Sinus arrhythmia found but is this really what I am feeling?

[Saltwater]

Hello, this may seem like an odd question, but please allow me to explain. For a couple of years now, since my hashimoto's (thyroid disease) diagnosis, I have been complaining of feeling palpitations or missed beats, skipped beats etc. I have had numerous ecg's and been in the ER on a couple of occasions because the 'episodes' can really be intense some times but medics never seemed concerned, despite them causing me great disruption to my life and obviously causing distress.

One time, the weird floaty feeling and 'skipping' was so awful that I ended up having a panic attack out of worry and had to go to the ER because after querying what was going on with me, they wanted to check me out just to be safe. Again, they did tests, bloods and ecg and said all was fine.

I recently found myself up at the walk in centre again, due to many disturbed nights with this feeling of fluttering and skipping in my chest and this is the ecg that they ran. Please see pic. I was having the sensations the whole time I was on the monitor.

They diagnosed sinus arrhythmia and tachycardia. I was glad that my heart continued to 'perform' its tom foolery whilst strapped up to the ecg as at least they got to see what was going on. But my issue is that I read that people don't know they have sinus arrhythmia so how come I can literally feel every miss timed beat!

I have periods where the arrhythmia doesn't seem to be present and it is bliss but the off putting beats are a part of every day none the less. Sometimes it is gentle enough for me to dismiss and get on with my life, but at other times, it seems to come on full force and it feels like ectopic beats, about 6 or so a minute. My heart is beating normally it seems, then there is a longer than normal pause and then a floaty, sickly feeling followed by what feels to me like a stronger, more powerful beat. I always thought I was getting typical ectopic beats but they are showing on the ecg as just normal beats that are out of their normal rhythm. If sinus arrhythmia is just the speeding up or slowing down of heartrate due to respiration then why does the heart seem to stall and skip as it changes pace?

What triggers the episodes is tiredness, eating, (it can sometimes stop me from eating my food as it is not pleasant while you try to eat and often subsides about half an hour after food.)Not eating, stress and generally moving about also trigger it. If I sit still, I can have a good period of quiet but once I get up and start moving around, they start again and I can feel the fluttering going on. Exercise is uneventful and life is normal on the bike which is curious.

They said that this is nothing to worry about and I have read that it is related to breathing cycle and I can certainly relate to that as when I take deep breaths, it also seems to trigger a 'skip' and if I hold my breath when I am getting runs of them, they happen less.

What I didn't realise though is that there are two kinds of sinus arrhythmia and that one can be a sign of heart damage but they never said which type I had and they wrote simply sinus arrhythmia on the ecg print out and not Respiratory Sinus Arrhythmia. I am also 44 so why have I developed this now if it is mostly a young person thing?

I just wondered if anyone else has this and can you feel it too? They put me on propranolol, just a low dose (10mg) and the beats are softer and more fluttery and without the big thuds that were keeping me up at night, but it still makes me feel woozy and sickly as this feels like I am constantly going up and over a rollercoaster.

Also, any ideas why this has got worse in the last few years and is it possibly to do with my thyroid as obviously there is a connection to thyroid and heart regulation. I used to get the odd skipping feeling several times a day a few years ago, but now I get so many it can stop me from getting to sleep which often makes it worse the next day. I eat well and exercise and wish I could just understand why my heart does all this crazy activity because the ecg just doesn't do justice to how much this has impacted my life. I have removed as many triggers as possible, no caffeine, no alcohol, reduced stress and try to sleep when it lets me but I have lost weight from sometimes not being able to put food in my mouth without it signalling to my heart to go crazy! It doesn't seem to be any particular food either, just more about the amount or the calorific value.

Thank you and sorry for the rambling on. I don't seem to know how to make a long story short!

[Ernest76]

Firstly.You are doing absolutely the right thing to cut out alcohol and caffeine. Meditation to lower stress is good.

However,

Discuss with your GP considering the trigger coming from the stomach via the Vagus nerve.

A simple digestive tract medication may well be the answer for an accurate diagnosis.

Hope you feel better soon.

