic hypotension, and to psychiatric conditions, such as agoraphobia.

Vestibular Autonomic Regulation begins with timely reviews of the vestibular system and respiratory, cardiovascular, and autonomic control.   It then discusses the basic science and clinical implication of vestibular autonomic integration, elegantly uniting both areas.  This is an excellent multi-authored resource for scientists in neurobiology, vestibular physiology, respiratory control and cardiovascular regulation, and clinicians in neurology, internal medicine, otolaryngology, and military medine.

Authors - Bill J.Yates, Ph.D. and Alan D. Miller, Ph.D.

[MennieBeats]

I don't know about baldness, but cancer my be caused by vestibular damage in some instances.....

THE VESTIBULAR SYSTEM AND THE IMMUNE SYSTEM

Laryngol Rhinol Otol (Stuttg) 1985 Jan;64(1):1-8
Immunopathology of the inner ear.
[Article in German]

Arnold W, Altermatt HJ, Gebbers JO, Pfaltz CR

It has been shown in animal experiments that the production of autoantibodies against inner ear components is associated with morphological and functional changes of the inner ear. The human endolymphatic sac releases secretory IgA into the lumen. Its epithelium contains (intraepithelial) lymphocytes, whereas lymphocytes, plasma cells (IgA, IgG) and macrophages occur in the perisaccular region. In this manner, the inner ear has its own immune system, which can possibly react independently of the systemic immune system.
____________________

ORL J Otorhinolaryngol Relat Spec 1987; 49(5): 225-233
Experimental immune system of the inner ear.

Harris J P, Tomiyama S.

The experimental evidence that establishes the operation of a distinct inner ear immune system is presented.
___________________________

Acta Otolaryngol (Stockh) 1997 Jul; 117(4): 501-504
Autoantibodies in inner ear disease.

Soliman A. M.
The present study was conducted to determine whether patients with inner ear disorders produce antibodies that may be pathologic to the inner ear or result from its damage.

[arthur]

Take a deep breath.

There's absolutely no connection between a nervous system disorder to cancer.  

We are wise to your use of cut and paste tactics, no doubt plagiarizing commentaries and taking them out of context, just to amaze us inbreds with your profound insight.

Regardless of your over-zealous state, I will continue to plod through the scientific literature and follow-up on your statements re. the potential role of inner ear autonomic tone in cardiac arrhythmias...thus far, the connections seems tenuous (even after checking out the good doctor Yates' latest publication)...since the autonomic regulation of the heart is generally confined to rate control.

[cuteyNca]

OK I KNOW U HEAR THIS ALOT BUT IM REALLY AFRAID. SAT NIGHT I HAD A FEW DRINKS HAD A HANGOVER SUN. NO PALPS. MONDAY MORING I STARTED GETTING THEM PRETTY BAD THEY SETTLED DOWN BY THEMSELVES AND A KLONIPIN. TUES. WHEN I WOKE UP I AHD THEM SO BAD EVERY 2 AND 3 BEAT I CALLED 911 AND THEY CAUGHT THEM TOOK ME INTO THE HOSPITAL AND DID ALOT OF TESTING. CK CAME BACK NORMAL SO NO HEART ATTACK BUT THEY CAUGHT OVER 2000 OF THEM IN 5 HOURS. THEY SETTLED DOWN A LITTLE WHEN I WAS HOME. I HAVE BENN HAVING SOME TODAY NOTHING BEFORE I DID MY 2MILE EXERCISE PROGRAM AND THEY STARTED UP  AFTERWARDS. OK I AVE HAD PVCS ALL MY LIFE BUT NOTHING LIKE THIS. IM 33 IN GOOD CONDITION EXERCISE ROLLER BLADE TRY TO EAT RIGHT. NO CAFFINE AND I DO SMOKE ABOUT 5 CIGS A DAY. I HAVE HAD EKGS, STRESS TEST WITHAND WITHOUT THALLIUM ECHO AND 5 HOLITORS WHICH MY LAST ONE WAS GREAT NOT A SKIP. SO WHY NOW OUT OF THE BLUE I HAD SURGERY ON THE 21ST OF JAN ETOPIC PREGNANCY DIDNT HAVE A ONE THRU AND AFTER SURGERY? OK THEY DID MENTION MY POTASSIUM WAS A LITTLE LOW THEYGAVE ME A FEW PILLS. IM AT MY WITS END THEY SCARED ME AND I NEED TOKNOW WHAT TO DO KNOW. GO BACK TO A CARDIO OR MAYBE A SHRINK..OUT OF ANSWERS IN CALI...DAWN...P.S. I HAVE 4 KIDS THAT NEED ME AND I DONT WANT THEM TO FIND ME DEAD.. WHEN DO I NEED TO WORRY ABOUT A CHANGE THEY SAY A CHANGE IN WHET I HAVE HAD THE WORST.

[arthur]

It sounds like your PVCs (or PACs) have increased to the point they bother you a lot.  I am not a medical doctor, but if you check out these posts you'll find that most would recommend you find an EP (a cardio specializing in electrophysiology) and have yourself checked out by him/her.  It would appear you have enough data accumulated, so just ask your cardio for a recommendation to an EP for further evaluation.

If all that's cooking here are skips (I get 0-6 / min every day), then you need to figure out if you can live with them, use meds or qualify for an ablation.  Again, if all else is normal, then skips won't kill you, but they will annoy you...to the point of getting an anxiety or panic attack, which makes things worse.
It's easy to say take it easy...I know...so get advice from an expert (EP) and go with it.

