Symptoms, confusing results!!

[shelley67]

I have had some problems recently and would like your opinion.  Im 27, no major health probs other than labile hypertension.(only at teh doctors office!!)I have been to the hospital a few times in the last few months with palpitations.  All the ekgs teh doctors say are normal, though I notice on 90% of them they say either possible left atrial abnormality, probably lvh or abnormal p force??  Not each dkg says each of these diagnoses, but at least one on each on(there have been about 5 or 6)The drs however disregard this saying that the machines pick up things that are not present, and that they have to overread them.  Eventually I had an echo, lv diastolic was 5.94, and systolic was 4.64, but dr says this is normal, and that wall motion was normal.  After reading about it, these values seem somewhat enlarged, but he maintains it is normal.  In any case, had a holter recently, and am confused about the results.  In the supraventricular column, it says there were 39 supraven beats, 4 of which were atrial couplets, atrial pairs and I think 3 atrial runs, the longest lasting 6 beats.  Otherwise there were a few pacs and some "late beats"??  My symptoms are feeling a "flutter" in my chest and throat, and of course the usual skipped beat, but am concerned about the flutter, as i get this frequently.  Can a pvc/pac present as a butterfly feeling, and why in the throat.  I often feel my heart in my throat, along with a tight feeling, but no pain. Should I be concerned, though the dr says it is BENIGN? What do you make of the holter, is this normal?  Im so confused, Thank you

[CCF-M.D.-KE]

Dear Shelly67,

An electrocardiogram may show a left atrial abnormality or LVH, however the echocardiogram is one of the definitive tests to describe these findings. I am not sure from exactly where the measurements you have described are taken. It sounds like the pumping function of your heart is normal. Consider asking your doctor specifically about where the measurements were taken.

Your holter report describes PACs and some runs of supraventricular tachycardia.  A total of 39 supraventricular beats on a holter monitor test is very low and likely would be found on millions of people. These findings can cause the symptoms you have described but in and of themselves are not serious. From what I have read so far I have not seen anything to suggest a lifethreatening condition. I would recommend avoiding alcohol, caffeine, tobacco and stimulants such as those found in decongestants. Continue to follow-up with your doctor.

Thanks for your question,


CCF-MD-KE

[chickachicka]

I too have read the description late beats on my holter..is there anyone here that knows exactly what a late beat is?
I will assume it is a normal finding but what exactly is it?

[arthur]

That fluttery sensation in your throat...do you have a normal pulse, no skips, when you feel this?  If so, I may have an answer for you... aside from the normal fluttery feeling after a skipped beat, there are a couple of other reasons why this sensation can present itself.  I am not a doctor, just an inmate, so take what I say with a grain of salt... two scary reasons are a turbulence caused by blood trying to get past a slight blockage or a vibration due to a distended aorta... these are unlikely, as I think your doc would have picked up on these possibilities.  One other reason, though perplexing, is the possibility that the focal origins of your skips are being amplified by your nervous system.  In this case, you might feel the vibration (flutter) as if it was right above (and behind) your heart, feeling as though it was in your throat, perhaps at times, as if your upper abdomen was vibrating.  To you, these vibes feel significant, however, they are very difficult to feel from the outside (palpate). If this is the case, then you may have pulmonary vein foci (tiny twittering areas of the vein located at the attachment point to the back of the heart).  Ask your doc about it, however, don't expect anything more than a shrug...PV foci are to blame for a variety of arrhythmias, and they can present themselves as fluttery sensations (when they are not particularly productive in generating skips).

[shelley67]

If this is a pv foci as you suggest, how serious is it and are there treatments for it, or is treatment necessary?  I have had the fluttery feeling when a skipped beat occurs, but i do notice the trembling sensation you speak of around my chest and abdomen often.  I have never had any problems with it that i know of other than the annoyance assuming thats even what it is.  any info would be appreciated, thanks.

