slight autonomic dysfunction?

[arthur]

For several years I have been troubled by a feeling of an internal vibration located in the chest, somewhere near the heart. I have undergone extensive heart-related tests, endoscopic examinations, and a variety of other non-invasive tests including sonograms to exclude aortic abnormalities...which ruled out the esophagus, heart, abdominal muscles, and the diaphragm as culprits.

This "vibration" started shortly after an ear infection (which was not bacterial)...the circumstantial connection is that within several weeks I experienced unusual undulations of my abdomen (probably the diaphragm) which would come and go for a few more weeks...this devolved into brief periods internal vibrations in the chest (at about 200 bpm, nearly palpable at the abdomen)...which in several months time, devolved into vibrations at higher bpm, usually not palpable at all.

As I understand, the sympathetic/parasympathetic systems work in concert to help establish heart rate among other things. My little theory is that a viral infection starting in the inner ear, may have descended and caused the sequence of uncontrolled diaphragmatic undulations, followed by lesser forms of "myoclonic" like presentations.

At this point, the vibrations appear when I am excited, suddenly changing posture, when sudden exertion is needed...they last perceptibly for 10-15 minutes, and in fact, induce some PACs.

What can be done to treat this apparent "slightly" imbalanced system, and is this really the only explanation?

Thanks

[arthur]

Hey Fred...have you gone the ablation route yet?  
For myself, I have gotten out of the anxiety cycle and hardly notice any PACs anymore.  The vibes are still around, although they too appear to be following the declining path.  My scientific training is the thing that still drives me to find out what those buggers are, but I guess we're just a complicated mass of nerves and when a twittering occurs, especially a subtle one, it could be any number of things.  The hope is that by ignoring them, they may go away.

Hope you're feeling better these days.  Say hi to the Lady O' the PVC.

-Arthur

[fwilson]

Still trying Arthur?

Good luck.

Fred

[arthur]

It sounds like anxiety to me.  In my opinion, you have allowed your worry over heart skips and the vibes to rule your life.  I can say this, because I have done the same thing.  It's a natural thing...to try and figure out what's wrong and where it's coming from.  The reality is that there is basically very little wrong.  The nervous system is very clever at "learning" and will quickly provide an anxiety cycle based on certain triggers (like the vibes, and/or palpitations).  I know what you mean about waking up because of these internal vibes, and having a hell of a time gettin back to sleep...typically waking 3-6 times due to an  overactive nervous system...it'll wack you out.  I cannot claim to know what is the base cause for the vibes...I get them much the same way as you describe.  But I've decided that whatever the cause (and it's not an allergic response to my environment, nor is it alcohol, caffeine, food additives, minerals, vitamins, or any other concoction that an overactive imagination can come up with), it's something that exists, it's part of me now, and I can decide to accept it or continue on with my quest for the cure.  So after three years of it, I've decided to accept it, and simply calm myself when it happens, and guess what...the bouts are almost gone, and when they do occur, they last 10-15 min.  Is this a cure?  And what does it mean that the vibes can be modified in this way?  My gut feeling is that the vibes where (and still are) an outgrouwth of a panic attack precipitated by my realization that I had some kind of arrhythmia (which freaked me out).  Although drugs could act as a temporary bandaid, the real deal is to try an get around the problem by ignoring it.

This is EXTREMELY difficult to do.  Nobody wants to admit they are suffering from a panic disorder or anxiety attack, and the symptoms can be misleading, making you think that there's a mysterious reason behind it all...it's exactly that thinking that sends you around and around the anxiety carousel.  Think about it.  

Just as a scientific aside...the anxiety turns up the nervous system surrounding the heart (it also dumps more acid into your stomach), and that nervous system acts as a gateway for electrical noise to trigger heart skips.  We all get those skips (assuming you're not getting runs of these buggers, these are perfectly normal).  

Good luck with your quest.  My advice is to take a hard look at yourself, your life, and ask yourself if this is the way you want to live.  Go with the answer.

-Arthur

[any good doctors?]

