Copied & pasted lengthy article to ease your mind about palpitations

Let's start here by talking about a very special part of the human anatomy called the Vagus nerve. The vagus nerve, also referred to as the 10th cranial nerve, is appropriately termed a "mixed" nerve. It provides a sort of two-way communication of nerve impulses back and forth between the brain and the pharynx, larynx, esophagus, stomach and associated abdominal viscera (basically, your throat, windpipe, your tummy and guts), the heart, lungs and several more complex but irrelevant body organs or functions. The vagus nerve is the longest and most complex of the cranial nerves in the body.

The key point here is to make note that this nerve involves the "heart," the "lungs" and basically the whole digestive system of your tummy and intestines. Now let's pair that with some real specific and limited physiology about the heart and its rhythm. We also need to bring clarity to some of the medical jargon being talked about by many of you in your messages. The term PVC, or Premature Ventricular Contraction, is just one of many arrhythmias and not necessarily isolated to what many term as "palpitations." So for our purposes here, when we speak of benign palpitations, what we in essence are referring to is the presence of extra cardiovascular electrical activity and the precise induction of these beats felt as dancing of the heart or a flutter sensation in the chest, the prominence or intensity of which is determined by the precise moment of the extra beats in proximity to the most recent beat and the upcoming beat or contraction of the heart ventricles or atria.

Think of it in relation to your memory of your worst date, where the person you're with has no rhythm whatsoever but wants to impress you with all the right moves and clumsily tries to introduce their own dance-step into your otherwise smoothly flowing and natural pace with the music. Depending upon their rather untimely entry, they can cause awkwardness that either simply causes you to quickly pause and regain your rhythm or literally trip you repeatedly until you're forced to leave the dance floor. Well, the same holds true for the heart in our example. The extra beat, or palpitation might come at a point that's subtle, or it might be at a point where the heart is in a different part of the cardiac cycle and stumbles repeatedly until normal sinus rhythm is regained. Now let's get to "why" palpitations occur.

The heart has a natural pacemaker called the sinoatrial node among several less distinct and similar pacers, whose steady rhythmic signals can be affected by which nerve? You guessed it; The VAGUS nerve. Among its many duties, the vagus nerve helps transfer signals within the parasympathetic nervous system to the brain to regulate the heart in addition to other functions taking place and is doing its job right now in each and every one of us. Think of the nervous system as a two-way street, one being the sympathetic nervous system that sort of represents stepping on the gas pedal, and the parasympathetic nervous system that is analgous to stepping on the brakes so to speak. When your heart races, think sympathetic nervous system and when it slows down, think of the parasympathetic system. See?

So for our purposes, we want to focus mainly on the parasympathetic nervous system, particularly with respect to the 10th cranial nerve otherwise known as the vagus nerve. The variability of your heart rate during inspiration and expiration of your lungs is an effect of the vagus nerve. We've all noticed that when we take a breath in, our heart tends to beat just a little faster and when we breathe out, a little slower. It's an entirely normal bodily function and is connected to the need by the body's system to respond to the environment. It's a very simple example of the sympathetic and parasympathetic nervous system working in concert with other physiological processes. But sometimes extra signals along the vagus nerve due to over-stimulation can directly affect the organs involved in a way that was not normally intended, namely the heart, and cause extra activity to occur like palpitations. It merely represents a misguided nerve impulse coming from the nervous system and not a message from the heart that something is wrong in this case. Does that make sense? It's sort of like an involuntary muscle twitch. Nothing more.

Now that we kind of have a little medical background under our belts, let's take one of the complaints by many of you regarding the proximity or untimely appearance of palpitations and indigestion. Remember that we said the vagus nerve is linked to the tummy, the throat and the heart. Let's assume that we've eaten a meal and it's caused us to experience some gastrointestinal discomfort, or in other words, gas. The irregular presence and activity by your tummy and intestines stimulates, more appropriately irritates, the vagus nerve which sends a rather inappropriate signal back along the pathway to guess where? That's right, the heart.

The heart is busy pacing away regularly and is relatively unconcerned with all the food you poured into your tummy, when all of a sudden in comes a signal from the vagus nerve because it has been inappropriately stimulated and tells the heart to beat. Well, just like our bad date example, the signal to beat is rather untimely and awkward but the heart has to accept it and respond. The result is extra beats that make the heart feel like it is stumbling. The degree to which it stumbles oftentimes depends upon the extent to which the vagus nerve is irritated and the relative states of indigestion present as the causative agent.