[arthur]

If it's due to a pv focus (or foci) there's not much anyone will do to treat it, unless the PACs you are getting also lead to something a bit more involved (like sustained tachycardia, or afib).  This is what happened in my case, and the afib I had was cured by ablating one of the foci...leaving a couple behind which only create occassional PACs.  The problem is that it's really not for certain that the foci themselves create the fluttery feeling.  A good EP might be able to use an EKG cleverly to look for the connection, maybe an esophageal EKG might pick these things up better...just to prove where the sensation comes from.

In the meantime, I am trying to get used to that flutter and generally don't notice it during the day.  At night, with all distractions gone, it becomes pretty evident.  I notice that it gets cranked up with vivid dreams and sudden movement...even getting out of bed to make that bathroom run is enough to kick it up for a few minutes. All this suggests a significant nervous system involvement, as that's the only thing kicked up with night time movements.  I noticed also that taking a benadryl at night seems to inhibit the fluttery sensation somewhat...probably due to a major side effect of benadryl in affecting cholinergic systems (it's actually used in treating Parkinsonism).

Good luck  -Arthur


If that fluttery sensation ever gets diagnosed (and better yet, cured) please let me know.

[shelley67]

Thanks for the swift response....As I was saying, the flutter I was describing to the forum doc Im almost sure is a pvc/pac type of issue, as it only happens once in a while and is very noticeable when i occurs, though only briefly......however, the other "fluttery" or buzzing sensation can be reproduced.  I have noticed if someone slaps me on the back, or on my chest, it will buzz or tremble, though no effect on heart rate, so i assume(d) it was muscular, and something everyone experiences, so im not really sure if we are talking about the same things or not.....but basically you are saying that if that was it, its generally a benign condition that needs to be ignored as is the pac/pvs issue?  Again, thanks for your insight.

[arthur]

It's an awfully difficult thing to describe, but what you have thus far related sounds like the same thing.  Mine started up as a clear vibration, similar to a very rapid heart beat (prior to ablation), which would come and go, basically showing up during times of physical stress and sudden movement.  It would pulsate about 200-250 bpm, with no direct affect on the rhythm of the heart.  After ablation, it changed its character to a very fast vibration, often a "buzz", still set off by anxiety, sudden movement, even a slap on the back.  So I guess this thing is benign, since I've had it on/off for about three years (ever since the eruption of the PACs and AF).  I wonder how many folks have experienced the same thing, but attributed it to feelings of anxiety.  You and I know it we can feel that buzz without feeling anxious.  Of course, it doesn't exactly make one calmer.  My suspicion is that the nervous system connection which allows us to feel the foci will eventually become less efficient, and "burn out"...leaving us to our normal background "silent" PACs.

btw...try this experiment...when you are feeling that "buzz" try inhaling, holding your breath and placing your hands on your abdomen to provide a little pressure, then exhaling very slowly and see if you feel as though your breath is coming out in a sequence of tiny puffs.  In my view, this suggests the location of the vibes to be exactly at the PVs (between heart and lungs). This was a lot easier to notice when the vibes were slower than the buzz they seem to be now.

Best wishes,

-Arthur

[Ianna]

Hi Arthur,

This is Ianna.
Hope you are doing well.
The vibrating.
I too still 'suffer' from it.
Isn't it just simply good old 'nerves'?
And being very very susceptible to adrenaline?
I mean the effect of it due to whatever. Conscious or unconscious reasons. Causing the diaphragm to vibrate and taking along the rest, like the stomach, colon and heart and everything surrounding that? Aren't they all placed close together in there? Sometimes it feels like it is the stomach that is trembling...and being so close to the heart!?(especially after a meal), other times I think it is the colon I feel.
I read about a Doctor who treated anxiety-patients who complainted about 'our' problem (among other things) too.
It was according to her 'very common' (a vibrating heart) in patients with a sensitive nervous system; and the only thing she advised was: to accept it as something that comes along with being so sensitive to the lovely adrenaline; just try to ignore it she wrote..... (ignore?- hummmm...it's buzzing along right now...). But it's true, I need small amounts of adrenaline to set them off. That jumpy feeling by a sudden pat on the back is enough.
I know now that I am a HSP (Hyper Sensitive Person).
I know too that 20 percent of the population is, it's quite normal, so yes, when people with anxiety or other nervous complaints say 'I'm trembling inside', than that can be 'it'. I am vibrating inside too.
Of course I am not sure, but it is just another 'idea'. What do you think?
-
Untill we finally solve this, I greet thee, as always - **Ianna**
-