I've had the internal vibration for over 3 years.  Always at night upon awakening.  In my legs while sitting at a movie. Are pac's extra or missing heart beats?  I get those also, so bad that I've been to the emergency hospital several times, both here in Florida and in Los Angeles and San Francisco.  I cannot write everything that I know, but it is extensive.  I have been to at least 20 doctors, Mayo,Cleveland and Cancer clinics with no help.  I thought that the malady was induced from my environment, so I checked and double checked my bedroom.  Covered the carpet, headboard furniture, more than once, trying to find the cause.  Had the air contidioner changed and followed up by major overhauls, because the 3 year old American Standard (Trane) leaked water into the pan.  I thought that maybe mould was the culprit.  I have a dehumidifier and a hepa air filter in my beedroom. I would like to consult with you, because, by now I know some ways to prevent some  of the problems.  I also found out that I was low in vitamin B12 ( cannot even take a pill or shot) , low in Iron, Hi homosteyne level etc.  The extra beats can be felt below my rib cage.  The vibration (I am not positive) comes from the same place. I sometimes  feel the vibration in my stomach, legs, shoulders, or hands and arms.  It is real. My first portion of sleep is ok, but after I wake the first time I am doomed.  When it gets too bad, my blood pressure goes up to over 200.  When I went to the e room for hi bp, they would give me an Ativan.  After 5 trips to the e room, I decided to get my own Ativan.  I have been using it for years.  Only 1/2 or 1 mg per day or as needed day or night.   I have tried every vitamin, food or lack of it,  everything imaginable, but cannot defeat the malady.  When it is real bad it affects my heart. A bad night and I barely have the strength to shower.  A really bad night and I am in bed for up to 3 days, feeling very very bad.  I was a non drinker for over 17 years, but tried alcohol to see if it would help somehow.  No help, but other bad effects from it even in moderation.  I believe that the trouble comes from my stomach, going into shock at night.  
  However my aorata  is enlarged from the stress caused by the malady. I think there is a connection  between the nerves and the stomach. I have had many theories, but cannot prove any of them. I' ve tried the gym, no help. Tried  going to bed, early, late, different time zones etc. etc. etc.  
If you get rapid missing beats in your stomach, take a Ativan or Valium right away. This works for me.  While in San Francisco, I got a spell that lasted very long. I went to the ER and they plugged me into a heart monitor.  While I was talking to the Dr. I would tell him when I felt my heart  jump.  I was right.  Also,  I remember that I went to a gastroenterologist that gave  me prilosec, that worked for approx 60 days and then I knew I had to stop.  If you know where to get help PLEASE LET ME KNOW.  Thanks

[arthur]

I have had much the same experience in diagnosing those internal vibrations.  It would appear that there is no simple, single answer to the question, as there may be more than one way to obtain such a feeling of internal quivering.  I personally have ruled out (with tests) any involvement of the esophagus, arterial embolisms, obvious myoclonic activity and tumors or blood vessel blockages.

In my case, the sensations began when I first developed lone atrial fibrillation...this sounds quite disturbing, but it wasn't the AFib which caused the sensation.  I have since been cured of the AFib which was caused by isolated pockets of cardiac tissue (refered to as foci) which send out abberant signals and actually twitter away on their own.  The cure involved an rf ablation of one of these foci (basically toasting the critter).  What remains is a group of foci which don't do much more than occassionally cause a premature beat.  

Back to the internal vibes...In my case, there can be two sources for this feeling: (1) the actual tiny movement of the foci being sensed by my nervous system (in particular, the nerves surrounding the heart) and/or (2) some kind of autonomic dysfunction which causes a difficulty in the parasympathetic/sympathetic balance, which in turn may present itself as a twittering of the muscles (abdominal/diaphragmatic).  It is known that when the nervous system surrounding the heart is affected, this in turn, can lead to premature beats...it's a little complicated, but the electronic noise from the foci can move through the cardiac tissue a lot more easily when the nervous system surrounding the heart is jacked up...this is what can lead to premature beats...again, in my case, and this is what I observe...a simple test is to lie down and allow the nervous system to relax, making it more difficult for the abberant electrical noise to connect with the heart's pacemaker...this cuts out 99% of the premature beats for me.  These are my guesses, based on the observation that the vibes seem to increase in amplitude (I become much more aware of them) when I become excited (like an adrenaline rush when exercising, or awaking from a vivid dream).