[Saltwater in reply to Ernest76]

That is interesting what you say about digestion and the vagus nerve. It does seem to trigger things. I can rub on my upper stomach just under my chest and it sometimes triggers skipped beats, as do different positions. A bath often does this too. I have had digestion issues. I have gallbladder inflammation and sludge/small stones but they cannot do anything right now because of covid and appointments all delayed. I feel like things are squashed in there sometimes, like maybe things press on each other and irritate the heart in some way? I don't know if that's possible, but that's how it feels. I also have a prominent abdominal aorta they say and I can really feel heartbeats in my stomach. I am slim and can see visible heartbeats, even the skipping is visible on the skin.

They did scans and everything is fine but I feel so much activity that it causes a sickly feeling.

I have anxiety too so I feel every little thing. It isn't nice at all. I am currently doing mindfulness and it is helping me to relax a lot and clear my mind of anxiety. Thank you so much for taking the time to reply.

[meadfoot]

Sorry you are having this Saltwater. It is horrendous i know as i have the same issue. I do have afib and svt too but the ectopic beats you refer to are also dreadful to experience.

I have the incessant low level ectopics that drive me mad and are felt in my epigastric area, plus other ectopics which feel to be in the middle of my chest and these endanger kicking me into afib. I also have ectopics i call donkey kicks in my upper chest which are so harsh they make me gasp and step back with their ferocity.

Eating is a big trigger for me and i do have gastric issues which my cardiologist and gastroenterologist accept are causing issues as gastric is often triggering my afib.

Unfortunately they say there is nothing they can do and i am to have a seven day heart monitor to try and catch the pauses i have where my heart feels to pause for five or six seconds when my stomach growls and heart goes back to normal. I feel as though i am about to pass out at these times so they are trying to catch what is happening. Good luck with that as the ectopics fail to oblige when i am being monitored. I take a beta blocker to try to calm things down.

I wonder if your thyroid is your issue, could you seek further medical input to check that aspect out further. Do you have gastric issues too if so there may be a connection for you too. Your vagus nerve tone could be an issue. Its all worth pressing your medics for a full diagnosis. You really need to get in front of a relevant specialist to follow things through. Best wishes i hope you get some help.

[Saltwater in reply to meadfoot]

That sounds awful for you. I hope you can manage to get some evidence of what's going on because that's half the battle. All I get is the odd beat show up on ecg but they don't realise that this is all the time for me, 6 weird beats every minute some times and it ruins my peace of mind. They say it doesn't matter how many beats like this I get as the electricity is coming from the right place and so there's no need to treat but it feels appalling and causes depression. It's hard to get answers isn't it and even when they say it is benign, it doesn't help as I feel so much that it is hard to accept that it is normal when other's don't feel their heart at all. Like you, I feel like it is stomach related. It has created a lot of anxiety around meal times as some times it doesn't let up and I can't eat properly. I try to eat small meals and have gone gluten free to help with the burping and indigestion that I was getting all the time. It has really helped and I don't burp any more but the heart stuff continues. I will ask if they are doing routine bloods again as they used to check me every six weeks for thyroid and I don't know when I last got checked. Thank you so much for chatting with me and I sincerely hope you get peace with this soon and some answers. All the best.

[meadfoot in reply to Saltwater]

Thanks Saltwater. It really is horrible and not being able to look forward to a meal is hard work. I seem to have runs of time when eating anything even a cheese biscuit for example sends me into fast afib at 270 beats per minute and i feel dreadful for an hour or so until it subsides.

Perhaps getting your gastric issues checked out along with thyroid bloods review may possibly give you some answers and assistance. So sad you are having all of this to deal with, it really is draining. Best wishes.

[Saltwater in reply to meadfoot]

Thank you. Hopefully, we will both be able to get a break from all this over Easter and perhaps eat a meal without feeling like we are on a rollercoaster! Take care.

[Deary63 in reply to meadfoot]

Hi meadfoot Your describing just what happens to me . The pause in the heart beat, fluttering like it’s stopping altogether, I feel so heavy headed where the bloods not getting to my head then I feel like Iam going to pass out !! Never had 🙏🏻 But all the 24hr tapes I’ve had it’s never happened 🙄 .

