diagnoses of impending doom: gerd, gad & pvcs

you know that feeling, that gut-wrenching sense that something terrible is about to happen? your heart’s racing, chest tightens, and there's this dread washing over you like a tidal wave of anxiety. for many, this overwhelming sensation of impending doom isn’t just a fleeting thought, but rather a recurrent and terrifying part of their lives.

let’s get into the nitty-gritty of it, what could really be happening to your body when this feeling hits.

 

the fire-breathing dragon in your esophagus

let’s kick things off with gastroesophageal reflux or GERD. it's a set of medical words that basically means your esophagus has a propensity to bring acid up from your stomach. why? the lower esophageal sphincter (LES) is the major culprit here. the LES normally acts as a valve between the esophagus and stomach. in folks with GERD (myself included), the LES becomes weakened or relaxes inappropriately, allowing acidic stomach contents to flow back (reflux) into the esophagus (Harrison et al., 2018). this acid exposure then irritates the esophageal lining, causing symptoms like heartburn, chest pain, and the sensation of acid regurgitation (Harrison et al., 2018).

you’d think the burning sensation is the biggest issue, but it’s the creeping feeling of something is terribly wrong that gets you. studies have shown that patients with GERD are far more likely to report episodes of panic and doom during reflux flare-ups (Flóvenz et al., 2023).

here’s the deal; the esophagus and the heart are next-door neighbours with similar nerve supply. when acid backs up and irritates the esophagus, your body can misinterpret the discomfort as a cardiac insult. the vagus nerve, a major player in both gut and heart function, picks up this irritation, and before you know it, your body screams “heart attack.”

panic sets in, your body braces for the worst, and the sensation of impending doom takes over (Harrison et al., 2018). 

 

your brain’s alarm system gone rogue

generalized anxiety disorder (GAD) is like living with a broken smoke detector. there’s no fire, but your brain is constantly setting off alarms. according to Stahl (2021) and his work on neuropsychopharmacology, GAD is the result of an overactive amygdala. 

click here for more on the neurochemical dysfunction of serotonin found in anxiety

 

when these neurotransmitters are out of balance, your brain’s ability to manage stress falters. you get caught in a loop, where the smallest trigger like an upcoming deadline or even an ambiguous text message sends your brain into overdrive. and what’s at the core of anxiety? that haunting sense of impending doom Stahl (2021). GAD sufferers often feel like they’re teetering on the edge, anticipating disaster without knowing why. the body responds as if it's bracing for catastrophe, activating the sympathetic nervous system (SNS) and causing symptoms like palpitations, sweating, and yes—dread (Stahl, 2021).

 

heart skips, brain trips

premature ventricular contractions (PVCs) occur when your heart’s ventricles contract prematurely (duh), causing a thud or a skipped beat sensation. for those unfamiliar with this sensation, the immediate conclusion is often “heart attack.” 

why does this happen though? normally, the heart’s electrical impulses start in the sinoatrial (SA) node which is known as the natural pacemaker in found in the atria. this impulse then travels to the ventricles. in PVCs, an abnormal electrical signal in the ventricles causes them to contract prematurely, disrupting the normal heart rhythm (Harrison et al., 2018). the exact causes of PVCs can vary, but they can be triggered by stress, anxiety, stimulants (like caffeine or nicotine), electrolyte imbalances, and yes of course underlying heart conditions (Harrison et al., 2018). 

though they are usually benign in healthy individuals (Harrison et al., 2018).

what’s particularly sneaky about PVCs is their amazing capacity to trigger anxiety symptoms, even though they’re usually benign. however, when your heart skips a beat, it signals the brain to initiate a “fight or flight” response (Harrison et al., 2018). your heart races, adrenaline surges, and you’re trapped in a loop of dread. the link between PVCs and feelings of impending doom is well-documented, especially in individuals with anxiety disorders, who are already MUCH MORE attuned to even the slightest alterations in bodily sensations (Stahl, 2021). 

 

so, why the doomy feelings?

your body’s complex feedback system is responsible for this, especially through the autonomic nervous system and vagus nerve. our brain’s response to these feedback systems is then manifested as the sensation of doom, rather than the condition itself (Harrison et al., 2018).

when the body’s internal alarm systems activate, whether it’s from acid in the esophagus, extra heartbeats, or unregulated stress hormones, the brain FREAKS OUT. and we all know, the brain is not a subtle creature when it’s alarmed. it wants to protect you, and in doing so, it sometimes goes overboard (much like my mother), flooding your system with anxiety and panic.

• low levels of serotonin, particularly in the amygdala and prefrontal cortex, impair the brain's ability to regulate emotions and stress responses.
• this leads to heightened anxiety and a sense of foreboding or doom 
• overactivity of norepinephrine, part of the body’s fight-or-flight response, can exaggerate feelings of anxiety and panic 
• excessive norepinephrine increases arousal, heart rate, and alertness, contributing to the physical symptoms of impending doom, like palpitations and hypervigilance 
• dysfunction in GABA signaling reduces the brain's ability to calm excessive fear or anxiety signals, heightening the sense of panic 
•  (Stahl, 2021)
  

i could write about this endlessly, so i'm just gonna leave the link to my blog post on serotonin and anxiety for more insights into the neurochemical origin of these symptoms

• understanding serotonin: unsung hero of anxiety

 

 

do i just live like this then? 

managing these conditions requires a multi-pronged approach. for GERD, controlling acid reflux through medications like proton pump inhibitors (PPIs) and dietary changes can ease both the physical and emotional symptoms (Harrison et al., 2018).

tackling GAD often involves cognitive behavioral therapy (CBT) and depending on case-based decision making - medications like SSRIs or SNRIs (Stahl, 2021).

as for PVCs, reassurance is key. while antiarrhythmic drugs can be used in some cases, understanding the benign nature of most PVCs can help break the doom-anxiety loop (Stahl, 2021).

• mindfulness, meditation, and controlled breathing can also shift the body out of that fight-or-flight response.
• (Stahl, 2021)

 

the sensation of impending doom is visceral and terrifying, but when we understand the mechanisms behind it and how our heart, brain, and gut can team up to trick us, it becomes easier to manage.

you’re not losing your mind; your body’s just a little confused. 

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references

Harrison, T. R., Kasper, D. L., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (2018). Harrison's principles of internal medicine (20th ed.). McGraw-Hill.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.