[arthur]

Glad to hear from you again.  It looks like the "nervous" condition is shared by a few others... Although it's possible, as you suggest, that the whole thing is only nerves, I doubt it.  In my case, the so-called nervous condition only showed up when my PACs/PAF showed up...too much of a coincidence.  Also, I discussed these symptoms with several EPs including a world famous one in France (who introduced the ablation of PV foci to the medical community), and they all concur that the nervous system covering the heart could indeed pick up the focal activity, and as a result, one might be able to "feel" those vibes.  How this comes about is a mystery to all.  So, I guess there is some satisfaction in being a mysterious person.

Keep well,

Arthur

[shelley67]

Hi,

How long have you had this??  I have only noticed mine for a month or two, but it may have been going on for some time.  I often wondered if it werent somethin colon or stomach related because it rumbles like you do when you are having a build up of gas, or even a hungry stomach.  Does it affect your heart, or do you just notice that it seems to feel as if it is near the area where your heart is located??  It seems to be benign though annoying.  See ya

[Ianna]

Hello Shelley,

The vibrating started about a half a year ago.
I had a double pheumonia in January.
After that I felt weak a long time.
The vibrations started shortly after that. I am 56 years of age and in the middle of menopause-problems too. Of and on very nervous, and that is my biggest problem.
The shivering inside is nasty.
I do not know where it starts or takes place.
It feels like it is the heart, but I may be wrong.
Sometimes it's gone and that feels very relaxed.
It has got nothing to do with my having PVC's at the same time.
I can have the vibrating but no BUMPS at all for hours.
It will worsen when I am tired or when my stomach is too full.
The Dr. did not notice the vibrating on the EKG but I felt it strongly. Neither on the Echo did it show, yet I felt them twittering.
I take Inderal(propanolol) 80 mg.for High BP. and a somewhat high HR. That's ok now, as is my migraine, which profits from the propanolol too!!!(I'm glad!!) :-). I too have anxiety problems, not to big, I control them well.
I watch my dieet and do not use caffeine, nicotine or other stimulantia. I do take some vitamins and minerals -esp. Magnesium, vit E and Qio and hope they do something for me.
Relaxation-technics help, and oh, small meals over the day instead of three 'big' ones! And no aspartame and little sugar.
I feel great except for that one little quivering something in my chest.
-
Yes, I think it is benign.
But that is me thinking that.
And I am 'but' a Dutch 'housewife'.
-
The best to you from me, **Ianna**
  

[arthur]

I don't know if I mentioned this before...but when I asked my EP about the vibrations, he indicated that many other patients have complained about the same symptoms...he also mentioned that he could not explain them.

I also can confirm that in my case, an EKG was incapable of noticing them, even when they were particularly pronounced and slow (200 beats per minute, and actually palpable at the abdomen).  

In 1723, a janitor/scientist by the name of Antony van Leeuwenhoek (father of the microscope) was the first to describe a condition similar to ours...he complained of epigastric pulsations and shortness of breath.  Doctors at the time diagnosed his ailment as "palpitations", however, he noticed that his heart was beating quite regularly while these pulsations were going on.  He concluded that the vibes were coming from his diaphragm.  Up until 1973, only 48 more human cases were reported.  These days diaphragmatic flutter is often seen in race horses and it is apparently caused by low magnesium levels due to over exercising.  Now these were rather obvious pulsations, easy to notice externally...as the diaphragm is a large muscle and when it undulates, it's obvious.  However, very minor oscillations of such a muscle would mimic our current symptomology...and it's not impossible to consider that electrical noise (via foci) could be picked up by the epicardial nervous system (covering the heart) and amplified by the diaphragm picking up those signals.  