It’s so frustrating, but as I keep repeating the magnesium has been helping .

Just feel so sorry for everyone on here that’s suffering , it’s the worse feeling in the world ..

All the best

Sue

[drooi]

Sorry to hear about your woes. I know how you feel. I have suffered from frequent multiple ectopics, plus the occasional AF thrown in. I believe you when you say you can feel every single missed beat. I can feel every ectopic when they come on, and boy they really affect my quality of life. The ECG you enclosed had a very short rhythm strip, but I would say there could be 2 ectopic beats there rather than dismiss them as simply sinus arrthymia. I would get a second opinion....

[Saltwater in reply to drooi]

Yes, it really doesn't show just how bad I get this. I never really feel that the medics see what's really happening to me. I wanted them to do the 7 day holter that records all beats over the period but I only ever get given the kind that record isolated beats that you press when you feel them. I want them to see how many are happening but they say it doesn't matter because they are benign but they certainly don't feel that way. I have lost weight and am not my normal self because of how they make me feel and I can't even do simple things like eat and sleep and it gets you down. I am so sorry that you too are able to feel all this in your chest and stomach. It is awful, I know. I am taking propranolol and it is weird now because I feel sickly on it and my stomach feels all churny because the thuds are less apparent but the stomach seems extra sensitive to the lurching feeling and so now I just feel nauseous on it! I wonder also if it is maybe my age. I read that some people develop arrhythmias and weird beats before menopause? Hope things get better for you.

[drooi in reply to Saltwater]

You almost certainly have ectopics, and possibly runs of AF. Sinus arrthymia unlikely to cause the symptoms you describe. As I said, the ECG you posted shows 2 ectopic beats in the rhythm strip (last line of the ECG image), and that was over a recording of about 15 seconds. So you may be getting several ectopics each minute during that bad episode, and that would cause the thumping you describe. It’s disappointing that the doc dismissed it as sinus arrthymia, as that particular ECG actually captured the ectopics. You don’t even need a Holter. You could invest in a hand-held ECG recorder (very low cost), which you can record your own ECGs when you feel it bad, print them, and then get your cardiologist to analyse them! Good luck!

[Saltwater in reply to drooi]

Thank you for your observation. I am confused as I don't see that Sinus Arrythmia will cause the bumps, pauses and thuds that I go through. Although sometimes, I breathe in and in skips for sure, other times, the skipping is not there at all. If it is RSA would the speeding up and slowing down of heart rate not be present all the time? I certainly do not experience it all the time. It comes and goes. I am very aware of it so I know that it is not doing it all the time as each missed beat or thud is felt. Very predictable around food and late at night around tiredness. If I get stressed, there it goes again. I don't feel that my heart rate is all that sped up, but there is an ectopic feeling that is generally felt about 6 or 7 times a minute and this lasts for typically half an hour and is very unpleasant, but much softer feeling of thudding since the propranolol. I tend to feel the pause first in my stomach, as a sickly floaty 'going over a hill fast' feeling, then if I put my finger on my pulse, I feel the pause in normal heart rhythm and then a stronger beat to follow and normal heart beat resumes. Sometimes I get a few of these together which is very unpleasant when they happen back to back. The most I have had is about 11 in a minute and this continued for an hour or so but there are always normal heart beats in between.

I explain all this to the GP but I don't feel that they get what I am experiencing. My quality of life has nose dived considerably. It is more of a worry having thyroid disease as they think I had the disease for a decade or more before diagnosis and I know there is a connection to SSS and thyroid disease but no one seems concerned just because of my age and why would I suddenly develop RSA at 44 years old when it is supposed to be a sign of good heart health and I have never felt worse!

[ejpt21]

I felt the same. I had the same answer from my cardiologist. I decided to attend a psychiatrist and I have felt much better since. She has been treating the condition as panic terror.

