Harm Reduction Stims in the context of benign heartrate anomalies

[Endpoint_Null]

Hi all,

Made a post about part of this a while back with a whole backstory and got zero replies, so I'll keep it briefer.

In short, over the past few months I've developed some weirdness with my pulse due to a combination of lifestyle factors/a pretty extreme anxiety disorder/stress. Main symptoms are some sort of ectopic (skipped/early) beats, and occasional SVT (runaway high pulse) episodes - though these are only induced by a very specific posture/breathwork that I have to do pretty much on purpose, while also being already tired or under strain, and can terminate at will by letting out my breath.

I've done a lot of research and spoken to lots of doctors/had a lot of tests, my heart is structurally totally ordinary, it seems like I just have some issue with increased electrical sensitivity/vagus nerve stimulation which I've been told is "annoying - but totally harmless".

I like to do stims occasionally - most recently molly and 4-mmc (plus a few other substances that affect the heart like weed and psychedelics, but let's not focus on those ig). Obviously any stims that affect the heart could perpetuate or trigger episodes of either of these issues, but considering that I've been told that ectopic beats and even the SVT are harmless, I sort of don't mind the risk of triggered episodes specifically as an increased risk factor. For what it's worth, I've done molly twice since this started happening and if anything my pulse felt a lot less "irritable" if that makes sense, in part because my anxiety was lowered so much at the same time. That may have been somewhat of an illusory effect, I'm not sure.

That said, despite lots of anxiety-fueled research (I have health OCD) there is a chance that there's some additional risk I've missed. I've been assured again and again that none of my symptoms can progress to any sort of worse type of heart event, but there is little research for that in the context of substances. Lots about how substances can increase risk of heart-related issues in a vacuum, but that's a level of background risk I was already and still am willing to shoulder... This is not a hobby I want to give up over symptoms that everyone trips over themselves to tell me are benign in all other contexts. But the voice in my head telling me "hey what if there is an increased compounded risk in someone with your symptoms beyond the worsening of those specific symptoms, what if having an SVT episode while also on stims could short out your heart or something". Mostly certain that's just anxiety talking to me and there isn't a plausible mechanism there, but you know. It's not like any doctor is going to sign me off for illegal stim usage in any context, either (although my probing questions about "drinking lots of caffeine" or "ADHD medication" or "very strenuous exercise" have still been met with "you're not in any particular mortal danger").

Anyway, wondering if anyone here had any personal experience with these types of symptoms (PVCs(?)/SVT/PSVT) while also taking recreational stims and what if any bad reactions they've had there, or otherwise has any relevant information.

Once again I'm aware that I would be taking a risk of this triggering episodes of my current symptoms. But then a lot of things already do that in daily life; in particular I can get ectopic beats just from stepping out of the shower, or being nervous about social drama. So the trade-off is more than worth it for me because I love stims ^_^ and it's gone okay so far. Just don't want to be tripping across an even worse time inadvertently.

 

[rentedbythehour]

Hi all,

Made a post about part of this a while back with a whole backstory a while back and got zero replies, so I'll keep it briefer.

In short, over the past few months I've developed some weirdness with my pulse due to a combination of lifestyle factors/a pretty extreme anxiety disorder/stress. Main symptoms are some sort of ectopic (skipped/early) beats, and occasional SVT (runaway high pulse) episodes - though these are only induced by a very specific posture/breathwork that I have to do pretty much on purpose, while also being already tired or under strain, and can terminate at will by letting out my breath.

I've done a lot of research and spoken to lots of doctors/had a lot of tests, my heart is structurally totally ordinary, it seems like I just have some issue with increased electrical sensitivity/vagus nerve stimulation which I've been told is "annoying - but totally harmless".

