Palpitations

[Ihatepalps]

I have a normal heart I have been told.  I sometimes get these times where my heart seems to skip every second or third beat (maybe every couple of weeks or so).  This lasts maybe 1/2 hour or so.  I have had a normal cardiac workup with no signs of heart disease whatsoever.  Would a normal heart do this?  It really worries me.  I have had holters, ecg's, echo, stress test.  If all this shows up as normal how come my heart still skips?  Could it be some sort of scare tissue or something on my heart?  I wish they would just find something wrong with it so they could fix it but they say I have less than a 1% chance of anything cardiac happening.  Could that be true?

When I was out shopping yesterday I felt a large thump in my chest probably once per hour.  Do you think that is cause for worry?  I also get this sort of zap sensation in my heart every so often (maybe every couple of days).  I can tell if it is a PAC or PVC, just kinda a zap feeling.  I am a 42 year old female.

Would those tests show if there is any electrical things wrong with it?  Do you think I should pursue this or should I just not worry about it?

[circadrt]

Your reply to "ihatepalps" makes alot of sense. In the 35+ years I have had PVC/PAV's off and on, (I am 57 now) I have also had (although now it is very much under control) anxiety/OCD/panic/General Anxiety Disorder also. When I am under much stress, not had enough sleep, or am worrying about anything, I tend to get the PVC's/PAC's and FEEL them (the palps).

Focus on ANYTHING, and it will almost always become more intense, brighter or louder (like a dripping faucet at night gets louder if you focus on it).

When one of the many people with "normal hearts" (no structural problems at all including MVP, which for most is the least dangerous I think) have had a full cardio "workup" and they still do not believe that their heart is normal, they can certainly go to another cardiologist and have one more workup and opinion. But after that, I know from personal experience and from alot of study on this, that it is the anxiety/obsessive disorder aspects of the patient that need to be addressed, not the heart at that point. Not unlike people who get headaches and are convinced they have a brain tumor (despite MRI's and seeing many doctors to r/o that as the cause) the anxiety-worry-stress-obsessive worry-anxiety cycle needs to be identified, acknowledged, and worked on with a good cognitive therapist. If they don't they will suffer with worse symptoms and the continual unwarranted fear and concern over body sensations and "what disease they might have that nobody can find" for the rest of their lives. And as you said, quality of life will and does suffer a great deal if that emotional componant is not addressed and resolved.

I want to give hope to those out there who continue to feel they are dying or going to die from these symptoms (assuming you have had the necessary cardio tests to rule out any possible physical cause with the heart, the blood chemistry, or other organ that affects the heart and it's rhythm) that you can get past this. But you will need to quit seeing the medical doctors (aka "doctor shopping") and start talking with a good cognitive therapist or counselor who has experience in working with anxiety disorders. Once you do this, and learn how your mind can actually create these symptoms if you focus enough on them, you can learn to not focus on them. It takes some time, but with medications and a good "talk therapist" you can really get to where you have very few palpitations, and only the NORMAL PVC/PAC events which, as this forum doctor has said, and which any medical textbook will tell you, are common for ?? reasons in most people with very healthy hearts who can live to rip old ages!

Please continue to stress the importance, even with someone who has a real defined cardiological issue that causes something other than benign ectopic events, that stress and anxiety play a critical part in how fast the heart beats, how regular it beats, and whether you feel the beats or not. I think that type of "holistic" approach, where there is "mind over matter" AND good medical evidence and advice, is the best combination for approaching any disease or symptom. Especially something dealing with the heart, which for most people is abit more worrisome than if they had a pain in their arm, leg or stomach.

Keep up the good posts! Too many doctors do not mention or suggest to their patients that good mental health, excercise, diet and stress control, will help most people live a better quality life no matter what their health issues are. It can also prevent health crises, a severe MI, hypertension, or a severe rhythm event, being some of the most common.

[Michael J. McWilliams, M.D.]

Hello,

Would a normal heart do this?  

I structurally normal heart can have PVCs.

If all this shows up as normal how come my heart still skips?  

You will not find an answer to this question.  As I mentioned in a previous post, there are some people that have phenomenon called after depolarizations that cause PVCs.  Even with an EP study, they probably will not be able to give you a mechanism.

Could it be some sort of scare tissue or something on my heart?

Scar tissue can cause PVCs.  I do not know if your heart has scar tissue.  An MRI might show small areas of scar tissue if it is present, but this is usually only done to evaluate for RV dysplasia.  Your ekg or echo would probably suggests if something like this could be present.


Could that be true?

Your risk of cardiac events could be calculated by the Framingham score.  It does not include PVCs to risk stratify for cardiac events though.

Do you think that is cause for worry?

If you have a structurally normal heart, EKG, and holter, you should not have to worry about cardiac causes.  To be honest, what I would worry about the most is excessive worrying.  This can have a serious impact on your quality of life.

Would those tests show if there is any electrical things wrong with it?

The tests that are done help risk stratify for cardiac events, they don't really evaluate the mechanism of your PVCs.

Do you think I should pursue this or should I just not worry about it?

I think you need a second opinion because you sound very worried.  You  need to see someone you trust and if the work up determines that you have low risk, you need to focus on the worrying component to improve your quality of life.  From reading your posts, I get the impressions that these worries are stuck in your head and circulate constantly-- although I could be wrong.

I hope this helps.  Good luck and thanks for posting.