[Saltwater in reply to ejpt21]

Sorry you too have these issues. I definitely relate to the panic element. Mine have caused panic attacks in the past and it is hard for me to separate anxiety from what's going on. They always tell me that I could be causing the beats with my anxiety. But also, they come on out of nowhere and cause anxiety, when I am just going about my day and not even thinking about them. I am learning to just let them skip away and not acknowledge them but it is hard as they can be very frequent indeed and take your breath sometimes. I can't concentrate when I get them bad and can't talk if I am mid conversation.

I know I bring them on sometimes when I am stressed and don't mind these ones so much because I relate them to stress, but some times they just appear out of nowhere and make me feel anxious. I have anxiety on my medical history so they don't take me all that seriously which isn't fair. I am doing a mindfulness course right now and also learning meditation techniques and it is helping. I can get a good day and it feels great but them they are back with a vengeance and it gets me down. I certainly would like to reduce the anxiety element that is contributing to the beats. I don't doubt that I could do with less stress in my life and need to manage stress better for sure. It may be useful to speak to a psychiatrist as I think they could help me get some control back. Thanks for your input.

[Jeff1943]

I had 11% ectopic beats, couldn't feel them though unless I took my pulse rate. Diagnosed as sinus node disease and 2.1 heart block. Someone told me that Magnesium citrate 200mg x twice a day had been recommended for frequent ectopics from their cardiologists so I started taking them, I'd had the missed beats for 11 months by then.

Three weeks later all the missed beats stopped and I've been free of them for two months.

It can happen!!

[Saltwater in reply to Jeff1943]

That's very interesting, thanks for sharing. I will look into it. Glad you are doing better with this. I would certainly love not to feel all this going on

[Coco51]

Sorry to hear your problems. It is stressful to have palpitations like this and stress feeds on stress. In answer to your question - yes, others do feel these symptoms. That lurching feeling from the pauses and ectopic beats is vile! The racing palpitations are unnerving. Medics are quick to say it's nothing life threatening when in fact one's quality of life is in shreds.

Why now you ask? Well your heart's naturaI pacemaker is acting up and all sorts can affect it. Inflammation can be a culprit, after an infection perhaps, or stomach problems, or worrying events that increase cortisol - stress hormone - production. Big meals, big rises or drops in blood sugar don't help. I don't know about thyroid though.

I suffer from Atrial Fibrillation. Vagus nerve is an issue because the times before and after meals can be trigger points for me (although it can start in the night out of the blue too). I have had two Ablation procedures and take various medications which have helped. But by far the biggest difference to my QoL has come from seeing a psychologist who practices hypnotherapy. She taught me to relax! Things like the 7/11 breathing technique - which slows the heart rapidly - plus techniques for self-hypnosis which opened my eyes to how anxious I was, and how I was making things worse by catastrophising and over-thinking. I suspect your exercise on the bike is ok because you are thinking of something else.

The thing that struck a chord with me was your weight loss and inability to eat sometimes. Those are key symptoms of anxiety. I had the same. I went to dinner at friends' and couldn't eat a bite. I had no saliva! It was awful. But as I say, the therapy helped so much.

You say propanalol helps so that is good. You eat well, but smaller more regular meals would be good too, with food that keeps you going so your blood sugar stays regular. Like more protein and good oils, good carbs and fibre. Important to have some fun too.

Hope you get some good help. Bon Courage!

[Saltwater in reply to Coco51]

Thank you for your very helpful and considerate reply. Yes, the effects around eating are getting me down. I get worse runs in an evening which often correspond with being tired around evening meal and I am left just picking at my plate feeling miserable. I have been trying to figure this out for a few years now, especially since my thyroid disease diagnosis. It's hard because I interpret sinus arrhythmia as just the speeding up or slowing down of the pulse (heart rate) due to the breathing cycle and don't see that that would create the bumps and thuds (ectopic feeling) that I experience. This creates more anxiety for me as I am not convinced that this is what is going on. Every time I ask for more intervention, I get the health anxiety question, but I don't have health anxiety or create 'symptoms' out of the blue, I have anxiety about my health at times because I have ongoing problems and symptoms that I can't seem to get resolve for. I have done so much to help myself over the last few years, switched to healthy gluten free food due to the autoimmune issues and really worked hard on stress and mindfulness. I just don't get that if it is sinus arrhythmia, (due to breathing) why isn't it there all the time, why does it respond to triggers like food and anxiety and why do I feel it as ectopics ?(missed beats, skipped beats, pauses and thuds)Like you, there is definitely a vagus issue. I can even trigger palps by rubbing or pressing on my upper abdomen, breathing in deeply and certain positions.