I like to do stims occasionally - most recently molly and 4-mmc (plus a few other substances that affect the heart like weed and psychedelics, but let's not focus on those ig). Obviously any stims that affect the heart could perpetuate or trigger episodes of either of these issues, but considering that I've been told that ectopic beats and even the SVT are harmless, I sort of don't mind the risk of triggered episodes specifically as an increased risk factor. For what it's worth, I've done molly twice since this started happening and if anything my pulse felt a lot less "irritable" if that makes sense, in part because my anxiety was lowered so much at the same time. That may have been somewhat of an illusory effect, I'm not sure.

That said, despite lots of anxiety-fueled research (I have health OCD) there is a chance that there's some additional risk I've missed. I've been assured again and again that none of my symptoms can progress to any sort of worse type of heart event, but there is little research for that in the context of substances. Lots about how substances can increase risk of heart-related issues in a vacuum, but that's a level of background risk I was already and still am willing to shoulder... This is not a hobby I want to give up over symptoms that everyone trips over themselves to tell me are benign in all other contexts. But the voice in my head telling me "hey what if there is an increased compounded risk in someone with your symptoms beyond the worsening of those specific symptoms, what if having an SVT episode while also on stims could short out your heart or something". Mostly certain that's just anxiety talking to me and there isn't a plausible mechanism there, but you know. It's not like any doctor is going to sign me off for illegal stim usage in any context, either (although my probing questions about "drinking lots of caffeine" or "ADHD medication" or "very strenuous exercise" have still been met with "you're not in any particular mortal danger").

Anyway, wondering if anyone here had any personal experience with these types of symptoms (PVCs(?)/SVT/PSVT) while also taking recreation stims and what if any bad reactions they've had there, or otherwise has any relevant information.

Once again I'm aware that I would be taking a risk of this triggering episodes of my current symptoms. But then a lot of things already do that in daily life; in particular I can get ectopic beats just from stepping out of the shower, or being nervous about social drama. So the trade-off is more than worth it for me because I love stims ^_^ and it's gone okay so far. Just don't want to be tripping across an even worse time inadvertently.

The thing about your pulse is that it changes all the time. Everything from what position you're in, having your legs or arms crossed, physical activity, to dehydration can affect your pulse and blood pressure. If you've been assured by multiple trained physicians, I do believe it's ok to not overthink this so much.

 

[Endpoint_Null]

The thing about your pulse is that it changes all the time. Everything from what position you're in, having your legs or arms crossed, physical activity, to dehydration can affect your pulse and blood pressure. If you've been assured by multiple trained physicians, I do believe it's ok to not overthink this so much.

Yeah, I get that - the thing that makes my symptoms unusual is that they're actual interruptions of normal rhythm, and can cause noticeable palpitations when they occur (which doesn't exactly help my anxiety!). This is in the context of some other mild nervous and circulatory systems that can pretty much all be seen as consequences of stress and anxiety, too.

But I agree that the prevailing theme of advice I've been able to put together is that there isn't much increased risk aside from perpetuating those symptoms. Would be very interested to hear from someone with personal experiences in this area though. Seems to be fairly rare to be a combination of "health caution/anxiety issues that make me very aware of symptoms" and "isn't too afraid to touch hard drugs despite that"... I'm a rare breed I guess!

 

[rentedbythehour]

I'm not sure how old you are but a lot of people aren't as aware of the changes going on as you are. I am curious what made you notice the changes in the first place? A lot of people have idiopathic palpitations. I have hypertension and anxiety as well. I also have migraines, which puts me at a higher risk for stroke. I've been taking vasoconstrictors since 1994, sometimes multiple times daily. They say not to use more than 2 a week. I use meth every day. I'm extremely functional. I don't get psychosis or any real negative side effects. I've been using since 2017. I also have a background in the medical field. I worked in the operating room as a surgical tech for 6 years. I've had to take pretty much the same classes as a nurse. I've done everything from a&p to pharmacology. So I have a good understanding of what you're saying.

