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Vagus Nerve and Psychologist
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Vagus Nerve and Psychologist

I'm fed up, it's driving me mad, my arrhythmia has worsened, as long as I don't eat or sleep, I'm largely OK, but everytime I eat, my heart goes nuts. And everytime I lay down, automatic guadrigeminy or worse. I find it impossible to sleep waiting for the 4th beat. Last night, apparently it did it while I was sleeping. Normally, it starts after laying down, but must go into a normal rhythm at night. I would wake, waiting for the arrhythmia to start, and seconds later I wouldn't be disappointed. Not this morning, I awoke with it.

Cardiologists care not about stomachs and vagus nerves, gastroenterologists care not about the heart. The way doctors handle this things is by labelling the patients a nut case. I had seizures for more than 15 years before it was diagnosed, and even then my doctor essentially threw me out of his office, claiming nothing was wrong. I went to another Neurologist and he did a 24 Hour EEG, rather like a Holter, just with a lot of wires glued to my head, and I had to go home looking like a robot with pigtails and guess what, seizures. A few pills later (that i still take twice daily) and 15+ years of living he11 went away after taking medicine.

I also had thyroid cancer. I felt like I had a lump in my throat, later determined to be a Cricopharyngeal Spasm, but with a twist. Everytime I swallowed, (late in the day), my heart would throw one ectopic for each food swallow. My cardiologist said it was Vagal in nature. Vagus nerve huh?, so I went to my neurologist. I was told they don't do Vagus nerves, and I protested so much, saying how can a neurologist not do a nerve, so to pacify me he ordered a CT to be sure all was well. The nerve was fine, but they found nodules in my thyroid during the imaging, very small ones (too small to be causing the lump feeling), and they turned out to be cancer. Out came the thyroid.

Doctors look at the patient with a microscope aimed at the specific organs they specialize in. This is nuts, I'm sure it works often, but what about those of us that have other issues? Is it possible to find a doctor that looks at the entire system and not just specific organs?
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Avatar_f_tn
You have apparently had several genuine medical problems that were missed for a while:  Thyroid cancer and seizures of some type, for the latter of which you are still taking meds.

May I ask what medication you are still taking for the seizures?  The most surprising things can turn out to be relevant.

However, from your description--"...And everytime I lay down, automatic guadrigeminy or worse. I find it impossible to sleep waiting for the 4th beat...I would wake, waiting for the arrhythmia to start, and seconds later I wouldn't be disappointed..."--a big problem is the *anticipation* of ectopic beats.

Yeah, these are disconcerting.  I have a lot of PVCs, four thousand a day at last count, and they have repeatedly been shown to be benign.

The biggest issue--apart from the annoyance or fear ectopic beats cause--is whether or not they are dangerous or physically interfere with activity.  For example, while you are having quadreminy, are you able to walk normally?  Can you go up a flight of stairs?  Can you chase a cat or dog if need be?  Are you nauseous, breathless, or drenched in a cold sweat when you try to do these things?

If not, chances are that your ectopic heartbeats, though frightening, are in fact benign.  I have not read or heard of any surefire way of shutting down benign ectopics unless they are over 10,000 per day, when ablation is often considered by cardiologists, if the locus can be found.

So, if one is not in fact physically disabled by numerous ectopic beats below the 10,000/day cutoff, the issue is one of realizing that they are of no physicall consequence, but PLENTY of emotional importance.

Have you ever seen anyone about cognitive-behavioral therapy?  I am not joking here:  Repeated studies (and you can google this under 'scholarly articles ectopic heartbeats') have shown that a combo of cognitive behavioral therapy plus a little antianxiety medication is pretty darn effective against the worry caused by benign ectopic heartbeats.

The surge of adrenaline caused by anxiety tends to increase the number of ectopics, and I have personally found that decreasing the panic not only reduces my awareness of these beats but also their absolute number.
10 Comments Post a Comment
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257552_tn?1404606154
Update. Apparently the Holter showed no aberrant rhythms, just 6000 PVCs, none consecutive. The day I wore the holter wasn't my worst day in this outbreak, but it's still encouraging. I've asked for reconsideration of my meds.
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1807132_tn?1318747197
That is a lot of pvcs to deal with though not a number considered a danger by doctors so you are caught in a bit of a dilemma.  The best advice I can give you is to try and clear up your stomach issues as best you can.  I actually notice a marked drop in my pvcs once I gave up carbs, specifically breads.  But sugars of any sort and caffeine can aggravate them as well as stress.  Also from what I understand some meds can actually make the situation worse so if the number you are having has risen since starting the meds I might suggest seeing if you can try a different med to see if that helps lesson the amount you are having.  I know these can be difficult to cope with but do know you are not alone.  There are many on this site with similar issues as you.  Take care and I do hope you can get a handle on these some day.
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Avatar_f_tn
You have apparently had several genuine medical problems that were missed for a while:  Thyroid cancer and seizures of some type, for the latter of which you are still taking meds.

May I ask what medication you are still taking for the seizures?  The most surprising things can turn out to be relevant.

However, from your description--"...And everytime I lay down, automatic guadrigeminy or worse. I find it impossible to sleep waiting for the 4th beat...I would wake, waiting for the arrhythmia to start, and seconds later I wouldn't be disappointed..."--a big problem is the *anticipation* of ectopic beats.

Yeah, these are disconcerting.  I have a lot of PVCs, four thousand a day at last count, and they have repeatedly been shown to be benign.

The biggest issue--apart from the annoyance or fear ectopic beats cause--is whether or not they are dangerous or physically interfere with activity.  For example, while you are having quadreminy, are you able to walk normally?  Can you go up a flight of stairs?  Can you chase a cat or dog if need be?  Are you nauseous, breathless, or drenched in a cold sweat when you try to do these things?