I just don't know what to do as I am weary of the GP always eye rolling that I am back with my concerns but I have spent 90% of my life never even going to the doctors and since my thyroid disease, it has been awful and I have to go so often now that I fear they don't take me seriously. Bear in mind that I have social anxiety so I won't go to the doctor unless I have to as I hate being in a room with them. I can spend weeks pondering over whether to go in or not and then just come out feeling like I shouldn't have bothered.

They have beat me down that much at the clinic, keep throwing the anxiety diagnosis back at me that I even doubt myself now and don't know whether I should see a psychiatrist or a GP.

[Coco51]

It is frustrating for you I can understand. Is the thyroid in some way to blame? I think that hyperthyroid can pre-dispose you to palpitations.

Also I forgot to mention a lot of people with arrhythmias take a Magnesium supplement and it really helps. The first thing you get if you turn up in A&E with palpitations is a magnesium drip. Personally I take Magnesium Taurate, Vitamin D and Vitamin C ( C is anti-inflammatory as you probably know). I think they calm things down for me. Others find that they are low in vitamin B12 and take that.

Could you ask to be referred to an Electrophysiologist, (heart rhythm specialist) for a second specialist opinion?

As for seeing a psychiatrist, that seems a bit extreme, but a psychologist/psychotherapist might help, just for you mood.

I can see how difficult it is for you, but don't give up. The squeaky wheel gets the most oil!

[Saltwater in reply to Coco51]

Thanks for your continued support. I appreciate your time and hope that you are well.

They tell me that both over and under active thyroid disrupts your heart's natural rhythm so I suppose it could well be adding to my woes. When the heart slows down with hypothyroidism, there is more time in between beats for extra signals to come from outside the pacemaker, ie, ectopics. I think that's why my exercise on the bike might be helping me as the faster heart rate might meant there is less chance of any extra activity getting in. Just a guess. Taking the propranolol is rather contradictory to someone with under active thyroid. I take Levothyroixne to speed my system up and then Propranalol to slow it down again. It's all a bit daft if you ask me but that's how they treat these heart irregularities so I am a bit stuck for other options.

The propranalol supposedly affects some aborption of my thryoid meds and I have been on the beta blocker for 2 months now, so it may well be starting to affect my thyroid levels. I need to get it checked but my GP is still not offering routine bloods. I like the idea of magnesium to help support my heart health. I had bloods done a good few months back and I was very low B12 but they wouldn't treat it as I only just scraped in to the bracket for what is considered normal but I could well still be deficient or perhaps not able to use what bit I do get. I have stomach issues and obviously don't absorb nutrients well as I eat very healthy foods and should get all my vitamins easily. The thyroid disease causes a leaky gut which can mean you don't get your vitamins even if you eat well. That's why I switched to gluten free as it is meant to heal the gut in people like me but it can take years to get back to normal.

[Coco51 in reply to Saltwater]

It sounds very difficult for you. Not helped by the fact that our expectations are high these days. I have Atrial Fibrillation, Anxiety, take handfuls of pills that seem to act against each other, have had 2 Ablations and also a pacemaker.

But luckily I have found some sense of equilibrium - mainly since the hypnotherapy which changed things for me more than I can say. And if I'm honest I can do much of what I want given my age, 69.

I have found with doctors they've taken more notice if I have talked about impact on my life and emphasised effects like breathlessness, fatigue, faintness, inability to perform daily tasks, incapacitation. These words fit well in medical records and to them they justify better investigation.

But if life has taught me one lesson it's never give up even if it means changing your GP!

Good luck. Take care.

[Coco51]

Are you in the UK by the way?

[Saltwater in reply to Coco51]

Hi, yes in the UK.