In speaking to a number of cardiologists about this internal sense of vibration in the chest, most have displayed a profound ignorance of the subject, however, several have acknowledged that it does occur and they simply don't know why.  One has suggested that the epicardial nervous system (surrounding the heart) may indeed be picking up the tiny movements of the foci.

That's all the light I can shed on the mystery.  It began for me three years ago, about a month after a viral ear infection.  If you read the literature about vestibular autonomic disorders, you may come across a connection between inner ear disturbances which lead to nervous disorders lower down in the thorax.  This is certainly no proof, but it is a suspicious coincidence, as the one infection seems to explain the heightened arrhythmia (AFib) and subsequent feeling of internal vibes.  

One more thing, the vibes began as occassional attacks presenting as a slow uncontrollable undulation of my abdomen (probably the diaphragm), then progressed to a relatively slow internal vibe (150-200 beats per minute presentation) phenomenon, and now appear as a relatively fast hum (greater than 300 bpm)...this is over a period of three years...maybe this is a sign that some nervous system repair is afoot.  I'd be interested in your own experiences.  I think we both know that the medical community has a limit on what is well understood, and unfortunately, we may represent folks that are at the edge of that understanding.

-Arthur

[arthur]

Thanks very much for your thoughtful and detailed response!
Although I am tempted to continue this thread with even more anecdotes, I am willing to listen to reason and it does sound that what's presenting itself as a mild, mostly perceived, internal vibration, is not being caused by an autonomic dysfunction.  My guesswork was somewhat based on known myoclonic manifestations, often thought be be caused by viral insults, which in my case, may have been due to disturbance of the phrenic nerve system, which initially presented as undulations and over the years has become a mild hum (the vibes do affect my respiration, but only if I press on my abdomen to exaggerate their amplitude).

Thanks again for the follow up!

[CCF-Neuro-M.D.-JT]

CLARIFICATION: You are correct in that there are well known reports (largely in the ENT literature) of autonomic reactions to vestibular damage, resulting mainly in changes in blood pressure and respirations. And yes there are reports associating autonomic dysfunction with impaired perception of vibration in the limbs (hands/arms/feet)as a neuropathy-like syndrome especially in patients whose occupations expose them to constant vibratory stimuli such as drills. But there is nothing in the medical literature, either textbooks or current peer-reviewed journals that suggests that an isolated internal sense of vibration in the absence of documented cardiac dysrhythmias, hypo/hypertension, or respiration abnormalities is a result of autonomic dysfunction that stemmed from vestibular damage.

Now in your particular case, this may be a matter of semantics or a difficulty in distinguishing what the true symptom is and what is just accompanying it.  If in fact you are truly having other associated clinical symptoms/signs that can be objectively measured by current medical equipment along with the internal sense of vibration (that in itself is not the main manifestation, rather the perceived epiphenomenon of the abnormality) then it is possible that this does represent an autonomic dysfunction.  But if it's just a sense of vibration in the chest, then it's unlikely that this represents an autonomic neuropathy.

[arthur]

There is such a thing called vestibular autonomic dysfunction...ie, an inner ear upset which results in wide range of presentations including autonomic disorders...I just thought that someone in the neuro forum would have been familiar with it...I thought wrong.

[CCF-Neuro-M.D.-JT]

Isolated vibratory sensations in the chest do not sound like an autonomic neuropathy.  If you are having PAC's you may need more extensive heart monitoring to rule out an underlying cardiac rhythm problem, which it sounds like you may have done already. And if you're truly having diaphragmatic "undulations" I would think that you're breathing would be affected.  Not sure what to make of your symptoms, but I've never heard of an inner ear infection doing something like this, nor have I found evidence of this in the medical literature. Perhaps more imaging studies such as a chest/abd CT scan may be helpful to rule out a mass or abnormality in this region producing the vibration. Blood work to rule out thyroid disease, anemia, or electrolyte abnormalities may also be helpful. Talk to your PCP about your symptoms and the possible need for further testing. GOod luck.