If not, chances are that your ectopic heartbeats, though frightening, are in fact benign.  I have not read or heard of any surefire way of shutting down benign ectopics unless they are over 10,000 per day, when ablation is often considered by cardiologists, if the locus can be found.

So, if one is not in fact physically disabled by numerous ectopic beats below the 10,000/day cutoff, the issue is one of realizing that they are of no physicall consequence, but PLENTY of emotional importance.

Have you ever seen anyone about cognitive-behavioral therapy?  I am not joking here:  Repeated studies (and you can google this under 'scholarly articles ectopic heartbeats') have shown that a combo of cognitive behavioral therapy plus a little antianxiety medication is pretty darn effective against the worry caused by benign ectopic heartbeats.

The surge of adrenaline caused by anxiety tends to increase the number of ectopics, and I have personally found that decreasing the panic not only reduces my awareness of these beats but also their absolute number.
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257552_tn?1404606154
Thanks to archillea and michellepetkus,

Seizures are Temporal Lobe, controlled by 300 mg Phenytek (Phenytoin) twice a day.

No symptoms from the geminy patterns, whether bigeminy or quadrigeminy, no shortness of breath, no dizziness. My ejection fraction was in the 60s last stress echo test I had in Dec 2013.

I stumbled upon this site, an Electrophysiologist, that mentions 20,000 PVCs daily before he'd even consider doing an ablation, assuming no dangerous rhythms were evident. He also discusses PVCs.

http://www.drjohnm.org/2013/06/benign-pvcs-a-heart-rhythm-doctors-approach/

My Holter was interpreted by one of the top Cardiologists in Pittsburgh, apparently he sees no need for concern, he spoke with my Cardiologist. I would have guessed more than 6000, but the Holter, a model by Phillips, apparently screens the results for dangerous rhythms (once uploaded to their computers) the routine stuff is eliminated, and issues of concern are made readily apparent to the interpreting Doctor. Smaller than a flip phone folded, I remember the units from years ago that had a cassette tape in them and you could hear the motor running on that drives the tape. They were so big you had to wear a strap on your shoulders to carry it.

The Doctor wants me on 100 mg Atenolol for the next 7 to 10 days, and if no reduction, he'll change the medication.  
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1569985_tn?1328251082
Wishing you luck with these ectopics.  I have intermittent afib, plus pvcs, pacs, and short runs of tachycardia.  I am on an antiarrythmic and a low dose of Atenolol.  My afib is vagally mediated, and I can relate to the being afraid to eat or lay down.  I have gone into afib after drinking a cold drink or eating a large meal.  It sounds like your doctors are taking you seriously and doing all the checking.  Are you on a PPI?  That seems to help my gastric/reflux issues, and thus my heart issues.  It sounds like you have had a lot of different issues and I also think quality of life is not most doctors' strong suit.  Good luck to you on this.  Keeping you in my thoughts and prayers.
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257552_tn?1404606154
Thanks for the comments. I did research online on Trigeminy (actually geminies in general showed up) and found a 92 comment long thread on Medhelp of many other people with supine related geminy. (Bi, Tri, Quad), one woman having same for 20+ years. One article said quadrigeminy can be concealed bigeminy, citing technical reasons that are beyond my current comprehension.

Realizing the wonderful nature of the heart's electrical system, though some of us have some doubts, doesn't help when you feel them and they serve as a distraction to sleeping and they scare you. The SA node normally starts the process, the atrium contracts, the electrical signal hits the AV node, which discharges and contracts the ventricles. If the SA node fails to discharge, as sometimes occurs with the very old, the AV node will eventually discharge on its own, but the heart rate will be very slow. These people are given pacemakers to assist or replace the function of the SA node. But we have been imbued with a back-up system in the self discharging AV node. Unfortunately, other cells can be malicious in discharging and causing premature beats.

Talking with my cardiologist the other day, he said that PACs will cause the ventricles to contract as will PVCs, just that the premature beat in the PAC originates in the atrium, the PVC the ventricles. The PAC on the following EKGs looks like the other complexes, just early. The PVC has an easily identifiable look to it, no need to count the lines on the graph paper.

PAC
https://upload.wikimedia.org/wikipedia/commons/thumb/b/ba/PAC.png/798px-PAC.png

PVC
http://d2ik8svv2swg1p.cloudfront.net/ekgtracings/9.gif

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5851092_tn?1404137064
Heres some examples of my own pacs. I rarely get pvcs. But yea these have been confirmed with cardiologist

https://onedrive.live.com/redir?resid=4A2523273A7E6694!127&authkey=!AI4Hj2731TkA_xE&ithint=file%2c.pdf
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Avatar_m_tn
hello Artaud,

it sounds like you are really going through hell. i dont know how people keep their wits about them. God, a normal rhythm is something that I used to take for granted, not anymore. mabe, if you had some aciphex prescribed for you, that might help with some of the stomach issues.

thanks for all of your posts. hope things will get better for you and all.
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1464004_tn?1384139333
I too am post thyroid CA, 10 years. I may be going through a recurrence as we speak, going for my ultra sound and fna this week. I had noticed and increase of my rhythm issues since the cancer and I feel that may be too the thyroid hormone fluctuations although none of my myriad of doctors will give me a definite answer on that.
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257552_tn?1404606154
Thyroid levels, search for the terms "Sub Clinical Hypothyroidism" and subclinical "Sub Clinical Hyperthyroidism".

For example:
http://www.aafp.org/afp/2011/0415/p933.html

The premise is that the medical community has established a range of normalcy for thyroid levels, but some people, even within that range, can experience issues due to too little or too much thyroid hormone. This is something your average doctor's office will miss, they're just looking for the total range.

Best of wishes.
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