Good luck...

[Roys]

Just so you know you're not alone, I've gone through several 5 hour stretches with as many as 5000 PVCs. Like you, they can't find anything wrong but it sure is hard to ignore them. I've had all the tests you listed plus a catheterization. For me, exercise usually reduced them for a while. Hopefully, they will go away. If not have an EP study done.  Good luck!

[Jacobus]

I took amiodarone for one month for PACs and PVCs.  Although it worked at first, at the end of a month it was no longer working, and the side effects were kicking in.
I used magnesium, 1000 mg a day, and the arrhythmia went away.  Honestly, I don't much care if it is psychosomatic or whatever; it works for me.
Sundown Essential Magnesium which provides magnesium as an oxide and gluconate works well.
Spring Valley Natural Magnesium with Chelated Zinc which provides magnesium as an oxide doesn't work for me.

[LaurieD]

I HAD to post in regard to Minnie's comments on the ear thing. I think....that like the rest of us she is desperate to find a cause for these horrid things. God Bless her for at least trying. Maybe there IS some credibility there. Good luck Minnie and thanks for posting! Laurie

[Mr. Know it all]

Magnesium Oxide is the least expensive form of magnesium, I suggest using Magnesium aporates or Gylcinate, also check out this site about Magnesium and its connection to heart disorders
http://www.execpc.com/~magnesum/cardio.html#FACTORS

thank
***@****

[arthur]

Frostbite Falls....very very funny.  Now let's hope that everone else thinks it's funny too...it would go a long way to lowering the levels of anxiety folks are feeling, especially those living just outside the city limits.

[Sunnishine]

Anyone ever hear about irregular heartbeats connected with acid reflux? I have both, and sometimes I feel that they are connected. Sometimes eating food or taking an antacid makes them go away. I have already seen a doctor about my irregular heartbeat and he says that it is harmless. I was taking Prevacid for my acid reflux but that made it worse (I think my reflux is caused by a lack of stomach acid, not an overabundance). It sure makes me feel better to read all of these posts about other people who have my same problem. At least I'm not alone!

[arthur]

There are many posts re. the connection... folks often complain of PACs (premature atrial contractions) associated with bouts of upset stomach (GERD, acid reflux).  Docs don't have a clean explanation as yet, however, there are indications that there is sufficient crosstalk between the nervous systems running around the stomach/esophagus and the heart to suggest a nervous system cause.  PACs are often the result of isolated cardiac tissue firing off noise...these foci can get aggravated by certain foods, positional changes, exercise, excitement, even the process of digestion...as all these activities result in the release of agents affecting the nervous system and the intensity of focal firing.  It's definitely complex.

There's even a case where SVT and AF were precipitated by swallowing...a reflex action involving a couple of nervous systems running down that trunk line along the esophagus.  That problem was solved with ablation of the focus responsible.

[Dancing Heart]

Hello, reading your comments have really brought some comfort to me...I was diasnosed 20 years ago with MVP (Mitral Valve Prolapse).  I was having severe heart palps and have suffered with them for 25 years...and when I say suffer I mean suffer not only physically but emotionally from them...I also had panic and anxiety attacks, which I believe were helped along by the Dancing Heart...I have worn holter monitors, had stress test and EKG's and Echo's..my Dr. assures me they are benign tho annoying...
I find that they are extremely severe during my monthly hormonal time...
Has anyone experienced that?  I have tried several beta blockers which haven't helped.  My Dr. suggested something called Toporal???  I have not tried it as I am not big on using meds...I don't use any caffeine, don't smoke or drink....
I get lighthead, dizzy and extremely nervous when these attacks hit me...I feel so frightened......
Thanks for your comments
The only good thing out of it is that I found a name for my Art work...."Dancing Heart Designs"!  I guess there is good in everything....
Thanks

[Dancing Heart]

Hello, reading your comments have really brought some comfort to me...I was diasnosed 20 years ago with MVP (Mitral Valve Prolapse).  I was having severe heart palps and have suffered with them for 25 years...and when I say suffer I mean suffer not only physically but emotionally from them...I also had panic and anxiety attacks, which I believe were helped along by the Dancing Heart...I have worn holter monitors, had stress test and EKG's and Echo's..my Dr. assures me they are benign tho annoying...
I find that they are extremely severe during my monthly hormonal time...
Has anyone experienced that?  I have tried several beta blockers which haven't helped.  My Dr. suggested something called Toporal???  I have not tried it as I am not big on using meds...I don't use any caffeine, don't smoke or drink....
I get lighthead, dizzy and extremely nervous when these attacks hit me...I feel so frightened......
Thanks for your comments
The only good thing out of it is that I found a name for my Art work...."Dancing Heart Designs"!  I guess there is good in everything....
Thanks

[beanman]

I'm so glad I have found this website.  Many of the comments sound all too familiar.  I'm 28 yrs old and have had a "fluttering heart" for nearly 4 yrs now.  I have had several tests (blood, EKG, Echo, etc) with mixed results.  I'm told that the PVC's are harmless and to just live with them.  However, the irregular beats cause great anxiety in my life.  I also have minor chest pain that comes and goes.  My doctors do not know why the chest pain, since none of the test reveal a cause. I have been told by some to get on a Beta blocker to see if this helps.  Has anyone found success with Beta blockers? Or have associated chest pains with their irregular beats?  

Advise!  .........thanks