There is most often no pain associated with this occurrence because it is not the result of a lack of blood or oxygen that creates the palpitation, but rather just a simple additional electrical impulse or series of impulses. Pericardial pain, or pain adjacent to the heart, can sometimes accompany palpitations or exist exclusive of any arrhythmia, but is not necessarily considered pathologic or harmful to us. Remember that we're dealing with inappropriate electrical impulses and typically more nerves than just the Vagus nerve are affected and can respond inappropriately, causing a jabbing or shooting pain than many describe as a "catch" in their chest. We'll talk more about chest pain in a bit.

Let's discuss the sensation that some of you described as a warm flushing sensation of your face and perhaps other body areas that accompanies the palpitations. One of the causes for this is epinephrine, also known as adrenaline, released from the adrenal glands atop the kidneys and is designed to help prepare the body for fight or flight. Its effects can cause sensory disturbances, sweating, palpitations, nausea and other changes in physiology. Also recall our anatomy lesson. The vagus nerve stimulates many areas of the body in response to our environment or internal conditions caused by the outside environment, ie. a meal that produces indigestion. The vagus nerve provides all of us with a stable process called vagal tone. This tone or stability keeps us in a state of physiological preparedness with relation to our environment.

In response to environmental cues or situations, that tone or stability changes to prepare for what may be required. You've probably all seen a guy(or gal) that makes your heart "skip a beat." Ever wonder why that phrase ever came about? Think for a moment. If you've ever been emotionally overcome, your heart races or feels like it pounds in your chest, we begin sweating, our blood pressure rises, we feel nervous and at some point our face is overcome by a warm flushing sensation that we attribute to nervousness or embarrassment. Well, guess what nerve plays a very big role in that entire process? Right Again!!! The VAGUS nerve. And epinephrine is right there to assist in the process.

The above scenario would be a case of increased vagal tone. Well, if there's an increase, there's likely to be a case of decreased vagal tone as well. Indeed there is. Decreased vagal tone can make us weak, nauseated, tremble, and even faint. It happens in cases of being excessively startled or frightened. Other conditions, such as diabetes can cause decreased vagal tone, but for our purposes we'll stick to conditions that by what I've read from all of you are non-disease provoking conditions, with the exception of one individual with Mitral Valve Prolapse but we'll touch on that in a bit.

The point is that our body doesn't always accurately recognize proper environmental cues and the vagus nerve doesn't always know when and how to act. In other words, it misbehaves once in a while as a result of inappropriate stimulation. All sorts of things make the vagus nerve act out, including stress, anxiety, depression, illness and even idiopathic causes (origin or cause is unknown). In fact, there is work going on right now using electrical vagus nerve stimulation to treat depression, anxiety and even seizures. And here's a little extra for those who cough when experiencing a palpitation. Recall your anatomy lesson again. Remember we said the vagus nerve stimulates the pharynx, larynx, bronchi and esophagus. Well, what do you know? Those are exactly the processes involved in the cough reflex. So when the vagus nerve inappropriately stimulates the heart and causes a palpitation it also stimulates in some cases the cough reflex. How about that!

So we begin to see that the cause for palpitations and the palpitation itself is not a life-threatening occurrence at all. It concerns us for several reasons. First, it has to do with our heart and hey, that's the thing that keeps us alive basically. Big concern! Secondly, we've been bombarded by all the medical revelations and awareness about heart disease. But a case for heart disease does not make for every condition the heart demonstrates, especially palpitations. If you've ever had a cramp in your hand from typing too much, it probably never gave you pause to think you might not make it, so to speak. You reason in your mind that the cramp is caused by repetition fatigue and you need to take a break, massage your hand and rest momentarily. Well, palpitations can be considered sort of a cramp and nothing more. Under stress and other factors we talked about, the vagus nerve gets irritated or fatigued and acts out. Just because the heart is affected, doesn't mean that you've got heart disease or vascular problems that are looming. They're annoying, worrisome and even frightening, but knowing where they come from and why will help go a long way in knowing that they are non-injurious and if we respond appropriately, will subside and we can go about our lives with far less worry.

Let's touch on anxiety for a moment. Anxiety and depression too, can definitely cause a state of dysfunction in many areas of our body. Many patients who have these disorders are exhausted from constantly presenting themselves to the medical community with real and valid symptoms of pain, fatigue, bowel problems, vision problems, tinnitus or ringing in the ears, difficulty swallowing, excessive saliva, dry mouth, sore or sensitive tongue, and many more troublesome circumstances only to have repeated tests all return normal. How can that possibly be?!! It's there, we feel it, we experience it, we hate it. Why doesn't the test confirm that it's there? How frustrating is that?

