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Heart Disease (Expert Forum)
Advice for exercise with PVCs
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Advice for exercise with PVCs
by monicaq, Apr 03, 2004 12:00AM
I have completely quit exercising since last October when I began experiencing frequent PVCs-at least that's what I think they were-when I ran. The frequency was variable, but, in general, one for every 3-5 normal beats, sometimes more than that. This happened to me several times while running, and I do not get them with this frequency at any other time. Each time, I stopped running, and they would go away once my heartrate slowed. The onset was abrupt. I used to run 3-4 times per week 3-4.5 miles at a time, and was in great shape. I've had this checked out with an echo, stress echo and holter, although this never happened while I was hooked up--only rare (2-4) PVCs during monitoring. No structural heart problems, other than slight MVP and most recently, mild aortic regurg. I have been told by my cardiologist that I will live to be an old lady. I'm 37. My questions are: 1)Is there anything that I have described that raises questions or causes concern with you? 2)If I were to take up running again and this continues to happen, what advice do you have for me if this recurs? Do I just keep running and ignore the 6-12/minute PVCs that I'm getting when my heart rate is up around 150-160? 3)Is there any more danger with PVCs like this at a heart rate like this? 4)Why would I be getting these in this pattern only during exercise? Otherwise, I get them occasionally every day--which does not bother me. 5)And finally, if the PVCs can come on at a rate of one every other beat or two or three, etc., what is it, physiologically, that keeps them from deteriorating to VT or V-fib?
Doctor's Answer
by CCF-M.D.-RCJ, Apr 03, 2004 12:00AM
monicaq,
Thanks for the post.
Q1:"Is there anything that I have described that raises questions or causes concern with you?"
A diagnosis is necessary so that you can feel good about exercising again. If a holter monitor is ineffectual, then have an event monitor or Cardionet placed.
Q2:"If I were to take up running again and this continues to happen, what advice do you have for me if this recurs? Do I just keep running and ignore the 6-12/minute PVCs that I'm getting when my heart rate is up around 150-160? "
First, you need to establish that the palpitations are indeed PVCs. It is unusual for a person who doesn't feel PVCs at rest to then be troubled with them during exercise. If indeed they are PVCs, and you have an otherwise structurally normal heart, then it is generally thought that the presence of the PVCs is not associated with an adverse prognosis.
Q3:"there any more danger with PVCs like this at a heart rate like this?"
See Q2.
Q4:"Why would I be getting these in this pattern only during exercise?"
I don't know. Some people do get stress-induced PVCs, but it is less common. First, a diagnosis of PVCs needs to be established.
Q5:"And finally, if the PVCs can come on at a rate of one every other beat or two or three, etc., what is it, physiologically, that keeps them from deteriorating to VT or V-fib?"
A PVC is caused by an automatic focus in the ventricles that "fires" every now and again when the conditions are right. VT requires a circuit, which is most commonly produced in humans by scar formation from heart attacks. VF is different again altogether. VF requires varying refractory periods or conduction times in the heart to setup local wave forms whose "sum" does not add up to a contraction. Varying refractory periods or conduction times requires an abnormality of the heart muscle cells, like from a genetic disorder or from a heart attack.
Hope that helps.
Thanks for the post.
Q1:"Is there anything that I have described that raises questions or causes concern with you?"
A diagnosis is necessary so that you can feel good about exercising again. If a holter monitor is ineffectual, then have an event monitor or Cardionet placed.
Q2:"If I were to take up running again and this continues to happen, what advice do you have for me if this recurs? Do I just keep running and ignore the 6-12/minute PVCs that I'm getting when my heart rate is up around 150-160? "
First, you need to establish that the palpitations are indeed PVCs. It is unusual for a person who doesn't feel PVCs at rest to then be troubled with them during exercise. If indeed they are PVCs, and you have an otherwise structurally normal heart, then it is generally thought that the presence of the PVCs is not associated with an adverse prognosis.
Q3:"there any more danger with PVCs like this at a heart rate like this?"
See Q2.
Q4:"Why would I be getting these in this pattern only during exercise?"
I don't know. Some people do get stress-induced PVCs, but it is less common. First, a diagnosis of PVCs needs to be established.
Q5:"And finally, if the PVCs can come on at a rate of one every other beat or two or three, etc., what is it, physiologically, that keeps them from deteriorating to VT or V-fib?"
A PVC is caused by an automatic focus in the ventricles that "fires" every now and again when the conditions are right. VT requires a circuit, which is most commonly produced in humans by scar formation from heart attacks. VF is different again altogether. VF requires varying refractory periods or conduction times in the heart to setup local wave forms whose "sum" does not add up to a contraction. Varying refractory periods or conduction times requires an abnormality of the heart muscle cells, like from a genetic disorder or from a heart attack.
Hope that helps.
Dr's always tell me... "we know they are uncomfortable but they are not life threatening". Sorry, but they are not the ones having them and they don't know how uncomfortable they are.
If you can continue to run while pvc's are happening, I say keep on running. I hope you never have them as I do.
Glenn
I suffered from the exact same thing you describe. I thought I made them go away by agressively hydrating, but they would still happen with exercise. So much so that I felt like I had very few nl beats, with frequent feelings of fluttering. A cardiologist running partner and I were actually subjects of an office pool to see who had the most ectopic beats during a 15 min treadmill run. I won, primarily because I was given extra points for bigeminy and trigeminy, as well as couplets and triplets.
I have been lucky to have been able to make dietary changes which have reliably completely eliminated them. I have eliminated all products with sig amts of glutimate, including soy milk, energy bars, prepared frozen meals to list a few. Glutimate is an amino acid used to increase the protein content of foods and as a flavor enhancer. People recognise one form, MSG, but it also the main ingredient in: yeast extract, calcium or sodiun caseinate, soy or milk protein isolate, hydrolyzed vegetable protein, natural flavors and more.
Interestingly, if you search and read about MSG, the studies sited mention that women seem to be more sensitive to the arrythmic effects of glutimate, particularly with exercise.
Good luck! and keep running!
That said, I get more PVCs with an unhappy stomach than anything else. That is, if I've had a heavy meal the night before, with onions or alcohol, I may get 2 or 3 PVCs during exercise the next day. Most of the time I have no PVCs during exercise, and my heart rate gets up to 164.
kim
I've read where PVC's after a workout can be significant. Do they mean 6-7 per minute or do they mean bigeminy PVC's.