 

[Endpoint_Null]

I'm not sure how old you are but a lot of people aren't as aware of the changes going on as you are. I am curious what made you notice the changes in the first place? A lot of people have idiopathic palpitations. I have hypertension and anxiety as well. I also have migraines, which puts me at a higher risk for stroke. I've been taking vasoconstrictors since 1994, sometimes multiple times daily. They say not to use more than 2 a week. I use meth every day. I'm extremely functional. I don't get psychosis or any real negative side effects. I've been using since 2017. I also have a background in the medical field. I worked in the operating room as a surgical tech for 6 years. I've had to take pretty much the same classes as a nurse. I've done everything from a&p to pharmacology. So I have a good understanding of what you're saying.

Oh hey, sounds like you're a good person to chat to about this tbh.

Late 20s. I started noticing this after I basically overdosed on amphetamines back in June. That's a mistake I will not be repeating - ended up visiting the emergency room for rapid heartbeat and chest pressure. I have also since quit taking coke, which I'd also had a few excessive episodes with shortly before all that happened (and which I was starting to realize was pretty unhealthy for me psychologically) - was not a regular user, though, I'd been experimenting with it a few times.

I'm not sure if either of those were in any way the cause of any of this or just caused me to be more aware of it because after coming back from the hospital, even though I was told I was fine after they did an ecg, I became super paranoid about my heartbeat and circulation. I had also lost a lot of weight and had undertaken some medication changes around the same time (I'm on hormone treatments, I quit a long term course of SSRIs, I take semaglutide medications as I used to be overweight).

Main symptoms I started noticing were symptomatically noticeable ectopic beats (probably PVCs), which are sometimes pretty strongly felt in my chest, and what seem to be circulatory issues of some sort (I have really cold hands, and I've noticed that I get pains in the back and arms when I take certain psychedelics sometimes that I'm putting down to increased vasoconstriction?). I was initially terrified I'd damaged my heart somehow, but apparently it's perfectly normal and healthy as verified by multiple echos/ecgs/a holter, my ectopics and so forth seem to be entirely some sort of autonomic imbalance... maybe I irritated my system, who knows. But my main concern is and has always been that I don't want to risk some acute event and have a heart attack, everything I've been told so far says there's no risk of that.

The SVT stuff is newer because I only discovered that when I accidentally did the specific postural maneuver that can bring it on in me, apparently. A doctor has since looked at a home ECG of it and again told me that it's benign, risk-wise.

 

[rentedbythehour]

They said it was a vagal response right? Some people can pass out from that. It's very probably your heart is fine. If you are not a heavy heavy user, for years and years, you are probably not showing any signs of drug use.
I have a few questions and I hope you don't take any offense. Just with what you've mentioned, I need clarification.

What kind of hormone treatments are you taking?
Have you had your thyroid looked at?
Do these 'events' happen only when you're on something?
Have you thought they might be psychosomatic? Do they happen more often when you're thinking about them?
Do you work out or do any kind of cardiac exercises?

To me it sounds like you're not happy with the answers you've gotten from multiple professionals. You've had appropriate testing done. No damage is showing up. I'm sure they said something smart ass like if it's positional, don't get in that position. I hate that. I do wonder if you're hyper focusing on this because of the OCD. To me, it seems like you're really looking for an explanation, but don't want to accept the ones you've gotten. I can't tell you anything definitive. Do you have anything you do when you get intrusive thoughts or actions from the ocd?


I mentioned the thyroid because you said you used to be overweight. People with hypothyroid tend to be cold most of the time. There's also Raynaud's phenomenon which is your vascular system. I have it. My fingers and toes will turn completely white from lack of blood flow when it gets cold. It happens at the grocery store if I walk thru the refrigerated section. I do think it's normal to feel cold like you described when you've lost weight. Also after you eat.
I'm sorry I can't provide you with any answers. I don't know you at all and I don't judge. I think you brought up the anxiety and OCD for a reason. Unfortunately medicine is not a definitive science and I feel like that's what you want. An exact definition and answers. Drs can only diagnose what they see. If the tests are all normal, they aren't seeing anything to diagnose. Does that make sense?