Well, here's some news that should make you feel a bit less frustrated and even comfort you. Most all tests are based upon the algorithmic or sequential processing, of certain symptoms and signs that are all conclusive of various disease and illness. When someone with anxiety, depression or other condition that has somatic features(felt physically)undergoes these tests, the components that underlie the actual diseases which have similar symptoms simply does not add up and no presence of the actual disease is evident. So it's a case of false identity, sort of like having a biopsy of a mole that turns out to be benign. Looks like cancer, but is not cancer. Well, that same thing can happen to us with regard to all sorts of disorders and diseases. They look similar in presentation, but one reveals true disease and the other a non pathologic condition or illness. So the next time your doctor tells you he can't find anything wrong, be glad for that much at least. Many people get far worse news!

So with regard to depression and anxiety, these conditions impart disturbance upon body functions. I suppose you're already guessing that the vagus nerve is not exempt from those circumstances and you're exactly right. So when you have an episode of anxiety, rest easy when you have a palpitation or two, or three or even four. The vagus nerve is irritated and needs a break or to reset. No problem whatsoever and you needn't worry any longer that a palpitation is sure indication of worse things to come. Nothing else happens. Just an extra heartbeat or two where there should not normally be. What a relief!!!!! And the caveat I promised to the individuals with Mitral Valve Prolapse, your heart condition, while not necessarily life-threatening at all, does predispose you to panic disorder which I'm sure you are probably already aware.

Okay, so now we know what these palpitations are and what causes them. What the heck do we do about 'em? Well, there are several techniques that can help. Firstly, let me say that if a run of palpitations makes you feel faint or weak, don't panic and try to make it somewhere less embarrassing. Be safe and think smart. Squat to your knees or sit down until the feeling subsides. No sense in cracking open your skull by trying to make a mad dash for privacy. Anyone can feel faint and people in your company will always rally to your aid more often than not. So relax. The conditions will quickly pass and you'll be back to yourself in a jiffy.

Secondly, if you sense indigestion and gas, discomfort and bloating when the palpitations are present, try merely changing positions which often causes the distention to realign from its offending position proximal to the vagus nerve. If that doesn't work, then a short walk will usually help. Even taking small sips of water will eventually help relieve the indigestion. And you can certainly use antacids if necessary, but take care not to over-use them or other problems may begin to occur to make matters worse...

This is a great article and thank you for posting it!

This is really helpful. Of course at the back of my mind I don't know for sure that the palpitations are harmless. The doctors have told me they usually are, but because of a traumatic experience (not involving someone with palps though guys, please don't worry) it's hard for me to accept. They usually are. Statistically they are safe. I just wish there was a little more certainty than that.

I have a feeling mine are vagal linked.

Can anyone recommend any breathing exercises known to calm the vagus nerve?

And can it really be irritated by stress? I'm wondering what else irritates it because I'm only stressed about the palpitations, so they came first.

Thanks again for this great article.

---------- Post added at 22:09 ---------- Previous post was at 21:48 ----------

I just read an article by a Dr Robin Berzin that talks about how to activate the parasympathetic nervous system (the calming one, the other one is the sympathetic one which is the fight or flight one). The main suggestion is to make the exhale longer than the inhale. This apparently calms the body.

I tried it with mixed results just now, but in general I think it calmed and slowed my heart down. I think it takes practice though because it was only temporary. I've been having skips now since 8pm (though I was fine while walking the dog for 90 mins beforehand).

Here's a copy and paste of what this doctor says: Putting your body in a parasympathetic state is easy. Pick a count for your inhale and a count for your exhale that is a little longer. I like starting with 2 counts in, and 4 counts out, with a one count pause at the top of the inhale and a one count pause at the bottom of the exhale.

Step by step instructions:

"To begin, sit still and tall somewhere comfortable. Close your eyes and being breathing through your nose.

Then, inhale for a count of two… hold the breath in for a count of one… exhale gently, counting out for four… and finish by holding the breath out for a count of one. Keep your breathing even and smooth.

If the 2-4 count feels too short try increasing the breath lengths to 4 in and 6 out, or 6 in and 8 out, and so on. But if longer breaths create any anxiety there is no need to push yourself. The most important thing is that the exhale is longer than the inhale, not the absolute length of the breath.

Set a timer and breathe this way for at least five minutes! You will see a difference in your mood."

It all makes sense to me now. Thank you so much for this article .