Ectopics - aggravating factors

[chestnutty]

I have read somewhere, but I can't remember where, that ectopics can be affected by body position. Or perhaps that should be more noticeable? Mine are certainly more apparent in bed and most particularly when lying on my right side. It doesn't help with the insomnia! They are certainly more apparent when the pulse rate is low. I have never caught them on the Kardia when the pulse rate is higher. Another aggravating factor seems to be adding imigran for migraine to the mix during the night. Has anyone had experience of any of this?

[Hidden]

With the caveat that I’m not medically qualified. There are lots of things that we know for a fact can increase/cause ectopics for some people. Although we still don’t really understand why they happen, the working theory is that they occur more when the heart rate is lower because there’s more ‘space’ for them to happen, although a tiny proportion of people do get them relating to exercise. We also know that they can arise out of both the sympathetic and parasympathetic nervous systems. The ones arising out of the latter, which is said to govern ‘rest and digest’ processes in the body, are usually the positional ones and those linked to eating in general where it’s believed the vagus nerve gets irritated. I can reliably give myself ectopics by lying on my left, or bending forward and down. The sympathetic nervous system is ‘fight or flight’, so ectopics arising out of here are the adrenaline mediated ones, which depending on the individual can be increased by certain food stuffs (e.g. caffeine, chocolate, alcohol), substances like nicotine, stimulant drugs and certain over the counter medications, stress, anxiety, and insufficient sleep. Even scary films can cause an increase in palpitations as the release of adrenaline with a fright will do it. Beta blockers are prescribed for those with arrhythmias triggered by ectopics, like atrial fibrillation and SVT, entirely because they block the release of adrenaline. Less adrenaline hopefully means less ectopics, leading to less episodes of arrhythmia. Interestingly for your post, a quick google shows imigran (sumitriptan) is associated with triggering AF, which from what we know of episode mechanism means it increases ectopics.

[Threecats in reply to Hidden]

One of the best explanations I’ve seen, Charlie, brilliant! The only thing I can add is that I did read somewhere that some positions, lying on left, bending forward etc causes stretch in the atria as the heart moves down and forward and that can also trigger ectopics or A fib.

[chestnutty in reply to Hidden]

Thanks Charlie. A very helpful and clear explanation. It helps to reduce my anxiety over symptoms when I better understand what is going on. Of course in the middle of the night when insomnia is bad everything seems worse and rational thought is much harder to muster but the chances are much better with an understanding of what is going on!

[Thecyclist]

Definitely, ectopics and PVC's have many aggravating factors. I can also concur with the sleeping position, although sleeping on my left is worse. Bending down also seems to set them off for me. But by far and away the most aggravating ones are, stress and anxiety, guaranteed to get my heart jumping, also alcohol, lack of sleep, caffeine as well and some OTC meds, never had imigran but there maybe something in it that makes them worse.

Yes definitely worse with slower HR, I got my Bisoprolol dose reduced as the slower my heart went the more I got. I also find them a lot worse in winter for some reason, they seem to go in the summer.

I have to do my best to ignore them, had all the tests done, Echo, Angiogram, so many ECG's and with a structurally normal heart the doc wasn't too concerned. Hate the buggers though especially when I get a bad run or a salvo or run of tachycardia/PVC, very unsettling.

[chestnutty in reply to Thecyclist]

I think you are right that ignoring the thumps and bumps is the best option (though difficult to achieve) - once you have the 'all clear'. I recently had a 24hour monitor but await the results and in the mean time the ignoring is particularly difficult. I also feel sure that stress, anxiety and lack of sleep create a vicious circle with symptoms that is difficult to break.