Diaphragmatic flutter is also thought to occur via a lesion in the brain stem...especially if it occurs on both sides of the abdomen (bilateral)...in this case it is refered to as a myoclonic syndrome, for which there is no known cure.

Just some interesting observations...I don't think we have this sort of thing going on, but it is a remarkable example of the interplay of muscles and nerves in our chest cavity, making diagnoses and treatments extremely difficult.

-Arthur

[Ianna]

Hi Arthur,

I am so glad with the info you gave me in your latest comment.
And you know what?... I think that's it!
For me, that is.
I could kiss you...
It's what I all along subconsciously 'knew'.
Of course the Drs. cannot find anything in my (our?) EKG.
There is nothing really wrong. (I hope)!
It's the diaphragm fluttering and as you suggested in all probability taking along the rest in the neighbourhood!
They're having a party in there!!
I browsed the net for --diaphragm flutters-- and Anthony van Leeuwenhoek, and after eliminating 'the horses', there it was!
Most doctors don't know either I suppose?
(Do I sound too optimistic?)
You wrote: -"I don't think we have this sort of thing going on"- and I am saying: we most likely do! Wouldn't that be a relieve?
Thanks for all the detective-work you did en still do(I assume?)-where would we be without you!
-
Let me know what you think.
-
**Ianna**

  

[arthur]

It's not out of the question that we may have something like this going on.  If you continue to look through the medical literature, there are a number of cases written about wherein patients with arrhythmias also have diaphragmatic flutter going on.  The effect on a normal EKG is minimal to non-existent, however, I believe that a transesophageal EKG may pick this stuff up.  Certainly a EMG (electromyography) will do the job...the specialist here would be a neurologist with an open mind.

For a while, I was pretty much convinced that I had this condition and it was causing my arrhythmias...then came the discovery of my PV foci, then ablation.  The flutter is obviously not the cause, however, it may be the subtle (or not so subtle) remnants of a viral attack on the nervous system descending through the thorax.  This system includes the epicardial, vagus and the phrenic nerves (the ones responsible for diaphragmatic movement).  That same viral attack may have left the epicardial nervous system easy to agitate, and thereby opened the gate for those nasty little foci to reach the pacemaker system in the heart.

Most doctors never heard of diaphragmatic flutter and will likely  react with a knowing smile...thinking that you are really grasping at straws.  This is a recurring problem with specialists who cannot see beyond their own backyard...often forgeting that biological systems are never isolated but interplay, and it's this interplay that may be making us nutty.

-Arthur

[Ianna]

Arthur,

As always, very clear...
-
Thanks, see ya!
-
**Ianna**

[Kat58]

While researching chest chest pains my son is having, I stumbled on your question.  I also get the fluttering and so does my brother.  I have seen drs and taken stress tests.  In any case, my sister-in-law read an article about the fluttering/palpatations and we found that by taking extra magnesium every day, it stops it from happening.  Whenever I slack off on taking the magnesium, it comes back so I'm pretty sure that is the reason. In addition to my regular multi vitamin, I take an extra dose of calcium 1000/magnesium 400 mg. I may not have the same thing going on, but it might be worth it to try and I don't think it can hurt.  Hope you all feel better.

Kathy

[arthur]

It is interesting to note that in cases of equine diaphragmatic flutter, the usual treatment regimen is magnesium.  It seems that exhausted muscle is temporarily depleted of magnesium, so the treatment makes sense.  It's possible that certain muscle groups in an individual could experience some transient depletion of certain minerals, magnesium included...it's just hard to believe that the depletion is chronic, as that would generally show up in blood tests (and has not in my case).  Then there's always the fringe theory that the blood test only measures the magnesium in the blood and doesn't really guarantee levels in tissues are okay.  The bottom line, if it works for you and it's not toxic, go for it.

[Dimp]

A related discussion, Fluttering feeling and palpitations was started.