I will tell you that I worked in a hospital that did heart surgery. I once asked how old the youngest person was that had to have heart surgery. They told me 36. It was from a very hard partying lifestyle.

 

[Endpoint_Null]

They said it was a vagal response right? Some people can pass out from that.

It hasn't been said to me - it's just that it's been suggested to me that the ectopics could be triggered by vagus nerve irritation, and from what I understand the response to things like anxiety/temperature changes/how full my stomach is (that's another one) would be compatible with that idea. Not sure how any of that relates to passing out though, thankfully that hasn't happened.

What kind of hormone treatments are you taking?

I'm a transgender woman and inject estrogen for feminization purposes.

Have you had your thyroid looked at?

Yep, apparently normal levels.

Do these 'events' happen only when you're on something?

Not at all, it can happen pretty much any time, although my pulse seems more "irritable" in the days after I'm indulging, or during, depending on what I've taken... weed in particular seems to make the ectopics a lot more likely during, I've also felt pretty fragile coming down from psychedelics. Caffeine also seems to increase likelihood. Things like alcohol it feels more like I'm more likely to have weird heart stuff the next day.

Like I said molly makes me feel great during and my heart doesn't bother me at all, although I'm in such a good mood I'm not sure if that's real or just perceptual lol.

Have you thought they might be psychosomatic? Do they happen more often when you're thinking about them?

I definitely notice stuff more when I'm worried about it, but I will be interrupted by certain symptoms even when I'm totally distracted sometimes.

Do you work out or do any kind of cardiac exercises?

Not really, I'm pretty sedentary and honestly that's probably my biggest health risk. Edit: Well, maybe other than the drugs!

To me it sounds like you're not happy with the answers you've gotten from multiple professionals. You've had appropriate testing done. No damage is showing up. I'm sure they said something smart ass like if it's positional, don't get in that position. I hate that. I do wonder if you're hyper focusing on this because of the OCD. To me, it seems like you're really looking for an explanation, but don't want to accept the ones you've gotten. I can't tell you anything definitive. Do you have anything you do when you get intrusive thoughts or actions from the ocd?

Yeah tbc the OCD is a big part of the picture here, and why I am worrying so much. My normal tactic with OCD is to assure myself that the evidence proves that the worry isn't real... but the symptoms are definitely real even if I'm focusing on them more than I would otherwise, and I figure this is serious enough shit I find it hard to just dismiss from my mind. Especially as the standard advice for all problems of this type is avoid drugs to help improve symptoms. But that's pretty contrary to how I like to live my life these days, and I'm not looking to become an ascetic, that would sort of crush me.

I am trusting the professionals who have evaluated me, but a lot of the examinations are pretty cursory and I haven't been given a very good causative explanation for what is happening with my body. That said it's the reassurance that this is benign that means that I'm not currently having an existential crisis from the belief that I can never get high again, a reality that would extremely suck and I am extremely pleased to recognize is probably not the case. But nonetheless I've resigned myself to the fact that I'm going to have to do my own research in order to understand if there are any additional risks due to these symptoms, beyond the obvious one of "stimulants may trigger palpitations, or ectopic/SVT episodes". So I've been looking through online resources and have also been trying to speak to people with similar experiences, who won't immediately start scaremongering at me due to the drug use (I once mentioned in passing on a community about health anxiety/heart ectopics that I noticed this after going to A&E with drug induced symptoms, and people immediately flipping their lids about drugs and making dire prognostications entirely detached from the reality of my symptoms/any causative mechanisms involved in them.).

I mentioned the thyroid because you said you used to be overweight. People with hypothyroid tend to be cold most of the time. There's also Raynaud's phenomenon which is your vascular system. I have it. My fingers and toes will turn completely white from lack of blood flow when it gets cold. It happens at the grocery store if I walk thru the refrigerated section. I do think it's normal to feel cold like you described when you've lost weight. Also after you eat.

