hard heart beat (not pvc)?

Hi everyone, I'm a 23 year old, male with no previous history of cardiovascular disease. Lately I've been experiencing these hard beats, I've been consulted a cardiologist, electrophysiologist and have had multiple trips to the hospital, all of which have concluded that I've got "nothing to worry about". I've done multiple echos, multiple ecgs (going on around 20 or 30 now) a holter monitor, stress test, chest xray's, and the standard procedure blood tests like cbc, trop and the like when going to emergency doctors.
The only thing that came back was transient early repolarization which seems to go away when I'm exercising or anxious. Which I've been told is benign. I've read some nasty literature to suggest otherwise, but I found that it was a different kind of early repolarization to the one I've been documented with, something to do with ascending vs descending s-t morphology. etc etc. (I probably shouldn't be reading europace)

I've experienced these beats that feel "harder" than the other beats. I've had no adequate explanation for them and the cardiologist appointment for a follow up regarding the holter monitor isn't for another 2 weeks, I've spoken to him briefly to see if everything was okay, and he wasn't worried at all, he said just a couple of ectopic beats. The problem is, I know that I've had pvc's in the past, but these are not pvc's, they're not out of rhythm, there's no compensatory pause, and on auscultation there's no evidence of "skipping" or "extra beats". There's no gallop, or other murmurs, it's just literally a harder beat than the others, it sounds a bit louder on the stethoscope, but that's all I could really gather. That and my heart seems to go a tiny bit faster, but this seems irrelevant because it does so normally because of the respiratory sinus arrhythmia.

could it just be  be anxiety causing this noticeable beat that I keep experiencing? or is it something else? It's driving me mad and I know I shouldn't be seeking reassurance (I have a diagnosed panic disorder) but I feel as though I should ask someone about this.

Thanks in advance

[annoyed87]

to add, my blood pressure average is around 110/75
roughly.

[michellepetkus]

I don't know that anyone can say for certain what you are feeling.  It is possible depending on your heart rate that you might not feel the compensory pause.  I feel them more when my heart rate is slower.  You could also be having pacs instead of pvcs.  I unfortunately don't remember who posted it but they gave a pretty good description of what happens when the ectopics are occuring and basically the blood in the heart is a bit out of balance and thus possibly sloshing around a bit causing a hard beat.  Don't quote me on that but that is what I think I remember reading.  That said, you have had a lot of tests that indicate your heart is in general good healthy.  You have some issues, there is no denying but stressing about them is likely making the situation a lot worse than it could be.  I would say once you have your appointment with the cardiologist about your holter and get confirmation that this isn't going to harm you in the long run take some time to work though your anxiety about your heart situation.  In the absence of passing out you really are not in any danger.  Danger of being annoyed yes, but not in any mortal danger.  The odds are extremely rare for pvcs to morph into something fatal.  Hang in there.  Things will get better with time.  And check around the forum.  There are a lot of people in the same boat as you.  We are all doing our best to learn how to live with our condtions.  It can be tough sometimes but we are here if you need someone to lean on.  Take care and keep us posted on how you are doing.

[annoyed87]

I know what you're saying regarding how I may not feel the compensatory pause due to an increased heart rate, but the fact is, I should hear the ectopic focus going off on a stethoscope, which I've only done once, and I don't know if it was due to me moving my hands while using the stethoscope. With me, there is a clear distinction between an ectopic beat and this.
I think what you may have meant regarding how the sloshing around of blood occurs in the heart is when the ectopic beat is felt, from what I recall it's due to the heart pushing out the blood from the interrupted previous beat.

I've read there's different kinds of PVC's some of which can be "sandwiched" between normal beats without a compensatory pause, they're called interpolated PVC's. a PVC, PJC, or PAC should cause some kind of dysrhythmic sounding event upon auscultation. which none of these beats I am having are doing. its within sinus rhythm, it is part of my normal heart rhythm, it's just louder. I've read so much just to figure out what is going on, and to no avail. I should add that I've already had confirmation that it won't harm me, I guess I'm just seeking reassurance because I'm concerned. thanks for the reply, I appreciate it.

[annoyed87]

I found out it was due to increased contractility of the heart. Thanks again though!

[Krotoole]

Can you explain increased contractility?

I'm having nearly this exact same rotation of symptoms.  I'll get pvc's for days, then they'll go away and in other days I'll get long runs of very hard beats.  Some hard enough that if I'm sitting with my legs crossed the pulse will actually make my leg move a bit.

My doctor sort of looks at me like "uh-huh, you're thinking too much" when I mention this stuff, but it's absolutely real.  And really annoying!

Btw...I'm 40 years old, started having pvc's a year ago and have been through the battery of tests.

Thx

[annoyed87]

put simply, it's the state in which an agent alters the force of a muscular contraction. Another word for it is inotropy. So the heart's beating "harder". I hear it's supposed to increase stroke volume when this happens as well.

http://www.cvphysiology.com/Cardiac%20Function/CF010.htm

if you'd like an in depth view of contractility.

best regards.