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Having heart palpitations while resting with sleep apnea. Symptoms of nerve dysfunction?

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I've had heart palpitations the last couple months, with no spikes in high heart rate. It all started with a throat and nasal virus (or at least that was the only health reason) and after I stopped caffeine cold XXXXXXX I've seen two cardiologists, done EKGs, Echo Cardiograms, blood enzymes, glucose, and thyroid testing, etc. All negative to date and told they are common PVCs. My back and chest get tight and know when they are coming on because I feel it in my throat. I recently had cortisol and adrenal testing and am awaiting results. I'm rarely tired. When I sleep well, the palpitations and sensations are not as great the next day. The palps are usually non-existent in the morning and build throughout the day with the witching hour being 3 in the afternoon till about 9 pm. I seem to get more palps with certain foods (carbohydrates) and almost always get palps 20 minutes after food unless I eat only protein. I have not recorded a palp during exercise and I actually seem to feel better after exercise but then get palps almost always about 20 minutes after when I'm resting or stretching. The first bout of palps in December were eliminated for a month after I spiked by heart rate over 180 during a workout. (Almost like it shocked my heart into normalcy again.) I have low chlosterol and took the treadmill test beyond level 7. I have mild sleep apnea and hold my breath at times at night. I've cut back on caffeine and alcohol but ironically when I have had caffeine when having a bout of palpitations it actually helps or eliminates the symptoms. I began the usual homeopathics including drops of liquid potassium, magnesium and licorice. Like anyone with PVCs, it's no fun when they come with episodes and wonder if there's anything else I can do? Or if there are any other insights that can be provided. I am 49, a runner/cyclist have a fairly high metabolism and been diagnosed with anxiety disorder in the past. Finally, I've read up on vagus nerve dysfunction and many of those symptoms seem to mimic my symptoms.
Posted Wed, 20 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend,
Welcome to Health Care Magic

     ECHO / TMT, exercise capacity and so on are all normal.
     You are tolerating the rate well.
Apparently, it is not due to valve, heart muscle disease or Coronary Artery Disease.

Hence, an irritable focus / abnormal nerve paths in the heart (bypass tracts) is the likely cause.
As the problem is still bothering to the extent of interfering with life style, you can go on for advanced techniques of investigation of increasing complexity – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and has a risk (though minimal) and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.

Be in touch with your doctor - it is a question of time and you will be well.
Medicine is well advanced nowadays – management is possible for almost all situations...

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Having heart palpitations while resting with sleep apnea. Symptoms of nerve dysfunction? 5 hours later
Dr. ANANTHaramakrishnan, thank you for your insights so far. It's appreciated. Can you explain why caffeine or exercise may help the symptoms, if only for a time before I crash back into palpitations again? Is it possible to shock my heart into natural rythmn again, as it seemed after they went away for a month the first time?
Answered by Dr. Anantharamakrishnan 38 minutes later

A shock momentarily wipes out all electrical activity. When the beating resumes, it is usually regular. Thee is no guarantee. It needs sedation, observation and expert monitoring. The chance of recurrence is always there, depending on the underlying cause. It is not generally done - unless the situation is emergent like impending failure or collapse / or the chance of recurrence is felt to be least, by the treating physician.

Some arrhythmias are rate-dependent. A faster rate by caffeine may transiently suppress them. (the principle is at times used during cardiac catheterisation in electro-physiological studies - overdrive suppression)....Some arrhythmias occur when the basic rate is slow and so on. It depends on the nature of the focus, from which the ectopic beats arise. Only EPS (Electro Physiological Study) can give definite information.

Above answer was peer-reviewed by
Follow-up: Having heart palpitations while resting with sleep apnea. Symptoms of nerve dysfunction? 13 hours later
Dr. Haramakrishnan, thank you for your timely insights. It's greatly appreciated. Final questions as part of this program to wrap up this session:

1. You are recommending revisiting my cardiologist if palpitations continue. And possibly look at EPS but only if it's severe (or diagnosed as acute)?

2. In these circumstances where the electrical system of the heart is irregular, do you recommend less exercise or more? Is there a danger in either? Is rest the best panacea near term?

3. Finally, why do certain foods or stress trigger palpitations? Tied to hormone levels? And what are best foods?

I've talked to several people who have had these sensations suddenly stop or cease after a couple months. Why?

Many, many thanks again.
Answered by Dr. Anantharamakrishnan 2 hours later

Ideal solution will be to see the cardiologist now.
The decision for EPS is made by him, after overall assessment, Holter, TMT and so on...

The place of exercise is variable. In many, it increases the arrhythmia. In some, it relieves. Exercise test done under medical supervision (Treadmill Eercise EKG / TMT) in the doctor’s office wll clarify the question in the gien individual.

Foods may influence because of some constituents like hormones, electrolytes and so on. There is no need to avoid anything in particular, unless a specific association is suspected in the given individual.

The episodes are influenced by several factors, some of them extraneous.
The underlying cause might have been there long; yet it manifests now for some unknown reason; and as the reason wears off, the episode wears off..
Also, one gets used and learns to ignore the incident.

Above answer was peer-reviewed by
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