Yeah, could be a lot going on there. I underate fairly significantly for a while to lose the weight, it probably fucked up a few of my body's internal balance points. Apparently my thyroid functions is normal, though? As for Raynaud's phenomenon I don't particularly notice obvious finger discolouration, but maybe it's a less severe version of that... something more to pester my doctors about...

I'm sorry I can't provide you with any answers. I don't know you at all and I don't judge. I think you brought up the anxiety and OCD for a reason. Unfortunately medicine is not a definitive science and I feel like that's what you want. An exact definition and answers. Drs can only diagnose what they see. If the tests are all normal, they aren't seeing anything to diagnose. Does that make sense?

Yeah, thank you for your time, I do think what you're saying is helpful. You're right in that I want more definitive answers than I've got so far; seems the tests haven't shown much, and don't get me wrong I will continue to push for this stuff to be looked at with more specificity. Just also need to get to a level of satisfaction around my own safety level that I can quiet my OCD for a time... although maybe that's an oxymoron. It's the drug use that really catches in my mind, as it sort of precipitated this, but is also an important source of pleasure in my life. I want to be able to continue living my fullest for as long as possible.

I will tell you that I worked in a hospital that did heart surgery. I once asked how old the youngest person was that had to have heart surgery. They told me 36. It was from a very hard partying lifestyle.

It's reassuring. I still probably shouldn't fuck around too much, but my heart being structurally fine means that I'm a lot less worried.

I guess the outcome I'm fearful of in my head is the alterations to heart conduction that can happen with certain stims somehow negatively synergizing with whatever electrical weirdness is causing my symptoms to produce some new more threatening arrhythmia. I don't think that's actually likely, given that I've been told my symptoms should be benign, but it's what I'm scared of.

But knowing that there are people with similar sorts of palpitations/pulse rhythm issues, who have continued using stims probably a lot more intensely than I ever have, without some sort of direct acute consequence, that is a promising indication that it's unlikely to have a pathway to progress that way...

 

[Endpoint_Null]

Also to be clear on general substance use patterns; I'm more an occasional user, for events or in a social context. Weed/alcohol maybe a couple of times a week max, unlikely to do anything harder than that (stims or otherwise) more than once a week and usually less than that these days. Specific substances I'll also set a fairly strict gap time (don't want to lose the magic with molly for example), and more generally I try to space things out to try and avoid health issues that might come from sustained regular drug use. It's something I look forward to on the weekends or at parties.

 

[rentedbythehour]

Ok so you're 20s? When I was in my late teens, early 20s, it was the height of the 90s rave scene. I was going out 3-5 nights a week while still in high school. I was a multi substance user at that time. I would use whatever came my way. I've never been big into alcohol but drugs, anything worked. I'm telling you this because when I was 23 and found out I was pregnant, I stopped everything. I stayed that way for 17 years. I've had some issues with my heart/blood pressure for years. My blood pressure would be 165/110, and that was while taking medication. I had been sober for 10+ years at that point. I honestly don't think my drug use had anything to do with that though. It's genetic for me. You may find your answers looking at a family history.
I have had thoughts about the sometimes user actually doing more damage than a daily user. Your body gets used to things. When you do the same things to it consistently it handles it better. I actually know someone who is a long, very long time cocaine user. He's done serious damage to his heart but his Dr told him it would be worse to stop using for him. It would put his body into shock. So when you do things sporadically, your body reacts each time you do them. It doesn't adjust like it would for a daily user. I am not in any way saying use every day then, this is just me thinking.
I also think starting some kind of exercise, even walking a few times a week could be beneficial. A heart is like any other muscle. You have to work on it to keep it strong and healthy. I actually wonder if some of your symptoms would subside.
I have to say I think it's good you're so in tune with your body and what's happening to it. Most people with heart issues don't even know anything is going on until later in life. Figuring out how to be responsible about using so it doesn't do severe damage is great. To me, that's the epitome of what harm reduction is. I really hope you get more information and answers that's satisfy you. Sometimes things like this can take years of visits, tests, trying to figure the unknown. Be persistent. You are your best advocate.